Parent salvage and parent sabotage in the care of chronically ill children
P. Krener and R. Adelman
Department of Child Psychiatry, University of California, Davis, Sacramento 95817.
Adaptive parental behaviors produced from dealing with prolonged illness
may sabotage medical care of the chronically ill pediatric patient. Such
parental behaviors may be the result of unsuccessful intrapsychic or
interpersonal salvage operations in the response to the strains resulting
from illness in their child. They may resemble psychopathology, but
actually can be reversible. Five cases are presented to illustrate
differential diagnosis of parent difficulties ranging from adaptive strain
in normal parents to Munchausen's syndrome by proxy in parents of children
with chronic illness. A typology of parent-child pathology in health and
chronic illness is presented. The literature is reviewed, diagnostic
features are elaborated, and management strategies are suggested.
