Assessment issues in working with mothers who induce illness in their children

Mothers who induce illness in their children are abusing them. What must be uppermost in the mind of the child protection worker is the effect of the mother’s behaviour on the child. A good assessment of the mother is essential in making decisions about the child’s safety. Schreier & Libow (1993) estimate that nearly 10% of mothers who deliberately induce illness in their children ultimately kill them. The construction with the mother of a comprehensive genogram is an essential tool for assessment. Denial by the mother is usual and overt confrontation is usually not a helpful technique. Key assessment questions are: What are the mother’s real feelings about this child? Can the mother imagine what life will be like with a well child? Is this mother more than extremely anxious or overprotective towards her child? This difficult, complex work can arouse intense feelings in individual workers and within the assessment team. Good supervision is essential.