HEALTH A danger to her child?

A mother suffering from Munchausen syndrome by proxy will damage her child to get medical attention. But it is hard to diagnose, and some have been wrongly accused, says Jane Cameron finds out
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ANNIE and her husband, Ian, had been trying to conceive for years. Their only child, Simon, was a long-awaited baby. He seemed healthy enough for the first six weeks, though Annie thought it odd that he slept through the night. Then he collapsed while she was feeding him. His eyes rolled, the colour drained from his face and he flopped lifeless in her arms.

Ian, a trainee nurse, managed to resuscitate him, but on the way to the hospital the collapses kept occurring. The consultant at the hospital ran various tests, and suspected epilepsy. Simon was allowed to go home, where he was given anti-convulsant drugs and a monitor to alert his parents whenever he stopped breathing. "The drugs seemed to make him even drowsier, and the alarm on the monitor would go off constantly," says Annie. "We had to stimulate him by shaking him gently, or tickling his tummy."

The couple sought a second opinion. Another hospital ran exhaustive tests: they found no sign of epilepsy, but couldn't find anything else wrong with him either. Simon's collapses continued, however. Ater a particularly severe fit while they were out Christmas shopping, requiring an emergency dash to hospital by ambulance, even the paediatrician agreed: "You can't take much more of this."

Though the family live in Cornwall, Simon was referred to a paediatrician at a London hospital. When this one agreed to do a brain scan, Annie and Ian felt they would finally find out what was wrong. A special meeting was called, and the couple - expecting to meet the consultants who had treated Simon - were surprised to see a team of social workers. They realised they were suspected of fabricating Simon's attacks, and that he was being made a ward of court. "He is perfectly normal," Annie was told. "There has never been anything wrong with him, and we think it is you who needs help."

She discovered later that she had been diagnosed as having Munchausen syndrome by proxy (MSBP), a condition which causes carers - usually the mother - to invent or create symptoms in the person they are caring for to attract medical attention. In severe cases, the mother might even try to poison or suffocate her child. First recognised by doctors 30 years ago, MSBP is controversial and difficult to diagnose. Like its sister condition, Munchausen syndrome (in which sufferers invent or create symptoms in themselves), it is extremely rare.

Some experts think Beverley Allitt was an MSBP sufferer. In May 1993 she was given 13 life sentences after she was found guilty of murdering four babies - one by suffocation and two by lethal injections of insulin - and attempting to murder two more. She was sent to Rampton, the top- security hospital in Nottinghamshire, where she received psychiatric treatment.

In Annie and Ian's case, the paediatrician recommended family therapy to stop them seeking hospital treatment for their son. After a week in hospital, Simon was allowed to go back home with them. The case was transferred to Cornwall, where they live. Social services there agreed there was nothing wrong with the couple, and after a nine-month legal battle the wardship was dismissed.

Nobody disputes that some mothers do harm their children. Recently, a mother affected by Munchausen syndrome by proxy was convicted of manslaughter of one of her children, and causing grievous bodily harm to another. She was imprisoned for three years.

Paediatricians agree that it is a difficult condition to diagnose, but among those cases that have been identified there appears to be a set of common circumstances - a history of eating disorders; a disturbed childhood; an absent partner; and some medical training. The problem is that some aspects of the condition mirror the way any caring parent might react.

Dr Terence Stephenson, a consultant paediatrician at City Hospital, University of Nottingham, explains that a diagnosis is like building a jigsaw. "You examine the child, and when you can't find anything wrong, the medical notes of the mother and any other siblings are carefully examined," he says. "As a doctor, you have two roles: to reassure the parents and treat the child, while acting almost as a detective in recognising signs of child abuse. If parental access is withdrawn, and the child improves, it is quite powerful evidence that the mother is responsible. If a child remains ill after it has been removed from the parents, we have probably got the diagnosis wrong," he says.

Mandy is another mother who was wrongly suspected of damaging her child. Her daughter, Natasha, suffered from episodes where she would be violently sick, then stop breathing. These were witnessed by other members of the family, friends, neighbours and hospital staff. However, after observing Natasha during a short spell in hospital, the paediatrician claimed her mother was fabricating or inducing the attacks by attempting to suffocate the child.

When Natasha was a year old, she was taken away from her parents and cared for by foster parents while the case was being investigated. The conditions in the hospital during the investigation were trying; Natasha spent two-and-a-half weeks wired up to a monitor. "My husband and I could feed her through the bars of the cot, but we weren't allowed to give her a bath or take her to the play area. We were cooped up all day long, and even slept there."

After evidence from other consultants, the local authority withdrew the case, but it was nine months before Natasha was allowed home. "It was horrendous," says Mandy. "I look at her sometimes, and think there's still a gap in my knowledge of her. I missed her first words, and her first steps. Her foster mother bought her first pair of shoes. I was deprived of that."

Sarah and her husband, Ed, needed counselling after their youngest son, Josh, was taken into care. He had always been a sickly baby. When he was five months old, the couple were told he was brain-damaged and would never walk or talk. They refused to accept such a diagnosis, though it was clear Josh suffered from respiratory and neurological problems.

"His breathing was irregular, and he would vomit after feeding," says Sarah. "He also had a tremor, which he was born with, and had undergone surgery for a number of complaints when I was accused of tampering with hospital equipment and giving him the anti-convulsant drugs I had been prescribed for epilepsy. They also suspected I had been giving him incorrect doses of Ventolin, prescribed for his asthma."

Once Josh was in care, his parents were allowed to see him for only two hours a week. "A part of me would have been delighted if my little boy had become normal when he was taken away from us," says Sarah, "but he didn't. A year later, when we were finally able to bring him home, he was just the same as he had always been. He is in a special class at school, still has problems with co-ordination, and still needs speech therapy and physiotherapy. But those allegations destroyed my confidence as a mother, and robbed me of my self-respect."

How can doctors be sure when a mother is genuinely harming her child? One technique used by Professor David Southall, paediatrician at North Staffordshire Hospital, Stoke-on-Trent, is an event monitor which measures oxygen levels in the skin. The idea is to monitor and record "low oxygen episodes" - sudden, inexplicable lapses in a child's breathing which may indicate interference by the mother. Professor Southall claims that if this pattern is repeated, the evidence looks strong that the baby's fits are not caused by a genuine medical condition, but by interference such as suffocation.

Dr Paul Johnson, consultant clinical physiologist at the John Radcliffe Hospital in Oxford, believes the monitor is only partially effective. The device was developed for use with premature babies in hospital, and can be used accurately only if properly calibrated. Some parents find them difficult to use, and have also complained that the sensors burn their baby's skin.

Another diagnostic technique, pioneered by Professor Southall, is covert video surveillance. When a mother is suspected of harming her child, but there is still no firm evidence of abuse, the two are recorded - without their knowledge - in a room at the hospital.

"It is used in cases of suspected life-threatening child abuse, only when all other methods have been exhausted," says Diane Whittingham, director of operations at North Stafford-shire Hospital. "Before we do, we consult closely with the police and social services." On the Radio 4 programme, You and Yours, Professor Southall confirmed: "We have seen horrendous abuse occurring in the hospital under covert video surveillance: parents poisoning children, pushing toothbrushes down their throats. These are not things that can be confused with normal parenting behaviour."

One problem with this method is that parents are tricked into allowing themselves to be secretly filmed. Another is that the conditions - being confined to a room all day long - are trying for both mother and baby. "The quality of the recording can also be quite limited, especially during movement," says Dr Johnson. "So when a mother is doing something as innocent as playing peekaboo or washing her baby's face, it immediately looks suspicious."

Nobody denies the awfulness of child abuse, but some doctors are worried at the tendency to suspect MSPB in every case where a diagnosis is hard. One editorial in The Lancet suggested that more effort should be channelled into discovering why babies stop breathing, hopefully sparing families the stigma of being wrongly tarred with the Munchausen brush.

! Names have been changed. For further information, contact Parents Against Injustice on 01279 647171.