The presumed love of a parent: an uncomfortable cognitive bias #WILTW

This is the 110th #WILTW

On Tuesday (21st June 2016) Ben Butler was sentenced to life in prison for murdering his daughter, Ellie. His partner was sentenced to 42 months for child cruelty and both found to have covered up her death by faking a 999 call two hours after she had died.

Ben Butler had previously been convicted in 2009 for shaking Ellie when she was a baby although on appeal this decision was overturned. The couple then won a High Court ruling to have Ellie returned to  them. Ellie was murdered 11 months later.

The video of Ellie’s Grandfather talking on the BBC is uncomfortable viewing

This is a tragic case which leaves you feeling sad with the world. That family members can harm each other, whether it be emotionally, physically or otherwise, is difficult to understand.

It is an uncomfortable part of paediatric practice that a small proportion of the injuries you see in children will have been caused by a person well known to that child. This adds complexity to the already challenging task of learning how to identify when injuries are children protection issues. The unique context of child abuse distinguishes it from more traditional medical education pedagogical approaches. For example I have blogged not infrequently on how important it is to listen to, and more importantly hear, parents’ worries. Sadly, despite the focus on the risks of serious bacterial illness in children, we know health care professionals still miss sepsis even when parents do everything in their power to highlight their concerns. Imagine the challenge then, when a parent or carer is deliberately concealing information or fabricating stories about their child. Those working in acute paediatrics must be aware of these polar opposites; sensitively sifting through nuances in language to identify legitimate concern or illegitimate explanation.

Child Protection Blog

I must admit I am not sure my child protection training ever really prepared me for the actual reality. Experience making me increasingly more aware of my limitations rather than less. But in this area I wonder if we can work harder at raising awareness of a cognitive bias inherent in believing the person who should have the child’s best interest at heart always does. Ultimately truly hearing the parent or carer’s story and evaluating that with the clinical  information from the child or young person you are seeing is the best way of keeping all children safe – whatever the cause of their illness or injury.

What did you learn this week? #WILTW

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Child Protection Publications from the RCPCH

One thought on “The presumed love of a parent: an uncomfortable cognitive bias #WILTW”

  1. A really thought provoking piece that made me sit back and reflect on my own practice – something that WILTW often does. I like to believe the best of people and often try and to convince juniors to try and avoid attribution bias, a common occurrence with our frequent psychiatric presenters.

    Before sending someone home I have a cognitive stop point and force myself to ask “Could this be sepsis?”. If the story of injury or illness does not quite add up then I add,”Could this be NAI?” but it does come in many guises. More than physical abuse it is harder to identify the psychological or emotional abuse that some children are dealt,

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