New inquiry into child harm disorder

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THE CONTROVERSIAL diagnosis of Munchausen's by proxy, a form of child abuse that can end in death, is to be investigated by the Royal College of Paediatrics and Child Health.

Although rare, the consequences of misdiagnosing the syndrome, which affected the nurse Beverly Allitt who was given 13 life sentences for killing four babies and attacking nine others in 1993, are so serious that senior members of the college believe guidance is needed for all paediatricians.

The syndrome usually affects mothers, and occasionally fathers, who poison or harm their children to induce medical symptoms as a way of attracting attention from doctors and nurses. It is a variation of Munchausen's syndrome, in which sufferers fake symptoms or harm themselves so that they can receive medical attention.

Controversy over the diagnosis of Munchausen's by proxy has been fuelled by a series of court cases in which doctors and social workers have applied to remove children from families labelled with the diagnosis. In some cases, covert video surveillance has been used to trap parents suspected of abusing their children.

Complaints about the use of video surveillance are being investigated as part of a wider inquiry into the work of Professor David Southall, consultant paediatrician at NorthStaffordshire hospital in Stoke on Trent, who pioneered the method in the United Kingdom.

The inquiry, chaired by Professor Rod Griffiths, is focusing on Professor Southall's research on premature babies, but it has been widened to include his work with Munchausen's by proxy, which is also the subject of a separate investigation.

Although his use of covert video surveillance led to 33 criminal prosecutions of parents caught trying to smother their children or otherwise harm them, some parents claimed to have been falsely accused.

A group established to campaign against Professor Southall alleged that parents had been harassed and victimised. Professor Southall, who has himself been the target of threats, agreed to suspend his child abuse work for the duration of the inquiries.

Penny Mellor, co-ordinator of the group, said: "There is no scientific basis for the diagnosis. It must be suspended. There are too many children's lives at risk. Every women in the country could fit the profile. It has been one big witch-hunt. It is the arrogance of the male-dominated profession that allows it to question the validity of any woman even suggesting that she knows what is the matter with her child."

Mrs Mellor called for a public inquiry into the diagnosis. "Paediatricians cannot be trusted to investigate themselves," she said.

But Dr Harvey Marcovitch, spokesman for the college and a consultant paediatrician in Banbury, denied that the plan to set up a working party was triggered by the Southall controversy. "It is not a kneejerk reaction to the inquiry into North Staffordshire. But it is an issue which concerns paediatricians."

Every paediatrician would have seen a genuine case of Munchausen's by proxy, but because it was rare most relied on what they had read to identify the syndrome. "It is often very difficult to diagnose. You want to believe in human nature and then you get children with bizarre symptoms. I have looked after children who were being poisoned with salt and whose mothers diluted their milk so much they began to starve.

"If you miss the diagnosis you get Beverly Allitt and dead children, but if you diagnose it incorrectly you may be depriving a family of its child [when it is taken into care]," he said.

The difficulty for paediatricians was highlighted by a case in Sutton Coldfield, in which a child claimed by its parents to be suffering from chronic fatigue syndrome was not going to school and had almost never left the house. The local authority was planning to take the child into care when the parents sought a judicial review. The judge found in the parents' favour and the child remains at home. Dr Marcovitch said: "There are other cases up and down the country like this. People are concerned about the fuzziness of the law. These are difficult situations - difficult for doctors, parents, social services...everybody."

The plan to establish a working party has the backing of the president, Dr David Baum, and will be put to the council in the autumn. If agreed, guidelines could be issued next spring. t Some cases of cot death may turn out to be cases of murder when the amount of blood present in the child's lungs is examined, researchers say.

Examination of the lungs of 62 infants who died suddenly and unexpectedly for signs of excessive blood in the air sacs suggest 11 of 29 cases originally classified as sudden infant death syndrome (SIDS) may have been the result of accidental or intentional smothering. The researchers from the University of Sheffield say in the Journal of Clinical Pathology: "We question whether all the cases until now regarded as SIDS really are true SIDS."