By Rick Miller, Consultant Dietitian & Expert Witness, and Luke Simpson, Solicitor at Switalskis Solicitors

The Overlooked Factor in Paediatric Brain Injury

When a child suffers a brain injury , most discussions naturally focus on the timing of delivery, imaging results, or potential delays in diagnosis. Yet behind many of these cases lies a quieter, often overlooked factor: nutrition.

The way a child is fed, how their growth is monitored, and how their body responds during recovery can shape both their medical outcome and the value of any legal claim. Despite its importance, nutrition data is still too often incomplete or missing altogether from hospital records.

As a dietitian expert witness and a solicitor representing families in clinical negligence claims , we have both seen how inconsistent or absent nutrition evidence can blur the line between care and negligence.

The Clinical Perspective – What the Records Don’t Show

Rick Miller, Consultant Dietitian & Expert Witness

In many of the instructions I review, a familiar pattern emerges. Children with neurological or hypoxic injuries often have restricted food intake, prolonged illness, or multiple hospital admissions. Yet their nutrition screening and growth data can disappear from the record for days or even weeks.

When feeding finally resumes, there’s often no record of key markers such as thiamine levels, electrolytes, or weight trends. These are precisely the gaps where preventable complications, such as refeeding syndrome, can develop.

Guidelines such as NICE NG252 and ESPGHAN 2022 make the expectations clear.
Children who have eaten little or nothing for more than five days, or who have lost over 10% of their baseline weight, should receive structured nutrition support, vitamin supplementation and daily monitoring.

All too often, those steps are either delayed or undocumented. By the time dietetic input occurs, the child’s growth may have plateaued and their rehabilitation slowed. From a clinical standpoint, gaps in the nutrition record frequently mark the point where the duty of care starts to erode.

The Legal Perspective – When Omissions Create Risk

Luke Simpson, Solicitor, Switalskis Solicitors

From a legal standpoint, these omissions can have serious implications. Under the Bolam and Bolitho principles, clinicians are expected to act in accordance with a responsible and defensible body of professional opinion - and that includes following recognised national guidelines such as NICE and ESPGHAN.

If a hospital cannot demonstrate compliance, or the documentation is too limited to prove it, this may amount to a breach of duty.

Equally, when nutrition records are incomplete, it becomes far more difficult to show how that breach caused avoidable harm. Without consistent data on weight, feeding plans or biochemical results, experts are often forced to infer rather than demonstrate the link between poor nutrition and a child’s deterioration. That uncertainty can reduce a claim’s value and the court’s confidence in establishing causation.

Early instruction of a dietitian expert can make a significant difference. Objective analysis of feeding, growth and metabolic response provides measurable evidence that helps connect breach, damage and prognosis - the three pillars of any negligence case.

Why This Matters

Child brain injury claims rely on multidisciplinary evidence - obstetrics, neonatology, neurology, therapy and education all play a part. Nutrition should be recognised as equally fundamental.

Accurate nutrition documentation is a sign of good governance and clinical diligence. Missing or inconsistent data, on the other hand, may indicate lapses in care.

For both clinicians and lawyers, nutrition records can form the objective thread that ties care to outcome.

What Isn’t Measured Can’t Be Defended

The message from both professions is simple:

• Clinicians should assess and document nutrition as carefully as they would medication or imaging.
• Lawyers should review feeding and growth records at the earliest opportunity - they often hold the key to understanding causation and the child’s long-term outcome.

When nutrition is neglected, so too is the duty of care.
When it is prioritised, recovery improves - and so does the ability to achieve justice for families.

In paediatric brain injury cases, the smallest details - a weight measurement, an electrolyte result, a feeding plan - can tell the biggest story.
Because ultimately, what isn’t measured can’t be defended.