The baby had been admitted at about 6 weeks of age with a couple of rib fractures. It seems he might have had some other fracture but it was a long time ago and I don't remember for sure. Child abuse was number one, two, and three on our list of possible causes. I was a second year resident at the time and dutifully filed a report with Protective Services. The parents weren't too happy with me. I asked the P.S. folks if they wanted me to come to court to testify, but they said no, that wouldn't be necessary.
Later that day I heard the news that the court ordered the child released to his parents, which prompted my phone call to the referee who made the decision. I have to give him credit, at last he took my phone call - but he didn't change his mind.
I think that a big part of the reason this baby went home instead of to foster care was because it was a white, suburban, intact family. There were other kids in the home, I think, with no signs of abuse. If this had been a black baby with a single mom on Medicaid, I can't help but think that things would have been different.
If only they had been. About six weeks later this baby was found dead at home. The medical examiner ruled it a SIDS case, even though one of our hospital pathologists said the baby had a cut frenulum - the thing that holds your tongue to the floor of the mouth - that he said can indicate smothering. Like most pediatricians, I've seen a fair amount of child neglect and abuse, but this stands out as probably the most preventable death I've seen.
A couple of days ago Flea wrote about a family he reported to his state's protective services, and he criticized them for removing the children from the home. Maybe he's right in that case, but I don't know. We are all influenced by our past experiences; I think I'll always be one who's in favor of erring on the side of removing the kids if it's questionable.