Rather terrifying article about social workers attempting to take baby from its mother as soon as its born.

[Callisto]

It was in the Sunday Telegraph which I got round to reading last night. The story plus a couple of related articles is here: www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/26/nbaby126.xml

That is probably a fair description oldstraighttrack, but I don't know if there are any proven cases of a woman who has suffered from adult FII/Ms definitely being a direct risk to her child. And I still worry that if Fran or another woman had mental health issues and or was a bit of a hypochondriac who tried doctors' patience, this label might come up. I mean, I don't know if Fran has or had real or imagined health issues, I don't know if her skin swelling and breathing problems are real or not, but they might be real. I still think it is a bit of a leap of the imagination to suddenly decide she is going to develop MsbP when she has a baby.

I'd like to know what the professionals here would think of a person who dosed 20g of salt to a very small child. Would they call that FII because it would certainly make the child unwell. Or would they call it plain child abuse?

It seems like the top "symptom" for MSBP/FII is to come into contact with doctors who don't have the ability or training to diagnose certain illnesses and who have an odd attitude to patients, regarding them as "attention-seeking".

That's how I read it too ost.

Agreed ruty in the main. I don't know if there is any evidence that MS definitely leads to a risk of physical harm to a child - but again the original article talks of a risk of emotional and not physical abuse. MS is a very serious condition and not a "bit of hypochondria" - indeed as I understand it as a non-medic, the difference between the two is that a hypochondriac genuinely believes themselves to be ill, whereas someone with MS knows they are not yet will still go to extreme lengths and often undergo life-threatening operations knowing there is no need. If a mother has MS then there are to me, quite obvious concerns for the child - if the mother forever putting herself needlessly in hospital, how will she care for the child adequately?

But as you say, we don't know if this is indeed the case with Fran, but that seems to be what the professionals are concerned about, and why they suggest a psychological assessment - though why this should be post and not pre-natal, I don't know. If it was done pre-natal, then if Fran is as well as is claimed in the media, then one would hope this would be pretty quickly recognised and she would be able to keep her baby.

Link to MS info

i'm just concerned about some professionals' ability to decipher what is an overly anxiously/annoyingly insistent mother who wants the best for her child and a woman with MsbP.

I'm not great at linking but I'll try, it's a link to a rather large PDF file from the Roayal College of Paediatrics and Child Health which needs a fair bit of time to read and assimilate, but may answer some of the questions that have been raised.

www.tripdatabase.com/SearchResults.html?dym=1&criteria=fabricated++induced+illness +by+carers

Agree ruty. I share your concerns about MSbP, but I'm beginning to wonder if it is MS that is the real issue in FLs case and not MSbP.

I think you have a point OST/ruty becasue she has had lots of physical problems in the past as well as psychiatric all sorts of labels may have been put on her (rightly or wrongly)

I find it very suspicious that on the whole, MSbP is diagnosed by paediatricians, not psychiatrists. If it exists, then it is a mental illness. I have never, ever understood why a paediatrician is qualified to diagnose a mental illness. Particularly if a doctor who actually does have expertise in the area (IE a psychiatrist) is contradicting the paediatrician's view.

If a cancer specialist diagnosed heart disease in a patient and the heart doctor said no, imo there is no heart disease here, the cancer specialist has got it wrong, wouldn't we be inclined to think the heart specialist is more likely to be right, what with him being the expert in the area and all? And yet when it comes to MSbP, psychiatrists' opinions appear to be routinely ignored in favour of the paediatrician's. Incredible.

And also, how comes 98% of sufferers of this mental illness are women? Really?

These two things make me very suspicious of MSbP. Of course I accept that there may be loons out there who deliberately make their children ill and they are child abusers. But MSbP as a phenomenon - I don't know...

it is very, very odd LittleBella and needs much more indepth enquiry from a psychological viewpoint. It ties in with the Freudian idea of women being 'hysterical' which has long been discredited.

Because being a woman is their number one "risk factor" on who they suspect, Bella. Malleus Maleficarum anybody?

I'm sure most people aren't as sad as me and will actually read the Royal College of Paediactrics report that nonametoday linked to on FII/MSbP (even they can't make up their mind which term to adopt and use them interchangably throughout) but if you want to read an exercise in illogic, suspicion and lack of scientific rigour you probably need to go no further than that.

It was published in 2002 before Roy Meadow was discredited as an expert witness with his 1 in 73 million murder stat claims and before that famed crusader for children's rights David Southall was banned from doing child protection work for three years. However the report does draw extensively on their work on MSbP to justify these doctor led witch hunts. Whether the now highly publicised professional misconduct/mistakes of Meadow and Southall have made the RCP think again about its guidelines is something perhaps the MSBP defenders here can inform us of.

Anyhow for anyone who doesn't have the time to read the 94 odd pages, highlights include:

• a set of case studies purporting to be examples of MSBP some of which sound like anything but (there are some which do sound like the parents have been deliberately making the child ill but then they might be case studies from Southall and Meadow and can we really trust them?) For example parents who give a herbal remedy to their child instead of the doctor-prescribed medicine (not following dr's orders isn't MSBP even if it is incredibly stupid); children whose parents said they had learning difficulties but refused medical assessment (MSBP is getting the doctor to treat your children when they don't need it not refusing medical care); a baby who was taken to doctor by its mother suffering from apoenic attacks, the baby was found to be being abused by an adult man (not MSBP, abuse was being carried out by someone else); a baby who was brought to hospital and found to have rib fractures, its father later admitted to abusing the baby (not MSBP unless he was the one taking the child to hospital).

• a suggestion in the report that it might be a good idea for a paediatrician who suspects to get a second opinion from another doctor to rule out any possibility of a diagnosis of organic disease. Can anybody believe that it isn't mandatory that more than one doctor is involved when there is an accusation of child abuse? No wonder there has been such a wide opportunity for abuse of this diagnosis.

• guidance that doctors should go right ahead and set the child protection wheels in motion (including calling the police) even before all possibility of organic disease have been ruled out.

• a suggestion that the child protection team (drs, nurses, social workers etc) meet in secret every week to discuss their feelings about the case. Because feelings are such a good guide when you are investigating child abuse.

• accusing paediatricians who don't accept the existence of the MSbP diagnosis as "wanting to run away". Of course hidden in their responses to the survey that the report's compilers set out are criticisms that the MSbP diagnosis is unscientific, that if doctors suspect child abuse they should report it to the police not try to become amateur detectives (the whole second half of the report is a bizarre set of guidelines to evidence gathering as if doctors are detectives rather than people who help patients to heal). The report quotes someone as saying (shock horror) "that there is a network of paediatricians who want to abolish the concept and defend parents". Thank god some paediatricians have a bit of sense.

Bloody hell that's frightening.
So many problems in all sorts of areas go back to a lack of critical thinking, don't they?

Well done Elizabeth for wading through all that waffle & giving us a concise summary!

The list of risk factor is on page 33 if anybody wants to take a look. They include being the child's mother, a former history of sexual abuse, mental health difficulties, the mother having an absent father (how the paediatrician finds that one out is a question worth asking) etc etc.

All very wooly and vague but enough to point the finger at a huge number of women, which is incredible given that the report itself says that MSbP is extremely rare - 0.4 per 100,000 children under 16 and 2.8 per 100,000 children in their first year. So why these professionals are seeing MSbP at every turn is anybody's guess.

Just to add, for good measure the report's compilers threw in a section on false allegations of sexual abuse. Again what that has to to the fabricated illness, as an allegation of sexual abuse is about somebody's behaviour towards a child not an induced illness, is anybody's guess. But it helps to keep the opprobrium heaped on mothers, making them out to be liars who are trying to "dupe" (they use that word a lot) medical professionals.

Thanks BB, I thought you might just think I was a sadster.

This stuff really pisses me off though. You're right Bella, it's a lack of critical thinking, which you'd think a professional training would give them a grounding in. Apparently not.

Guidance from the 2006 RCPCH document Cild Protection Companion:

6.12 Fabricated or Induced Illness (FII)
FII is a form of abuse, not a medical condition. Previously known as Munchausen
Syndrome by Proxy, this label applies to the child, not the perpetrator. The label is used
to describe a form of child abuse.
There is a spectrum of fabricated illness behaviour, and FII may co-exist with other
types of child abuse. The range of symptoms and systems involved is very wide and it is
usually the parent or care giver who is the perpetrator. FII includes some cases of
suffocation, non-accidental poisoning and sudden infant death.
6.12.1 Features
(a) A child is presented for medical assessment and care, usually
persistently, often resulting in multiple medical procedures.
(b) Mismatch or incongruity between symptoms described by parent/carer and
those objectively observed by medical attendants.
(c) The perpetrator denies knowledge of the aetiology of the child?s illness.
(d) Acute symptoms and signs cease when the child is separated from the
perpetrator.
(e) Intentional or non-accidental poisoning often presents with bizarre
symptomatology ? a range of substances are involved (e.g. methadone,
salt).
6.12.2 Think of FII when:
(a) Inconsistent or unexplained symptoms and signs.
(b) Poor response to treatment.
(c) Unexplained or prolonged illness.
(d) Different symptoms on resolution of previous ones, or over time..
(e) Child?s activities inappropriately restricted.
(f) Parents/carers unable to be assured.
(g) Problems only in the presence of parent/carer.
(h) Incongruity between story and actions of parents/carers.
(i) Erroneous or misleading information.
(j) Family history of unexplained illness or death.
(k) Exaggerated catastrophes or fabricated deaths.
The paediatrician is usually the professional who suspects FII. This hinges on taking
very detailed histories from all adults who may have information to give, careful checking
Page 52 Child Protection Companion / 1st Edition / April 2006
Child Protection Companion
of aspects of history which can be corroborated, and if necessary a period of admission
or specific tests, constantly weighing up the balance between needing to confirm the
abuse and avoiding necessary harm to the child.The production of a detailed chronology
is essential in the investigation of this form of abuse.
6.12.3 Professional roles:
(a) Paediatrician ? the consultant responsible for the child?s clinical care
should take lead responsibility to find out whether the child?s illness and
individual symptoms and signs have an unequivocal explanation as a natural
illness. If this is not clear, the possibility of fabrication or illness induction
has to be considered as part of the differential diagnosis together with the
effect on the child.
(b) General practitioners should be encouraged to share information about
the parents/carers, and avoid being an advocate for the parent/carer where
there are serious concerns about possible harm to the child.
(c) Psychiatrists and psychologists may be needed to look at the effects on
the child, and establish whether there are underlying disorders in the carer.
(d) Police must investigate a possible crime.
(e) Social workers make an assessment of the child?s welfare including the
risk of harm, parental capacity and family and environmental factors and
provide services to parents during the assessment.
6.12.4 Management (DoH et al. 2002; HM Government 2006; RCPCH 2002)
The first principle of management is to avoid any ongoing harm to the child.
(a) Paediatricians must work with other professionals and not in isolation. Start
with discussions with all the medical and nursing staff looking after the
child.
(b) The criterion for referral to Children?s Social Care and/or the Police is that
the paediatrician has continuing concerns about the child?s welfare; NOT
that fabrication or induction of illness has been proved.
(c) Involvement of other agencies should be early and not wait for an absolute
identification of FII. A multi-agency strategy discussion is indicated and
should involve very careful consideration of how the concerns might be
disclosed to the parents, as uncontrolled disclosure may cause a parent to
behave in unpredictable ways, which may be harmful for the child.
(d) It is not necessary to share your concerns with the parents if by doing so
you may put the child at increased risk of harm. It is important to consider
carefully the risk of disclosure of concern to the family before adequate
discussions have taken place and protection achieved for the child.
(d) Existing diagnosed chronic illness in a child does not exclude the possibility
of induced illness.
(e) The strategy discussion should identify an appropriate person to assemble a
It is not necessary to
share your concerns
with the parents if by
doing so you may put
the child at increased
risk of harm. It is
important to consider
carefully the risk of
disclosure of concern
to the family before
adequate
discussions have taken
place and protection
achieved for the child.
Child Protection Companion / 1st Edition / April 2006 Page 53
Child Protection Companion ? Chapter 6
health chronology. This is usually the paediatrician, who will have to obtain
the following documents/talk to relevant professionals:
(i) Child?s general practitioner and health visitor records and/or
community child health records.
(ii) Child?s records from any hospital the child has attended.
(iii) Minutes of all social service meetings and child protection case
conferences.
(iv) Medical and social records of parents/carers and siblings, with
consent by Court Order.
It is important that although the clinician has to rely on other people?s documents,
they should not rely on another professional?s chronology. Chronologies prepared
by Children?s Social Care or lawyers often omit important medical facts, and only
a paediatrician may have the insight to realize the significance of these. Wherever
possible the paediatrician should indicate what aspects of the history were told to
that paediatrician personally, and what parts of the history were copied from
previous medical notes. Similarly the paediatrician should make clear what
aspects of the examination of the child the author undertook, and to what extent
the paediatrician is actually recording the examination findings of others.
(f) Using these documents, and from the paediatrician?s own experience of
the case, a written report is produced to include:
(i) Detailed account of the child?s medical problems:
? Chronology.
? History including therapy/interventions.
(ii) Examination:
? Be graphic.
? Include photos/charts.
? The date of any examination.
(iii) Opinion:
? Has Fabricated or Induced Illness occurred?
? Mechanisms if known.
? The future likelihood of suffering significant harm, and prognosis.
(iv) Conclusions.
(v) Signature and date.
(vi) Outcome of any covert video surveillance
Page 54 Child Protection Companion / 1st Edition / April 2006

And here's the key part in that piece that you couldn't be bothered to summarise LaDiDaDi -

"The criterion for referral to Children?s Social Care and/or the Police is that the paediatrician has continuing concerns about the child?s welfare; NOT that fabrication or induction of illness has been proved."

They can make unsubstaniated allegations about parents and they will still be taken seriously. I don't think this has anything to do with child protection (given that taking a child from innocent parents is appallingly abusive) I think this is about Doctor as God Syndrome.

Actually Elizabetth, that point is in Ladidah's post, under 6.12.4 (b)

Yes that's why I quoted it, because most people aren't going to bother reading through a long list with no summary so I highlighted the key point.

The MSbP defenders seem to be unable or unwilling to summarise their position, or highlight key facts that they think support their arguments.

But if she does summarise anything then she'll be accused of putting her bias on it, won't she, Elizabetth?

Much better I think to allow people to read the full thing and make their own decision.

Like I said, most people won't bother reading it which is why I highlighted the key point. What do you think of the idea that a single doctor can make allegations of child abuse before all possible organic diseases have been ruled out thus setting the wheels of the child protection system in motion.

Oh no Elizabetth, I'm not playing that game.

I just wanted to ensure a bit of fair play in this debate.

Playing what game? The game where we stick to the actual topic in hand rather than creating random accusations?

If you're keen on ensuring fair play then perhaps you need to chastise the person who was subjecting me to real insults rather than creating an imaginary scenarios where LaDiDaDi gets accused of being biased.

So I'll ask you again, what do you think of the fact (it's not just an idea) that a single doctor can make allegations of child abuse before all possible diseases have been ruled out thus setting the wheels of the child protection system in motion?

The syatem is there to protect the child so if a doctor suspects child abuse then of course they must act

This article was linked to further upthread but I think it deserves publishing in full as it gives quite an insight into social worker attitudes and activities once they've got the MSbP bit between their teeth:

"Secrecy culture of social services

David Harrison, Sunday Telegraph
Last Updated: 12:16am BST 02/09/2007

Social workers have been accused of trying to pressurise a psychiatrist into dropping his support for a pregnant woman who faces having her baby taken into care at birth.

Dr Rex Haigh, who had written a character reference for Fran Lyon, a 22-year-old charity worker, said that a social worker was "clearly trying to undermine" his support for Miss Lyon, who is five months pregnant.

A social worker contacted Dr Haigh last week, two days after The Sunday Telegraph highlighted Miss Lyon's case.

Social services have recommended that Miss Lyon's baby should be taken into care for fear her mother will "emotionally abuse" her - despite the support of Dr Haigh and another consultant psychiatrist, Dr Stella Newrith, who said there was "no evidence" she would harm her child.

Campaigners condemned the actions of the social worker and called for her to be suspended while the incident was investigated. John Hemming MP, chairman of the Justice for Families campaign group, said it was not an isolated incident but "part of social services' culture of secrecy".

In the email to Miss Lyon's solicitor, seen by this newspaper, Dr Haigh says that he received a message on Tuesday asking him to contact Pamela Burke, a social worker, about Miss Lyon. He rang back and spoke to Paula Wright, another social worker, who said she was also working on the case. The psychiatrist, who was "a little worried" by the approach, made notes of the conversation.

Dr Haigh, who has known Miss Lyon for several years through her work, says Miss Wright accused Miss Lyon of giving hospital staff incorrect details about her health.

"Rather than to support Fran, as I had made clear that I wanted to do in my character reference, the conversation was asking me whether I knew these things about Fran - clearly trying to undermine my support for her by making me disbelieve her," he says in the email. "I was asked, I think on three occasions: 'what do you think about that?', and another statement I wrote down that was said to me was, 'You know her at the moment but the information she's giving might not be the truth'."

Social workers from Northumberland county council also tried to contact Dr Newrith last week.

Miss Lyon, from Hexham, who is seeking a judicial review of the recommendation that her baby be taken into care, said: "I am co-operating with them to find the best solution for my baby and I find out they are going behind my back."

Social services have focused on Miss Lyon because she had a mental health problem when she was 16 after being physically and emotionally abused by her father and raped by a stranger. But after therapy she passed five A levels and gained a degree in neuroscience from Edinburgh university. She now works for two mental health charities.

Mr Hemming, a Lib Dem MP, said the social worker should be suspended until the allegations had been investigated. He claimed it was not an isolated incident and said this kind of "interference" was "all too common".

Miss Lyon's case will increase concern over a rise in the number of babies under 12 months being taken from parents - 2,000 last year, three times the figure a decade ago.

Northumberland county council said it was unaware of Dr Haigh's allegations but would launch an investigation if it received a complaint.

A spokesman said: "Safeguarding children is our top priority. We speak to and listen to all sides without bias or pressure. We would welcome a review of the family court arrangements and support transparency as long as this is in the best interests of children.""

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/09/02/nsecrecy102.xml link