As a nurse, sometimes I have to confront the fact that parents can do terrible things to their children
I watch as my staff nurse colleague hands a two-year-old child into the waiting arms of the social worker who has just returned from court. He’s being taken into temporary foster care under an interim care order. It’s a decision we’ve been working towards for months, which I believe to be right. It should feel like a victory but it really doesn’t.
I’m on the children’s ward surrounded by carrier bags containing this boy’s belongings. I’m hoping his mother has left him some familiar item of comfort for later on tonight; a cuddly toy or a special blanket, perhaps. He’s been on the ward for weeks and the staff have grown fond of him. We’re sorry to see him go, but hoping that it’ll be for the best.
This child has been a victim of fabricated or induced illness, what we used to call Munchausen syndrome by proxy. A team of healthcare professionals has been observing, assessing and gathering evidence for months. This is an incredibly difficult diagnosis to prove and the judge, rightly, needs to know that there is no doubt. We believe that this child’s mother is fabricating accounts of her son’s illness, most likely to gain attention for herself.
We are as sure as we can be that there were occasions when the child was younger that his mother partially suffocated her son so that she could “save his life” and come to hospital. More recently she has been telling us that her child vomits repeatedly after food and will starve. She is demanding more and more investigations, medical interventions and medications.
This may be because of multiple problems and abuse in her own past. Nevertheless, she has a child to protect; her responsibility as a parent is to meet her child’s needs and our responsibility as professionals is to put the child at the centre of all that we do. We know that mothers who fabricate illness in their child have some sort of unmet need for themselves; we don’t know exactly why it happens but the effects for the child can be devastating. Many end up having repeated medical procedures and medications which may themselves cause harm. Some mothers, in a desperate need to prove their child is ill, end up killing the child. We cannot take the risk that this will escalate. This child has already become socially isolated, he barely speaks and he plays with toys for babies.
Earlier on in the day I was confronted by a relative of the boy’s mother. She asked me whether I had children and I told her I did. “How would you feel if this was you?” she asked. I thought of my two happy, healthy children at home and was lost for words. So much of my job relies on empathy and compassion, but I can’t go there. How can I empathise with someone who is able to harm her child in order to get attention for herself?
That’s the thing with safeguarding children cases. We have to think the unthinkable, to confront the fact that parents, even those who love their children, can do terrible things to them. I don’t doubt this child is loved but it’s not enough.
My colleagues and I have done much soul searching over the months that we have been in contact with this little boy. Time and again we have asked ourselves: “Is there a medical explanation for the symptoms this mother describes? Is there some form of support we could put in place to help them? How bad do things have to be before the best option is to remove a child from their mother?”
As a nurse and a mother, I know that being a parent means putting your child’s needs above your own. This mother is unable to do that and her child is suffering as a result. We presented our evidence to the social work team and they took it to a judge. He agreed that this two-year-old would be safer, at least for the moment, away from his mother. This, then, is what “bad enough” looks like. Despite my many years in this job, I am still unable to come to terms with the fact that parents can harm their children.
As he leaves with two strangers he doesn’t cry or ask for mummy. He sees a hospital porter he’s never met before and says “daddy?” enquiringly. I see them down to the car, not really because they need me to, but I suppose because I want to see this through to the end. I will probably never know whether this story has a happy ending or a sad one. I’m convinced that we have done the right thing by this child and I hope that, when he is old enough to understand, he agrees.
Anonymous
29 June 2017
