Original articleMaternal behaviors associated with smothering: a preliminary descriptive study☆
Introduction
SOUTHALL, PLUNKETT, BANKS, Falkov, and Samuels (1997) have described 39 cases of life threatening child abuse, among which there were 30 cases of apparently intentional suffocation. In these cases, a parent (usually the mother) presented their child as having recurrent apnoeic-cyanotic episodes. Clinical suspicion of induced illness was aroused by the history and physiological findings, and confirmed by covert video surveillance. The procedure was initiated after multi-agency strategy meetings convened by social services, and within guidelines agreed by the area child protection committee. The video monitors were observed by specially trained police officers and nurses, and staff intervened when an assault was observed.
Apnea induced by smothering has been described by Rosen et al 1986, Meadow 1990, and Samuels, McLaughlin, Jacobson, Poets, and Southall (1992). Southall and his colleagues discuss the application of the concept of Munchausen’s Syndrome by Proxy (MSBP; Meadow, 1977) to such behaviors. Understanding of the different kinds of behaviors described as MSBP has been limited because the abusive acts are carried out in secrecy. Although it is reasonable to assume that the relationship between abusing mother and child is abnormal, it has not been possible to study this directly. The covertly obtained video tapes provided a unique opportunity to observe both maternal behavior and maternal-child/infant interaction in a highly selected sample of women who put their children’s lives at risk. Looking at the interaction of these mothers with their babies may provide clues to aetiology, and have important implications for treatment.
We undertook to study in detail the behaviors and interactions of mothers identified by covert video surveillance as having smothered their children. This was a study carried out prior to the larger, more general, description described in Southall and colleagues (Southall et al.1997). We hypothesized that there would be pervasive abnormalities in the parent-child interaction. In this study, we describe:
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the interaction between mother and child, using a standardized instrument.
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the assaults, as they took place, before staff intervened.
Section snippets
Method
The Maudsley & Bethlem Hospitals Research Ethics Committee gave approval for the study.
Methodologically, it would have been ideal to obtain covert video recordings of normal mother-child interactions in other health care settings, where there was no evidence of intentional suffocation, for comparison purposes. This was not considered to be ethically justifiable and is discussed later in the paper.
Results
Of the original 16 tapes, 15 useable sets of video tapes were obtained. These yielded 11 complete sets of scores. In two cases, only the assault sequences had been retained for evidential purposes so it was not possible to rate mother-baby interaction. In two cases, the sections of tape containing the assault sequence were not available.
Discussion
The main limitation of this study is the small and specialized nature of the sample, making it difficult to generalize from our study to other examples of life threatening abuse, or other variants of MSBP. The lack of a comparison group, for ethical reasons, also makes it hard to generalize. In relation to ethical approval, we were advised that we would have to seek consent from any comparison subject, not only for her but also for her child. However, the ignorance of the presence of the camera
Acknowledgements
The authors gratefully acknowledge the help and support of Professor John Gunn in the Department of Forensic Psychiatry at the Institute of Psychiatry; Dr. David Foreman, Consultant and Senior Lecturer in Child Psychiatry, Stoke on Trent; Dr. Jon Jureidini, Consultant Child Psychiatrist, Adelaide; Detective Inspector Needham, Chelsea Police; and Miss Anne Kavanagh, who provided secretarial support.
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This work was supported by a Christine Cooper Bursary from the University of Newcastle, for the study of issues in child protection.
This work was carried out at the Institute of Psychiatry, De Crespigny Park, London, England.