National Post

Tuesday, February 23, 1999

What the hospital cameras saw
Research brings to light the hidden nature of abuse

Donna Laframboise
National Post

Earlier this month, an autopsy performed on one-year-old Toronto resident Tamara Thomas revealed 11 broken bones in her tiny body. Despite the involvement of both medical personnel and the Children's Aid Society during her short life, the fact that she was an abused child went unrecognized.

Last week, a paper published in the Journal of the American Medical Association told a similar tale. In a study of 173 children who had suffered head injuries as a result of abuse, doctors failed to diagnose the abuse a third of the time.

Such lapses have a long, ignominious history. Twenty years ago, if a baby died unexpectedly for no apparent reason, its death would commonly be attributed to what had become a catch-all diagnosis: sudden infant death syndrome (SIDS). The child would be buried, and the matter would rarely be given a second thought.

Today, such deaths receive more rigorous scrutiny due to a growing awareness that a small percentage of them are the result of a rare but fatal form of child abuse.

Some of the most compelling evidence on this front has been supplied by a team of physicians led by Dr. David Southall. In the mid-1980s, Southall and his colleagues set up video surveillance equipment in the paediatrics ward of a British hospital. Over an eight-year period, 39 children thought to be in danger of abuse were assigned to special cubicles secretly monitored by four cameras and a microphone.

The events recorded by this equipment are nothing short of harrowing. In one instance, during the three hours a three-month-old baby girl spent in the cubicle, her mother slapped her, shook her, swore at her, and "deliberately and forcefully bent back the infant's left arm at the elbow," fracturing it in two places.

In another case, during the six hours that a three-year-old child was monitored, her mother attempted to poison her with disinfectant and then forced a toothbrush down the child's throat.

In a third, an 18-month-old child spent four days in the cubicle, with her mother present for 22 hours in total. As the cameras rolled, the mother repeatedly hit, pushed, slapped, and kicked the child. Departing on the second day, she told her daughter: "I'm going out. I don't love you anymore, babe." Southall's team finally interceded when the mother attempted to suffocate the child with a pillow.

Between them, the 39 patients monitored by Southall had 12 siblings who had previously died unexpectedly. After being confronted with the tape recordings, the parents admitted to suffocating eight of those 12 children. Following further investigation, the mother whom the cameras had caught trying to poison her daughter was convicted of poisoning another of her offspring, a 23-month-old.

In every one of the nine deaths for which a criminal element was established, doctors and police had failed to detect foul play during the original investigation. One child's demise was blamed on a medical condition called gastroenteritis. The remaining eight deaths had been incorrectly attributed to SIDS.

During the time they were under surveillance, 30 of the 39 children monitored by Southall were the victims of attempted suffocation at the hands of their parents. Many had been admitted repeatedly to hospital with breathing problems their parents had claimed were unexplained. Four had suffered brain damage as a result of oxygen deprivation.

Such abusers are 'frequently charming and attractive people . . . plausible parents'

Superficially, such abusing parents can appear ordinary. While it's predominantly mothers who inflict such abuse, fathers, step-parents, and grandmothers are sometimes perpetrators. In a 1997 research paper that shook the medical world, Southall and his co-authors reported that such abusers are "frequently charming and attractive people who [reveal] an ability to evade and deceive professionals from all agencies, as well as the media." By providing "attractive homes and satisfactory basic care for their children," these people often appear to be "plausible parents."

While several of the abusers observed by Southall behaved lovingly toward their offspring in front of medical staff and their spouses, they nevertheless turned vicious as soon as they were alone with their children.

Psychologically, it's theorized that such abusers crave attention, particularly from the medical establishment. After covertly injuring their children, these parents typically receive large amounts of sympathy from friends and relatives or strangers, whom they often regale with tales of how stressful it is to care for a sickly child.

In The Death of Innocents (Bantam, 1997), a gripping book about an American woman who smothered five of her children while doctors mistakenly blamed SIDS, authors Richard Firstman and Jamie Talan note that this "form of homicide is considered one of the few that is recidivistic: The payoff can become addictive. Typically, funerals are elaborately ritualized and marked by the mother's open plays for sympathy."

Today, medical researchers still don't know what causes SIDS, a syndrome in which perfectly healthy, well-loved infants die suddenly, usually while asleep in their cribs.

In both Canada and the United States, however, genuine SIDS deaths have declined dramatically in the past decade, largely, it's believed, due to public education advising parents to put babies to sleep on their backs rather than on their tummies. According to Statistics Canada, the annual number of SIDS deaths dropped from 329 to 166 between 1990 and 1996.

In recent years there has also been a growing consensus among medical and investigative personnel that while a single SIDS death in a family is a tragedy, more than one is strongly suspicious. Full investigations, including autopsies, have become the norm for unexpected deaths in children under the age of one across the country.

As recently as July, 1997, Quebec struck a committee to review the deaths of all children in that province under the age of five. Its report, delivered to the justice ministry at the end of January, has not yet been made public.

Copyright Southam Inc.