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Penelope Krener, MD; Raymond Adelman, MD

Am J Dis Child. 1988;142(9):945-951.

Abstract
• 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.

(AJDC 1988;142:945-951)

Author Affiliations
From the Departments of Child Psychiatry (Dr Krener) and Pediatrics (Drs Krener and Adelman), University of California, Davis, Sacramento.

Footnotes
Accepted for publication May 26, 1988.

Reprint requests to Child Psychiatry, University of California, Davis, 2315 Stockton Blvd, Sacramento, CA 95817 (Dr Krener).

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