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Yvonne Roberts on why social work and the medical profession need a better understanding of Munchausen's syndrome by proxy.

During the 1990s paediatrician David Southall developed a reputation as a researcher into respiratory problems and their links to cot deaths. He also became an expert witnesses in cases of Munchausen's syndrome by proxy. MSBP is the much-disputed label used to describe behaviour in which a parent creates "symptoms" of illness in his or her child, to engage the attention of professionals. For instance, by reopening wounds, poisoning or rubbing bleach into the skin.

Professor Southall and his team covertly filmed parents in hospital while they attempted to suffocate their offspring and inflict physical and emotional abuse. Almost all the parents were successfully prosecuted and a number of children were removed into care.

Southall subsequently faced a series of complaints both from parents who professed their innocence and those who had concerns about his research methods. Two years ago, he was suspended by North Staffordshire NHS Trust. Last week, he was finally exonerated and reinstated but the gruelling time he and his family experienced has made some paediatricians extremely wary of MSBP cases.

If MSBP raises difficult personal as well as ethical issues for paediatricians, it presents an equally tough terrain for social workers. "She was personable, articulate, co-operative, apparently a perfect mother. I was disarmed." These were the words of a social worker after she encountered her first, and so far only, case of MSBP in which a mother was suspected of giving excessive amounts of salt to her young child.

Most social workers know something of the theory of MSBP but perhaps little of the complex and contradictory emotions that such cases trigger among professionals struggling together to achieve a good outcome for a child. The extent of MSBP, and its understanding, is still relatively limited. What is immediately important is the prevention of further damage to the child. However, for social workers this almost certainly means rejecting one of the basic tenets of the profession - the importance of working in partnership with parents. If they persist in doing so, then as Schreier and Libow point out in their pioneering work Hurting for Love, there is a very real danger that once a parent knows she is under suspicion, she may escalate her assaults.

So, how to handle MSBP? Perhaps what's now urgently required is a resource centre to make available the insight of multi-agency professionals, such as Professor Southall, who have survived the wounds which MSBP appears to inflict not just on children but also on those who also seek to protect them.