Melissa Drexler (known in the popular press as the Prom Mom) disposed of her newborn in a bathroom trash can at her high school prom on June 6, 1997.5,15-17 She had kept the pregnancy secret from her family and boyfriends. After giving birth and disposing of the baby, she returned to dance at the prom. Her motive was “unwanted child,” the most common motive in neonaticides. She was sentenced to 15 years in prison but was released after serving 3 years.15
Perpetrators of neonaticide are usually unmarried women in their late teens or early 20s.9 They rarely obtain prenatal care for their pregnancies, which are usually denied or concealed. They rarely have premorbid Axis I diagnoses. Spinelli18 found that some mothers experienced dissociative symptoms around the time of childbirth. A small minority have psychoses.13,19,20
Because of the low base rate of child murder and the frequency of characteristics of filicidal parents that occur among parents who would never harm their children, filicide prevention is difficult. Fewer than half the cases of filicide are associated with parental mental illness; the majority of deaths actually stem from child abuse. Some parents in psychiatric treatment for personality disorder, substance use problems, or severe mental illness, for example, do neglect or abuse their children. Parents with altruistic or acutely psychotic motives are usually manic, depressed, or delirious.
When filicidal thoughts are elicited, the clinician must consider why the parent has these thoughts. This helps guide both treatment and risk management.
Parenting capacity should be considered in evaluating patients. Certainly, when children are present for a portion of a psychiatric visit, the psychiatrist can observe the appropriateness of the parent-child interaction. Parents should be routinely assessed for their potential to harm their children. Clinicians have a duty to report suspicion of child abuse and endangered children in all 50 states.
Most psychiatrists underestimate the percentage of depressed mothers who have thoughts of harming their young children.21 One study found that just over 40% of depressed mothers with children younger than 3 years admitted to having such thoughts.22
Infant and child troubles also play a role. For example, in one study, 70% of mothers with colicky infants reported having “explicit aggressive fantasies” toward their babies, and fully 26% had infanticidal thoughts during episodes of colic.23 Parents who are suicidal may also have filicidal thoughts. Those with risk factors for suicide should be asked what plans they would make for their children if they took their own lives. Parents may also be asked whether their children (and partner) would be able to do without them.