The paediatrician Sir Roy Meadow was yesterday vindicated by a high court judge over his evidence in a care case six years ago, when he told the court a four-month-old boy probably died because he was intentionally smothered by his mother.

In a 70-page judgment following an exhaustive and highly unusual review of the issues surrounding P's death in January 1999, Mr Justice McFarlane said: "I am driven to the firm conclusion that no criticism of Professor Meadow's role in this case can be sustained."

He had carried out the review of medical issues after the dead boy's parents, Mr and Mrs H, won the right to one after Professor Meadow's statistical evidence in the Sally Clark case was discredited when her convictions for murdering her two baby sons were overturned.
The couple have lost one child to adoption and risk losing another because of the finding by a high court judge in 2000 that Mrs H four times obstructed the airways of her first child, P, the fourth time fatally.

They criticised Professor Meadow's evidence at the original hearing and said P could have died from natural causes. The judge rejected their criticism: "Indeed, the passage of time and the exhaustive additional investigations have proved that, on the medical issues that were before the court in 2000, he was correct."

Mrs Justice Bracewell's finding in 2000 that Baby P was intentionally smothered by his mother on four separate occasions must be upheld, said the judge.

The judge's decision came in care proceedings over the couple's third child brought by Birmingham city council.

Following the birth of the couple's second child, a daughter referred to as K, in February 2000, the council went to court and, backed by evidence from Professor Meadow that P had been smothered, obtained an order which resulted in K's adoption. A third baby, a girl referred to as S, was born in July 2004. The council went back to court, concerned that she too could be at risk.

Two new experts were asked to review the issues in P's case in the light of current medical knowledge. They concluded that there were two other possible causes for his death, apart from smothering - either seizures, or reflux of food triggering one of the body's automatic defence mechanisms which prevents breathing and lowers heart rate. But after reviewing all the evidence, Mr Justice McFarlane concluded that smothering remained the most likely explanation.

The court will now decide whether the third child born to Mrs H and her husband, a senior business analyst, should be placed in their care despite what happened to Baby P or should be put up for adoption.

Professor Meadow, 73, was found guilty of serious professional misconduct in the Clark case, but the finding was overturned by the high court and court of appeal.