Caregiver-Fabricated Illness in a Child: A Manifestation of Child Maltreatment

Abstract

Caregiver-fabricated illness in a child is a form of child maltreatment caused by a caregiver who falsifies and/or induces a child’s illness, leading to unnecessary and potentially harmful medical investigations and/or treatment. This condition can result in significant morbidity and mortality. Although caregiver-fabricated illness in a child has been widely known as Munchausen syndrome by proxy, there is ongoing discussion about alternative names, including pediatric condition falsification, factitious disorder (illness) by proxy, child abuse in the medical setting, and medical child abuse. Because it is a relatively uncommon form of maltreatment, pediatricians need to have a high index of suspicion when faced with a persistent or recurrent illness that cannot be explained and that results in multiple medical procedures or when there are discrepancies between the history, physical examination, and health of a child. This report updates the previous clinical report “Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in the Medical Setting.” The authors discuss the need to agree on appropriate terminology, provide an update on published reports of new manifestations of fabricated medical conditions, and discuss approaches to assessment, diagnosis, and management, including how best to protect the child from further harm.

An adolescent with disabling abdominal pain

“…Such signs can also be displayed by the patient, once the process of obtaining medical attention is under way. 6 2. …”

“…9 Such behaviour might trigger suspicion of Factitious Disorder Imposed on Another, and should be carefully investigated to protect patients. 6 Persistent seeking for a hidden underlying disease can result in further impairment of daily life, and it is unlikely to reassure patients or their families. In contrast, a positive diagnosis offers an explanation as to why no further investigation is needed.…”

Prevención del maltrato infantil: función del pediatra.2da parte. Prevención antes de que ocurra, ante la sospecha y con la confirmación del maltrato

“…Por eso, cuando hay síntomas, signos o pruebas persistentes e incongruentes con un diagnóstico médico, hay que incluir en el diagnóstico diferencial el síndrome de Munchausen por poderes o enfermedad fabricada por los cuidadores. 45,46 Hay situaciones de maltrato intraescolar que el pediatra puede visualizar o sospechar por las consultas médicas repetidas los días lunes, las inasistencias injustificadas, la sospecha de fobia escolar, etc.…”

Cognitive Errors

“…Similar to anchoring bias, labels are sticky and will build over time, placing these children at extreme risk of morbidity and mortality. 16 …”