Elsevier

Child Abuse & Neglect

Volume 24, Issue 9, September 2000, Pages 1175-1183
Child Abuse & Neglect

Original article
Maternal behaviors associated with smothering: a preliminary descriptive study

https://doi.org/10.1016/S0145-2134(00)00174-5Get rights and content

Abstract

Objectives: To describe maternal behavior in 15 women identified as having smothered their children.

Design: A descriptive study of maternal behavior and interaction with her child, using videotapes of mother and child together. These were obtained by covert video surveillance in a hospital setting. Maternal behavior was rated using an assessment schedule designed to be used with video.

Results: The mothers showed a range of behaviors. Three groups emerged; one whose interaction with the child resembled normal maternal behavior, a second who interacted in a hostile way, and a third who showed a paucity of interaction.

Conclusion: These preliminary data suggest that smothering may reflect more than one type of abnormal maternal relationship or attitude towards children. This may have implications for treatment and prognosis.

Résumé

Objectifs: Décrire le comportement maternel de 15 femmes identifiées comme ayant été étouffantes avec leurs enfants.

Méthode: Il s’agit d’une étude du comportement maternel et de l’interaction avec leur enfant, à l’aide de bandes video de la mère et de l’enfant ensemble. Celles-ci ont été obtenues par enregistrement à leur insu. Les comportements maternels ont été évalués à l’aide d’un barème utilisable avec la video.

Résultats: Les mères ont manifesté une variété de comportements. Trois groupes se sont dessinés: le premier dont l’interaction avec l’enfant ressemblait à un comportement maternel normal, le deuxième où l’interaction se passait sur un mode hostile, et le troisième où il y avait un manque d’interaction.

Conclusion: Ces données préliminaires suggèrent que le comportement étouffant peut refléter plus qu’un type d’anomalie dans la relation et l’interaction avec l’enfant. Ceci peut avoir des implications pour le traitement et le pronostic.

Resumen

Objetivos: Describir la conducta maternal en 15 mujeres identificadas como sobreprotectoras de sus hijos.

Diseno: Se trata de un estudio de la conducta maternal y de la interacción con su hijo utilizando viedotapes de la madre y del niño juntos. Estas grabaciones se obtuvieron a través de una cámara oculta de vigilancia en un hospital. La conducta materna fue puntuada utilizando un isstema de evaluación diseñado para este estudio.

Resultados: Las madres mostraron una variado rango de conductas. Se pudieron observar tres grupos: Uno en el que la interacción madre-nino se parece a la conducta materna normal, un segundo grupo que interactúa de una manera hostil y un tercer grupo que mostró una cierta pobreza en la interacción.

Conclusiones: Estos datos preliminares sugieren que la sobreprotección puede reflejar mas de un tipo de relación maternal o de actitud hacia el nño anormales. Esto puede tener implicaciones para el tratamiento y el pronóstico.

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:

  • 1.

    the interaction between mother and child, using a standardized instrument.

  • 2.

    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.

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