Parent salvage and parent sabotage in the care of chronically ill children.
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.
Krener
P
P
Department of Child Psychiatry, University of California, Davis, Sacramento 95817.
Adelman
R
R
D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000523:psychology; D002653:Child Behavior Disorders; D002908:Chronic Disease / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009110:Munchausen Syndrome / Q000523:psychology; D010287:Parent-Child Relations; D010817:Physician-Patient Relations; D012803:Sick Role