Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in a Medical Setting

Abstract

The condition widely known as Munchausen syndrome by proxy comprises both physical abuse and medical neglect and is also a form of psychological maltreatment. Although it is a relatively rare form of child abuse, pediatricians need to have a high index of suspicion when faced with seemingly inexplicable findings or treatment failures. The fabrication of a pediatric illness is a form of child abuse and not merely a mental health disorder, and there is a possibility of an extremely poor prognosis if the child is left in the home. In this statement, factors are identified that may help the physician recognize this insidious type of child abuse that occurs in a medical setting, and recommendations are provided for physicians regarding when to report a case to their state's child protective service agency.

Monsters in the Closet: Munchausen Syndrome by Proxy

“…Other authors have simply described MSbP as child abuse that occurs in a medical setting. 2,8 Definitions: There Are Many…”

“…Those with severe disorders resort to actually inducing illness or injury in the child (Table 1). 2,16 …”

“…27 Although MSbP has no "typical" presentation, perpetrators almost always describe a history of signs and symptoms that are undetectable to the medical observer and are therefore both plausible and difficult to disprove. 2 One study Many of these conditions lack clearly observable or diagnostic findings. For example, how do you disprove that a child had a seizure in the face of parental insistence?…”

“…2 Findings that defy simple medical explanations send health care providers down a path of "chasing zebras" in an attempt to uncover unusual conditions. Even without maternal prompting, medical professionals may be easily seduced into prescribing diagnostic tests and therapies that are at best uncomfortable and costly, and at worst potentially injurious to the child.…”

“…Recognize that MSbP is child abuse gain, access to narcotics, or a desire to avoid work or other unpleasant situations (ie, malingering). 2 …”