Abuse, lies, and videotape

Paediatrician David Southall talks to Julia Hinde about his pioneering use of secret cameras to catch parents abusing their children and the criticism it has aroused

For the past ten years a Keele University scientist has secretly filmed parents hurting their own children. Critics have slated David Southall's methods of gaining evidence, accusing him of everything from overdiagnosis to vindictiveness. But after saving 38 children from potentially life-threatening abuse, Southall is convinced his work is ethical as well as crucial.

Working from a cluttered pre-fabricated office in the grounds of the Stoke City General Hospital, Southall welcomes me to his ordered mess. The 48-year-old medic, also a professor at Keele University, is a crusader of modern medicine with an important message for the welfare of children. Yet he has been surrounded by controversy and debate for much of the past decade. In that time, firstly at the Brompton Hospital in London and now at North Staffordshire NHS Trust, Southall pioneered covert video surveillance (CVS)to secretly record a particular form of child abuse.

If a doctor is called to a child who has stopped breathing, an immediate response is to check that nothing is blocking the child's airways. If no obstruction can be found and later tests for other causes prove inconclusive, but the child repeatedly stops breathing, then the unthinkable - that a parent may be suffocating the child - becomes a possibility.

Munchausen Syndrome by Proxy was the term coined some 20 years ago to describe an illness which leads parents, mostly mothers, to induce or fabricate illness in their own children. The incidents reported include suffocation, poisoning and fractures. Often there are no tell-tale signs, no bruising around the mouth and outwardly kind and concerned parents. The child-victims, who are often not yet one year old, have no ability either to defend themselves from these attacks or to speak out about the violence they endure.

Southall identifies CVS as a crucial means of gathering evidence which could spare such children unnecessary further suffering and possibly even death. He says that at the Brompton approval for the use of the new technique was given by the hospital's ethics committee. Now it is an established medical practice, no formal ethical approval is necessary. Nevertheless, his critics are vocal. They include both academics and mothers who claim they have been wrongly accused of MSBP by doctors using Southall's methods.

Last month court orders were gained by Southall and the hospital, preventing four defendants, including THES correspondent Brian Morgan, from circulating confidential research material taken from the paediatrician's office. The documents were taken by a woman, who claims she was accused, under Southall's methods, of MSBP. Publicity about the case forced the hospital to suspend the use of CVS, but the practice continues elsewhere.

Its critics complain of problems with interpretation of video footage, of infringement of parents' rights, of pressure on parents when their children are placed in unnatural surroundings away from a ward, of overdiagnosis, and of a lack of control experiments for comparison. But for each of the criticisms Southall, the Birmingham-born son of a government scientist, has an answer. He is certain that what he is doing is ethical.

Southall's interest in MSBP evolved through two decades of research into cot death or Sudden Infant Death Syndrome. Children who had suffered repeated near deaths were brought to the Brompton Hospital. One child whose repeated loss of breathing could not be explained medically led Southall to consider MSBP. With the help of the police, he caught the mother suffocating her child on camera.

Since this pioneering use of CVS, Southall and his colleagues have secretly recorded 39 babies with an unexplained history of near death events. When the child is admitted to hospital it is kept in a separate room. In the walls are four hidden cameras. In 30 cases using such equipment a parent was captured on film suffocating the child. In another instance, a mother poisoned the child, while another mother caused a fracture; 38 out of the 39 children were protected by court orders following the use of CVS. The 39 youngsters had 41 siblings of whom 13 had earlier died. Eleven of the deaths had been attributed to cot death, an alarming number says Southall, although he refuses to speculate.

However, despite the shocking nature of this abuse, some of his critics maintain that the parents he accuses have rights which CVS critically breaches. Discussing a child's medical condition without the involvement of a parent flies in the face of child protection policy, where "Working Together" has become a key phrase as well as a government policy document. Secretly spying on a child and covertly recording parental contact hardly constitutes "working together", say Southall's critics.

But Southall says CVS is essential, because parents who commit this type of abuse can be "truly Jekyll and Hyde characters" with an ability to deceive and lie to the bitter end. Moreover, there are no laws prohibiting CVS as long as the surveillance takes place in a public space. Worse still, says Southall, his latest research indicates that those abusing their children are not just attention seeking as initially thought, but may have more "sinister needs". "From the video tapes," he says, "there is evidence of sadistic abuse. CVS has shown that parents who intentionally suffocate and induce illness in their children may also abuse them in other ways." He lists an appalling catalogue of incidents of emotional and physical abuse all of which, Southall claims, were caught on film. Many of the perpetrators, he says, seem to suffer from personality disorders, with which they are born, though some may develop during a person's upbringing.

When investigated, these people appear to share many of the same characteristics - rebellious teenage years, a tendency to fabricate illness in themselves, to make false allegations of physical and sexual abuse, to be self-abusive and to have psychopathic tendencies.

Southall says: "But suppose you find (an adult with) this background and a child with several near death events, how can you link the two? Whereas we can say we are fairly satisfied that the child is being suffocated by the mother, what proof have we got? We may be suspicious, we have to prove it. This is where CVS comes in." Southall insists that working with parents to halt abuse may be futile. "Such an approach trusts that abusing parents will collaborate," he says. "The problem with these people is their behavioural disorders are of such a kind that they will lie the whole time.

"We are far from certain that the use of child protection registers, of case conferences which include the suspected perpetrators, or regular visits from social workers, can protect children from the kind of abuse that is undertaken by such parents. CVS has shown that personality disordered parents can appear caring and kind yet within seconds can become cruel and sadistic." With this in mind, Southall, whose MSBP research, funded by Keele University and the North Staffordshire Regional Health Authority, occupies about half of his time, believes a reconsideration of the framework of child protection may be needed.

"Acceptance of the need to consider abuse by personality disordered parents as different may lead agencies to have to work deliberately without the collaboration of parents if they are to place the interests of the child foremost," he says, stressing the need for professionals, including GPs and even specially-trained police officers, to work together in order to perform the highly skilled investigations needed.

Notorious incidents, such as the Cleveland sex abuse scandal of 1987 when allegations of over-reaction by doctors and social workers followed the separation of 121 children from their families, have made his work harder, admits Southall. "Cleveland has been thrown at us regularly," he says. "They say our work should be subject to the same scrutiny. No one wants to falsely accuse a person of abuse. Objective high quality data is therefore very important to avoid both sides of the error. An investigative approach, maybe with specially trained police officers, is needed."

Southall, who refuses to discuss his own children or his childhood, agrees with his critics that children may suffer under CVS in order for him to gain recorded evidence of abuse, but he denies that the recordings in any way smack of vindictiveness, as critics have suggested. He says that concern for only two or three of the children was sufficient prior to CVS to put them on the register of children "at risk". In each case, he maintains, CVS was essential in providing evidence to separate the children from an abusing parent. "Imagine what other things would go on if you didn't."

He says that although there have been more than 30 criminal prosecutions of parents, he is not particularly interested in pursuing them. "We are only interested in protecting the children. It is not my place to judge why these parents do this. It's only our place to protect children who cannot protect themselves."

Yet Southall's mandate extends further than the hospital wards of Staffordshire, as a map of the Sarajevan battle lines on his office wall suggests. In between diagnosing abuse and writing research papers, Southall has established a charity, Child Advocacy International.

Set up 18 months ago and working in war zones throughout the world, the charity addresses the effects of war on children, and seeks to protect them from any long-term trauma."There are 24 wars at the moment. Most are targeting civilians," says Southall who, as well establishing and equipping children's wards in Bosnia, wants a global reaction force to protect children threatened by war. He envisages an armed UN-style force able to establish internationally visible and legally protected zones for children and their families.

Child Advocacy International can be contacted at PO Box 716, Stoke on Trent.