The presence of old bone fractures in a 1-year-old Cambridge girl who died last week, allegedly at the hands of her nanny, has raised disturbing questions about how long she may have been abused and whether she exhibited past signs of physical distress that were, in retrospect, missed cries for help.
These injuries — to her left limbs and along her back and estimated to be up to two months old — are likely to give lawyers for the nanny an opening to suggest the possibility that someone else was the child’s tormenter.
“Defense attorneys like to see old injuries,” said Dr. Eli Newberger, a pediatrician and founder of the child-protection program at Boston Children’s Hospital. “It introduces the idea of another person.”
Newberger was extensively involved in the widely publicized trial in 1997 of British au pair Louise Woodward, whose defense team, upon learning of an old wrist injury in 8-month-old Matthew Eappen of Newton, raised the possibility that a previous major injury caused a brain trauma, but the devastating effects took weeks to show.
Jurors convicted her of second-degree murder, though a judge later reduced the verdict to manslaughter.
In documents released Wednesday in the Cambridge case, prosecutors say that the toddler, Rehma Sabir, suffered massive bleeding in her brain and the back of her eyes, a collection of severe injuries they say proves she was violently shaken just before lapsing into unconsciousness on Jan. 14, her first birthday. She died two days later.
Prosecutors say that the child was in the exclusive care of 34-year-old Aisling McCarthy Brady when the fatal injuries occurred.
Dr. Robert Sege said other medical evidence about Rehma’s injuries suggests that she was abused in multiple ways. ways.
Brady’s attorney said her client denies the charges and would never harm a child.
The prosecutor’s statement of probable cause went on to say that Rehma had numerous healing fractures based on radiologic images from Children’s Hospital, including several compression fractures in her spinal area, as well as what are called long bone fractures to one of her left forearm bones and the two bones in her left leg.
“The fractures appeared to be 2 weeks to 2 months old on initial impression,” the report said.
Pediatricians and child-abuse specialists say some young children can seem remarkably unaffected by fractures, which can be tiny or large breaks in the bone, though they say it’s likely that Rehma suffered because of the severity and locations of her injuries.
Given that she was 1 and had been a full-term, healthy baby, doctors said, she was probably at least crawling, if not trying to walk, which would put pressure on her back and limbs. Even if she were not wincing in pain, she probably at least exhibited signs of high stress, which can often provoke further abuse by caretakers who want peace and quiet.
“We know that infant crying and fussiness is the main trigger of shaken baby syndrome,” said Jetta Bernier, executive director of the Massachusetts Citizens for Children, a nonprofit that focuses on child-abuse prevention.
Dr. Robert Sege, the medical director of the child protection team at Boston Medical Center, said other medical evidence about Rehma’s injuries — such as the location of bruises — suggests that she was abused in multiple ways.
The prosecutor’s report said that there were “bruises to the top of and behind Rehma’s right ear and on her buttocks.”
Sege said the kind of bruises that children typically get if they fall at the playground, for instance, are near prominent bones. He said the location of Rehma’s bruises suggest a twisting of the ear, or other injuries inflicted by others.
While neither Sege nor Newberger is involved in Rehma’s case, they said their review of the preliminary medical evidence released by prosecutors — particularly the extensive damage to the retina — leaves little doubt in their minds that the child was the victim of violent head trauma, such as through shaking or blunt force.
They added that based on the pattern of most fatal child abuse cases, past injuries are usually caused by the same person who inflicted the deadly assault.
The results of the child’s full autopsy have yet to be released.
Prosecutors also noted that when police returned to the family’s home on Jan. 17, they found baby wipes with red-brown blood stains, as well as blood stains on the baby’s blanket and pillow. Though the report indicates no lacerations, pediatricians said the blood could have come from vomit or been expelled through the nose or mouth as a result of internal injuries.
In the prosecutor’s report, Dr. Alice Newton, medical director of the Children’s Hospital Child Protection Team, concluded that Rehma was the “victim of abusive head trauma given the constellation of injuries and the absence of a history of major trauma such as a high impact motor vehicle collision.”Patricia Wen can be reached at firstname.lastname@example.org.