The Angela Cannings case has raised many questions

The Court of Appeal rejected the cases of child U and child B, who were taken into care largely on medical evidence.

The decision means thousands of parents separated from their children may not have grounds for appeal.

The court said a previous case centred on Angela Cannings, cleared of killing her babies when medical evidence was discredited, had no bearing on them.

These are the first civil cases heard since Mrs Cannings was cleared by the criminal courts in December last year of murdering her two children.

Disappointment

That prompted a government review of civil cases where medical evidence was used to put children into care.

Explaining Friday's judgement, the president of the Family Division, Dame Elizabeth Butler-Sloss, said local authorities had a different job to criminal courts and a responsibility to look after children.

She also urged courts to treat medical evidence with great caution.

The family division, if there has been a death of a child, is looking at the welfare of surviving children Allan Levy QC Child law expert Munchausen's Syndrome by Proxy

Mrs Cannings told BBC News: "I feel very disappointed and sad for the families involved - I hoped there would be a positive outcome."

Allan Levy QC, a child law expert, said the higher standard of proof required in criminal cases compared to family cases lay behind Friday's ruling.

He told BBC News: "The criminal cases are usually about the death or serious injury of one child but the family division, if there has been a death of a child, is looking at the welfare of surviving children."

So the family courts had a more investigative role looking at all the circumstances, he said.

Serious fits

Child B was taken away from her mother after suffering from a series of life-threatening fits.

Doctors said the child's mother had Munchausen's Syndrome by Proxy, a medical condition which made her try to make her daughter ill.

But the woman had appealed against the decision because not all the medical experts agreed on the diagnosis.

It is up to the courts to decide what is the safe thing to do about a child - that is not our job, that is the courts' job Dr Harvey Marcovitch, The Royal College of Paediatricians

Child U was taken into care when medical experts agreed her mother had tried to smother her.

That child's parents lost their appeal in March and the judgement made on Friday will explain why.

Before the ruling, the Royal College of Paediatricians' Dr Harvey Marcovitch said he hoped the judgement would clarify what evidence could be used in such cases.

He said paediatricians should be there to provide evidence of injuries and the courts then decide what is the safe thing to do about that child.