Neurological outcomes following birth injury are not always clear in the first months or even years of a child’s life. In this INNEG podcast, Consultant Paediatric Neurologist Dr Anirban Majumdar discusses why prognosis can evolve over time and what this uncertainty means for solicitors handling complex paediatric claims.

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About the Speaker

Dr Anirban Majumdar is a Consultant Paediatric Neurologist at Bristol Royal Hospital for Children.

Having qualified more than 30 years ago, Dr Majumdar has extensive experience working with children and families affected by complex neurological conditions. His specialist clinical interests include neuromuscular conditions such as muscular dystrophies and spinal muscular atrophy.

He has also worked as an independent expert witness for almost two decades, advising both claimant and defendant solicitors in complex neurological and birth injury cases.

Paediatric Neurology and Birth Injury: Key Themes from the Podcast

One of the central themes of the discussion is that an early neurological picture does not necessarily provide a complete picture of a child's future.

MRI findings, neonatal examinations and the circumstances surrounding an injury can provide important information about likely areas of impairment. However, Dr Majumdar explains that childhood brain development continues for many years and that neurological function can evolve significantly over time.

A particularly important factor is brain plasticity. In young children, another part of the brain may sometimes take over a function affected by an early injury. This can make predictions made shortly after birth less certain than they initially appear.

The episode also explores:

• Why cerebral palsy extends beyond movement difficulties and can affect participation, cognition, vision, hearing and development.
• Why epilepsy and neurodevelopmental difficulties may emerge alongside an existing brain injury.
• Why some difficulties, including ADHD or autistic traits, may not become apparent until a child is older.
• Why causation and condition and prognosis may need to be considered at different stages of litigation.
• The importance of considering alternative genetic, metabolic or neurological explanations for a child's presentation.
• Why expert independence requires an expert to consider the evidence objectively, regardless of which party has instructed them.

What Does This Mean for Solicitors?

For solicitors dealing with paediatric neurological injury, timing matters.

Dr Majumdar explains that causation can often be considered relatively early because the relevant antenatal, neonatal and early postnatal evidence is already available.

Condition and prognosis can be different.

When assessing future needs and quantum, a child's neurological picture may need time to develop. An assessment from around three years of age may be appropriate in some cases, although Dr Majumdar stresses that later assessment can sometimes provide greater clarity.

The discussion also highlights the importance of multidisciplinary evidence. A paediatric neurologist may provide an important starting point, but neuropsychology, communication, care and accommodation evidence may also be required depending on the child's presentation.

For instructing solicitors, Dr Majumdar's final message is simple:

“Conciseness and clarity.”

Focused questions and well-organised records can help an expert identify the relevant evidence more efficiently and provide a more focused opinion.

Explore the Full Medico-Legal Analysis >

From the limits of early MRI findings to alternative diagnoses and the timing of condition and prognosis evidence, the issues discussed in this episode can have a significant bearing on causation and quantum in paediatric claims.