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Child abuse and child protection: The role of the expert

The evidence in NAHI cases usually comprises the triad – the group of three – encephalopathy, subdural haemorrhage and retinal haemorrhage, although not all three may be present. If the triad remains unexplained or equivocal, the evidence does not measure up to the burden and standard of proof, the case remains unproved. The defence often seek to rely upon the unified hypothesis defence. The degree of force or rough handling needed to inflict NAI is not susceptible to scientific proof. Relevant factors may include the age of the child, the severity of the injuries, retinal haemorrhage and comparatively weak neck muscles. The general view appears to be that the triad arises from trauma; the hypoxia cause has been discredited. There may be evidence of injuries additional to the normal triad, and also evidence from a previous incident leading to a hospital admission.