The Vitamin D Newsletter September 2010
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Vitamin D Deficiency Rickets: Another Tragedy
Dr. Cannell: On June 3, 2010 my five and a half week old daughter was introduced to "child protection" in a hospital in a local hospital by diagnosing her as being a victim of child abuse. I brought my new born daughter to the hospital, after she woke up screaming in pain when i moved her arm. Upon multiple x-rays we found out that she had a fracture in her right arm that had a transverse configuration, without any evidence of external injury (we later learned that a transverse configuration is a typical fracture morphology in a pathologically fragile bone). Not understanding how this could have happened to my daughter, my boyfriend and I had no explanation for the injury.
Apparently because of the injury and our inability to explain how it happened, the doctors suspected child abuse and contacted the child abuse team who sent social workers to the hospital to interview us. After several hours of questioning, they transferred us to another hospital where we were immediately admitted to the child protection department. After further x-rays and bone scans the hospital found multiple micro fractures throughout my daughter's body, and a slight bilateral subdural hematoma.
My daughter's initial physical examination revealed an asymptomatic child. She did not have any lesions, rashes, bruises, no external swelling, not a mark on her. The hospital did not conduct a careful assessment of my daughter's physical condition or of my clinical and social history. They assessed her vitamin D levels which were low-normal, but not mine; they did not question me about my nutrition during pregnancy or my delivery.
They did not take into consideration that I called her pediatrician on two separate occasions with medical concerns; one being that she had severe clicking in her shoulders which we later learned is due to joint laxity, a symptom of Rickets or that she had broken blood vessels in her right eye. Also knowing that I was breast feeding, he told me to stop drinking milk "stating that humans are the only other mammal to drink other mammal milk, which is not right" and he felt that me drinking milk contributed to my daughters gas discomforts.
The pediatrician's office told me these were "normal" occurrence's and not indicative of a need for a medical work up. Both hospital's did not act in an unbiased and reflective manner or take into consideration the totality of evidence. Instead, without conducting a complete evaluation, they quickly diagnosed my daughter as a victim of inflicted injury.
On June 4th my five and a half week old daughter was taken out of my care and placed in the state foster care system. Upon being involved with the child protection agency, the State appointed my daughter an attorney, who has become an angel for my daughter and to my family. Thankfully, the attorney took her job seriously and set out to determine the truth of what happened to my daughter.
After interviewing me and my family and reading the transcripts of the initial interviews of my boyfriend and I written by the emergency social workers from the hospitals, Attorney S requested all of the x-rays, bone scans and medical reports from both hospitals.
Attorney S asked several doctors to look at the medical information and give their unbiased, expert opinions who refused to touch the case because the hospital in question is very reputable. Thankfully, she finally reached out to Dr. Patrick Barnes, a world-renowned neuroradiologist who agreed to look at my daughter's case. He referred Atty S to Dr. David Ayoub a diagnostic Radiologist out of Chicago IL, to look at the xrays and bone scans specifically. After an initial review of the films, Dr. Ayoub proceeded to acquire every medical record in existence on my daughter including my prenatal records and ultrasounds, my daughter's delivery and pediatric records and he had me fill out a medical questionnaire survey.
After careful and thorough review of all medical reports he saw that my daughter was suffering from a metabolic bone disease which he diagnosed as infantile rickets in the state of healing, and that her bones were in a fragile state. He also stated that my daughters skull showed poor mineralization along the sutures and large areas or poor mineralization in the center portion of the skull plates. In addition the parietal skull was flattened.
As Dr. Ayoud was evaluating my daughters medical reports, he aksed Atty S to suggeste that I go see Dr. Michael Holick, a world renowned endocrinologist. Upon his full evaluation of me, Dr. Holick found me to be suffering from Osteomalacia, essentially the adult form of Rickets, and also possibly Elhers Danlos syndrome which is a genetic deficiency that cross ties to my daughters metabolic bone disease.
This process took two months to complete and now, because of the lack of follow through by multiple health care providers including the Doctors at the hospital, my daughter has been without one of the things most critical to her young development, a caring and loving mother. And I have been robbed of some of the most precious moments I could have had with her.
Because it took so long to get the proper diagnosis and after being in foster care for almost two months, the child protection people then decided to place to my daughter with her biological father who abandoned us when I was 2 months pregnant. He had not seen or even asked about his daughter until he was contacted by the child protection agency on June 4th, almost six weeks after her birth.
It has now been 3 months since I have had my precious baby girl. Even with two outstanding doctor reports from two nationally distinguished doctors, the child protection people do not seem to care that my daughter was taken from her mother in error. Because they are essentially a law unto themselves, they have no legal obligation to take this new medical information about my daughter and myself and do anything with it.
It would take pages to explain the twisted system that child protection is but this system is set up in such a way that there actually isn't a forum to bring this new information up in front of a judge unless the whole case goes to a trial, which would be months away.
The child protection agencies were set up to protect children, which I totally respect, but where are the laws set up to protect the children and families from these agencies ? What do you do when the child protection doctors are the ones responsible for neglect or abuse ?
Still to this day neither the child protection agency, or my daughters biological father have taken my daughter to get looked at by a specialist, to make sure that she is getting what she needs to fix her deficiency. (Thankfully, Dr. Ayoub assures me that because she has been fed formula since she was removed from my custody, I exclusively breast-fed her for the first 5 weeks, another risk factor for rickets, she is most likely safe from further fractures.)
I am not allowed to get any medical information about my daughter as her bio dad has temporary custody. He is only allowing me to see my now 4-month-old daughter one day a week, at a supervised visitation center. In what kind of world does any of this seem right ?
I will get her back, it will just take some time. I just hope that other families and children can be saved by being made aware of this epidemic. Health care providers need to be educated on these issues. Most doctors are not taught to know what to look for when they are dealing with rickets or other metabolic bone diseases. And when Neonatal Rickets are in the stages of healing the vitamin D and calcium levels are usually normal or high.
That's why it's important to test, everything!!! They need to do their due diligence in ruling out every medical possibility before making their diagnoses. They need to help save families, not help break them up. Helen, USA
Thank God that the court appointed an open-minded attorney to represent your child; that seldom happens in these cases. Usually the attorneys appointed to represent the children are the most rabid of the lot. Also, thank God you found Dr. Ayoub and Dr. Barnes. As you say, the child abuse authorities are a law unto themselves, they do not have to read your reports, file them in your child's folder, or give your child back. Now that you have two experts and know what is going on, perhaps you may not feel so alone, feel like everyone thinks you are a child abuser, which is the usual outcome in these cases.
A few months ago I discussed an absolutely frightening study. Basically, the study found that about 1/4 of all otherwise normal infants have evidence of infantile rickets while they are still in the womb. If these infants were x-rayed right after birth, I suspect they would be found to have multiple fractures from the very real trauma of coming through the birth canal. That is, it is likely that tens of thousands of infants are being sent home from the hospital with multiple fractures because no one has ever done a study looking for asymptomatic fractures. Mahon P, et al. Low Maternal Vitamin D Status and Fetal Bone Development : Cohort Study. (PDF format) J Bone Miner Res. 2009 Jul 6.
As an aside, the editorial that accompanied this study missed the point. Instead of asking for studies to discover what percentage of infants will have broken bones at birth and thus, how many parents are falsely accused of child abuse due to this tragedy, the authors of the editorial simply asked for more money for scientists. Hewison M, Adams JS. Vitamin D Insufficiency and Skeletal Development In Utero. (PDF format) J Bone Miner Res. 2010 Jan 15;25(1):11–13.
The "we care about kids more than you do" child abuse organizations are simply feeding at the trough of the child abuse industry. According to the late Dr. Richard Gardner, the reason for increasing false allegations can be rationally explained. "There's a complex network of social workers, mental health professionals, and law enforcement officials that actually encourages charges of child abuse — whether they are reasonable or not."
Dr. Gardner was referring to the fact that the Mondale Act of 1974 is responsible for the dramatic increase in child abuse charges because it affords full liability protection for the child abuse industry. They can do the most egregious and wanton things to the children in their care, and their parents, without fear that they will face civil liability charges. The Mondale Act indemnified the child abuse industry, and populated it with people whose livelihoods depend on bringing more and more allegations into the system. Your daughter is simply putting food on someone's plate.
The child abuse industry was behind the epidemic of "recovered memories" of child abuse in the 1990s and howled when judges started returning malpractice verdicts against recovered memory doctors, which quickly dried up that particular child abuse industry feeding trough. Now, the bread and butter of the child abuse industry is child physical abuse or battered child syndrome, first described 50 years ago in a seminal paper in JAMA, a paper that caused irreparable harm. Kempe CH, et al. The battered-child syndrome. JAMA. 1962 Jul 7;181:17–24.
Do not expect this tragedy to be solved soon. Too many mouths are sucking at the trough. Also, the child's father, the man who abandoned you and his child when you were two months pregnant, is he being paid to take care of his own child ? I doubt child protection will tell you but I suspect he is being paid.
For almost 50 years, parents like you have either been sent to jail or had their child taken away or both; we are talking about hundreds of thousands of parents. It is all based on a simple observation loaded with face validity : children with lots of broken bones must have been beaten by someone. Now, it is quite possible that most of those hundreds of thousands of infants were never beaten, never abused, never mistreated, they were misdiagnosed, they simply had infantile rickets.
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John Jacob Cannell MD Executive Director