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Section 4
Track #4 - Tools for Working with Clients Affected by SIDS or Filicide

CEU Question 4 | CEU Answer Booklet | Table of Contents | Grief
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

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On the last track we discussed three phases of adolescence.  The three phases of adolescence we have discussed are early adolescence, middle adolescence, and late adolescence. 

On this track we will discuss the responsibilities of therapists regarding clients grieving the death of children from SIDS.  We will also discuss the 6 common features of filicide (fil’-a-side) or death of an infant.  The 6 common features of filicide are first children, aged less than 7 months, suffering from seizures or apnea, recent hospital discharge, time of death, and mothers who smoke.

As you know, Sudden Infant Death Syndrome is an otherwise unexplainable, yet natural death of an infant.  Only after ruling out all other possible causes of death can SIDS be diagnosed.  However, you may also be aware that Emery, Taylor, & Emery conducted a study which suggested that as much as 10 percent of deaths classified as SIDS may not be due to natural causes.  This study also suggests a reluctance among healthcare professionals to suspect parents of harming children, sometimes even in the face of strong evidence.

#1 Purpose
Because limited progress has been made in identifying or preventing infant death due to filicide, the purpose of this track is to address problems associated with possible misdiagnosis of SIDS. 

The case study on this track represents a mother who grieved the loss her two children.  Until a pattern had developed, the deaths of her children had been misdiagnosed as SIDS.  Only after healthcare workers became suspicious, did the truth come out that the mother of two was responsible for her children’s deaths. The value of this case study is in alerting healthcare professionals as to how easy it can be to empathize with a client. 

Would you agree that such an empathetic response could contribute to resistance to serious consideration of evidence?  However, such an empathetic response of course is the initial response of any healthcare professional.  Only occasionally is it necessary to be more suspicious of the presentation of clinical problems.

Share on Facebook #2 Case Study
Missy represents one situation in which the suspicion of the presentation of clinical problems was necessary.  Missy claimed that her motive for killing her first daughter was because she was afraid to lose her.  After killing her first child, Missy stated, "I just lay in bed and I cried and cried.  There was nothing anyone could do with me.  At the funeral, I remember throwing my whole body over the coffin.  I was hysterical.  Almost every child I saw in the street I saw as my daughter.  It was real grief that I hadn’t dealt with, of course with all the other guilt and so forth and knowing what I’d done." 

As you can see, though Missy acknowledged her guilt internally for killing her daughter, externally she showed only signs of grief.  Through her displays of grief, her friends and family only saw a sad mother.  Do you agree that empathy was established through Missy’s grief?  

Missy had described her first child as badly wanted and wonderful.  Missy described her second baby as a burden.  Missy stated, "I really resented this child, really resented her, because all I ever wanted was my first daughter."  Missy described feeling anger rather than concern for her second child. 

Missy described killing her second daughter when she stated, "I knew exactly what I was doing, oh yes, I just, oh you know, I hated having to get up to feed her.  I hated doing this and hated doing that.  Well, I thought, OK.  I never got caught for my first child’s death, I don’t want this child, how am I gonna get rid of it, you know, so I smothered her the same as the first one." 

Both deaths of Missy’s children were initially diagnosed as SIDS.  After suspicions arose following Missy’s apparent lack of attachment for her second child, investigators found her guilty of killing both children. 

Do you agree that Missy’s strong emotional bond with her first child created painful grief even though she was responsible for the child’s death?  This grief led to others empathizing with her and therefore not suspecting Missy had anything to do with her first daughter.  The subsequent lack of emotion following the death of Missy’s second child created no empathy, leading to suspicion. 

Share on Facebook#3 Common Features
Though Missy’s case is atypical, it illustrates the importance of remaining objective.  Because cases like Missy’s are not common, limited data is available. 
However, out of 81 cases of infant murders originally thought to be due to natural causes, there are some common features:
-- Most of the children were born to mothers who had not had a previous living, healthy child.
-- Most were aged less than 7 months. 
-- Most of the children suffered from seizures or apnea. 
-- Nearly half of the children had been discharged from a hospital setting in the week prior to death. 
-- Most deaths occurred during the day or evening, within two hours from the last occasion the child was seen to be normal. 
-- Most of the children were killed by their mothers, who were all white adults. 
-- Most of the mothers smoked. 
-- Finally, in 24 families, more than one child died. 

Of course, the presence or lack of these factors by no means defines a case of filicide, but, as you are aware, these are simply warning signs.  In the same way warning signs for child abuse are used, these common features simply act as a reminder.  Could utilizing warning signs regarding filicide help you maintain an objective approach in your practice?

#4 Summary
Missy’s descriptions with respect to how she felt about her first child and the subsequent death contrast starkly with her chilling descriptions of lack of connection with and consideration of her second child.  However, Missy’s account of her experience with respect to her first daughter indicate her ability to arouse compassion.  This ability to engage trust and compassion is likely to have contributed to her getting away with murder. 

Do you agree that it is possible that it allayed suspicion in professionals?

On this track we discussed the responsibilities of therapists regarding clients grieving the death of children from SIDS.   We also discussed the 6 common features of filicide.  The 6 common features of filicide are first children, aged less than 7 months, suffering from seizures or apnea, recent hospital discharge, time of death, and mothers who smoke.

On the next track we will discuss the first of the five challenges of a grieving child.  The first of the five challenges of a grieving child that we will discuss is security.  We will also explore the four methods for reestablishing security.  The four methods are actively manage the level of change in the child’s life, actively increase the level of predictability in the child’s life, deal with any of the child’s health concerns, and increase the child’s feelings of control.

Online Continuing Education QUESTION 4
What are 6 common features of filicide? To select and enter your answer go to CEU Answer Booklet.

 
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