Is Omeprazole the new EDS?

Tina Cook KC and Kate Kochnari introduce our Family Law Webinar Series 2025 by discussing 'Is Omeprazole the new EDS?' Are there innocent explanations for allegations of inflicted or non-accidental injury? Tina and Kate discuss the dark corners of medicine, science, the unknown unknowns and the wider canvas. 

Throughout the session, Tina and Kate reference case law and research papers relating to this topic. The links can be found below.

Cases

• Devon County Council v EB & Ors (Minors) [2013] EWHC 968 (Fam) (22 February 2013) - [07:05]  
• A Local Authority v AA and Anor [2022] EWHC 2321 (Fam) - [08:25]
• M (A Child)(Non-Accidental Injuries; Wider Canvas), Re [2024] EWFC 209 (B) - [19:55]
• A Child (Special Guardianship Order [2021] EWFC B41 - [24:35]

Research

Malchodi 2019 [11:20]

• Research Paper
• Research Summary 

Wang 2020 [14:10]

• Research Paper
• Research Summary 

Fleishman 2020 – [16:10]

• Research Paper 
• Research Summary

M (A Child)(Non-Accidental Injuries; Wider Canvas), Re [2024] EWFC 209 (B) judgment

This was a single issue case, fractures to a baby boy.  None of the experts in their written reports supported the family’s contention that they had not harmed their baby.

The Judge made no findings against the family. This is a case where, put simply, had the Court followed the written expert conclusions unchallenged, the outcome for this family would have been entirely different. It serves as a reminder (particularly pertinent at a time where the Suspected Inflicted Head Injury Service pilot has commenced with little consultation) as to why specialist Counsel and excellent cross examination is so vital in cases such as these. The Judgement is long and considers the impact of Omeprazole -

§ “8.23 This is a developing field and there is still no established causal link between Omeprazole and fractures, but this research combined with Dr Jones’ late evidence explaining why the metaphyses may be more impacted due to growth turnover gives rise to a question about whether this may have been relevant for M, who was prescribed an unlicenced drug at a very young age”.

§ “8.25 The court is ever mindful of the need to consider the “outlier child”, taking into consideration the wide range of responses from children, as espoused recently by Lieven J in A Local Authority v AA & BB & Y through her children’s Guardian [2022] EWHC 2321 (Fam). The Court of Appeal has considered an appeal very recently on similar facts concerning the use of Omeprazole in fractures to a baby, W (A Child), In the Matter Of (Inflicted Injury - Delay) [2024] EWCA Civ 418, where King LJ criticised the first instance judge’s compartmentalised analysis of the medical evidence”.

§ “13.7 It is further essential that jointly instructed experts are able and willing to engage with countervailing arguments to an NAI hypothesis; if they do not, their open-mindedness is called into question, impacting on the impartiality of their evidence. The parents in this case have also lost the opportunity to determine whether M has sustained further injuries, through no fault of their own. The result is an inconsistent and incomplete radiological and paediatric expert opinion.

§”13. 8 The court is necessarily slow to disagree with a body of expert evidence, but it can and it can specifically do so when the rest of the evidence does not support that view (Re B (Care: Expert Witnesses) [1996] 1 FLR 667), per Ward LJ: “the expert advises but the Judge decides. The Judge decides on the evidence. If there is nothing before the court, no facts or no circumstances shown to the court which throw doubt on the expert evidence, then, if that is all with which the court is left, the court must accept it. There is, however, no rule that the Judge suspends judicial belief simply because the evidence is given by an expert.”.

§ “13.9 This is a case where, standing back and looking at the totality of evidence of the parents and caregivers combined with the broader canvas points, the evidence points strongly away from inflicted injury.

§ “13.10 The court is mindful that there is an evolving list of cases which consider the administration of PPIs such as Omeprazole and their impact on reducing bone density and consequently increasing the likelihood of fractures, notably recently the Court of Appeal’s decision in W (A Child) discussed at §8.25

§ “13.11 It seems to the court that the conclusion of Dr Jones’ evidence, where he spoke as to how the metaphyses may be more impacted due to growth turnover combined with the emerging link between Omeprazole and fractures does give rise to sufficient question over the possibility of organic cause, notwithstanding Dr Skett’s view and the research papers. This is an emerging field and no doubt more research will emerge, but given the involvement of rib fractures in the research papers there remains a possibility that this could explain all the fractures, albeit the absence of discernible pain and distress is not explained. There is no burden on the parents and intervenors to explain away any anomalies but I observe that there are obvious other factors over the relevant period, notably initially digestive discomfort/colic and latterly teething”.

20th Jan 2025

Tina Cook KC

Call 1988 | Silk 2011

Kate Kochnari

Call 2008