The mother, whose name has been suppressed to protect the child’s identity, has pleaded not guilty to four charges of ill-treating a child and three charges of infecting with disease.
The child, who was failing to thrive and gain weight, first presented at a hospital outpatient clinic with a reported fever, reflux, and blood and mucus in their stools. Photo / 123rf
The mistreatment was alleged to have occurred over a 19-month period before the child was removed from the mother’s care, after a doctor reported suspected medical child abuse was at play.
The allegations arise from medical interventions required for the child’s assisted feeding and treatment for complex intestinal failure.
The defence argues the events which formed the charges arose from management of a “medically fragile child living with complicated medical devices” and the actions of a desperate mother trying to help her child ,who originally presented with suspected reflux disorder, and failure to thrive.
Child ‘unable to eat’ by usual means
The court has heard that at various stages the child, whom the mother claimed could not eat by usual means, was given nutrition intravenously and also via feeding tubes directly to the stomach and alternatively, into the gut.
Management was handled in hospitals and at home, after the mother was trained in the intricacies and strict hygiene protocols needed to manage the lines and tubes.
The relative said she and the accused were once close, and she believed Child X had health issues linked to not being able to eat.
She was not sure of the problem, only that [Child X] was in hospital a lot and had several tests done.
She said when the family visited them in the city where Child X was receiving hospital care at the time, a couple of incidents “stood out”, including what appeared to be the child “searching for food off the floor”.
Relative ‘confused’ by seeing child eat
The defendant had arrived with Child X and a sibling for a pizza dinner.
The relative was told the child was unable to eat pizza, but she saw the mother give them a small piece of chicken tender.
“I was confused because she said [Child X] was unable to eat.
“I asked her if [Child X] could eat or not. [The mother] seemed blase about [the child] eating chicken.
“I also saw [the child] eating crumbs off the floor.”
In cross-examination, the relative said she could not remember if the child’s eating caused pain, which was a symptom the mother had frequently complained about, and for which she had regularly sought pain management for her child.
Neither was the relative aware of any feeding trials which might have been underway at the time.
However, she was aware that the child was occasionally given food to suck on.
Mother says ‘rare super bug’ to blame for infections
The relative said she caught up with the mother and child later in the year while on a business trip to the city where they had been transferred for hospital treatment.
She said by then, the child appeared healthy and was eating a lot of fruit.
She recalled the mother telling her how the child had harboured a “rare super bug” in its feeding tubes, which was resistant to antibiotics available in New Zealand, and required a “special antibiotic” from overseas.
The relative understood the child’s stomach had “just started working again” and had been fine since.
The child was removed from the mother’s care after a notice of concern was reported to Oranga Tamariki by a doctor who suspected medical child abuse.
A police investigation followed and the mother was charged in 2023.
The Crown alleged the child’s instances of sepsis were the result of the defendant having deliberately tampered with the multiple feeding and medication lines and tubes.
Surgeon says lines broke in ‘unusual way’
A paediatric surgeon who performed the surgery required to attach the child’s central Hickman line, and reattach it when it was broken or infected, said she had “never seen any break” in the way this occurred with Child X.
Dr Alison Scott told the court today that Child X had three to four different types of central line inserted over a period of time.
She said where a line might usually wear out, the central lines and catheters on Child X “broke in an unusual way”.
Scott said it would have been “extremely unusual” for a child to do it, and it was also unusual that one broke eight days after it was inserted.
The trial of a woman accused of medically abusing her child is being heard in the High Court at Nelson before Justice Lisa Preston. Image / NZME composite/ inset RNZ
In answer to questions from the defence, Scott said central lines were not generally vulnerable to handling and could remain inserted for two to three years without issues.
She said it was uncommon for repeated issues to occur.
Scott was concerned the breakages might have been because of a manufacturing fault.
Because of the Covid-19 pandemic at the time, she was worried about supply issues and asked a charge nurse to follow up with the company which supplied the equipment, but this did not happen.
She said no engineering analysis of the lines’ failure was carried out, and no tests were done on why the breakages occurred where they did.
Scott also said Child X had an increased rate of infections compared with other children.
She said bacteria found were “most unusual”, including one of oral origin, according to laboratory testing.
“Typically, infected lines only grow one bug, and multiple bugs are very unusual.”
Registered nurse Morgan Smith, who also gave evidence today, and who was involved in the care of Child X, also said that line infections were “pretty rare”.
Smith said that in the eight years she had been dealing with central lines, three of the “six or seven” line infections she knew of had involved Child X.
Tracy Neal is a Nelson-based Open Justice reporter at NZME. She was previously RNZ’s regional reporter in Nelson-Marlborough and has covered general news, including court and local government for the Nelson Mail.