Follow up of victims of fabricated illness (Munchausen syndrome by proxy).

Bools, Christopher; Neale, Brenda; Meadow, S R

doi:10.1136/adc.69.6.625

Cited by 86 publications

(39 citation statements)

References 19 publications

(9 reference statements)

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“…Genel olarak çocukluk ve erişkinlik dönemlerinde güvensizlik, karşıt olma karşı gelme bozukluğu, post-travmatik stres bozukluğu, dikkat bozuklukları, bağlanma ve sosyal ilişki ile ilgili problemler, tıbbi tedaviden kaçınma ve kendine az değer verme gibi sorunlar geliştiği bildirilmiştir (3,25).…”

Section: Prognoz Ve Tedavi̇unclassified

Munchausen Syndrome by Proxy; A Serious Child Abuse Form

İnce¹,

Yurdakök²

2014

Turkish J Pediatr Dis

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GİRİŞDünya Sağlık Örgütü, bir yetişkin tarafından bilerek veya bilmeyerek yapılan ve çocuğun sağlığını, fi ziksel ve psiko-sosyal gelişimini olumsuz yönde etkileyen davranışları çocuk istismarı olarak tanımlamaktadır (1). Munchausen by proxy sendromu (MBP) çocuk istismarının çok ağır ve özel bir şeklidir. Hastanene hastane dolaşarak hastalık öyküleri uyduran veya oluşturan, bu nedenle gereksiz ve çok sayıda medikal veya cerrahi girişimler uygulanan hastaların "Munchausen sendromu" olarak tanımlamasından sonra Meadow, benzer durumu çocuklarında oluşturan ebeveynleri "Munchausen by proxy sendromu" olarak tanımladı (2). Türkçeye "vekâleten Munchausen sendromu" veya "vekâleten hastalık uydurma" olarak da çevrilebilecek olan bu sendromda ebeveyn ya da bakımveren, çocukta bir hastalık varmış gibi yapmakta veya hastalık yaratmakta ve «hasta» çocuğu doktora götürmektedir. Sonuçta gereksiz tanısal işlemler, cerrahi girişimler ya da medikal tedavi nedeniyle çocukta ciddi tıbbi zararlar oluşmaktadır. MBP karmaşık ve potansiyel olarak ölümcül bir çocuk istismarı formudur. Otuz yıldan uzun bir süre önce tanımlanmış olmasına rağmen tanı ÖZETMunchausen by proxy sendromu çocuk istismarının çok ağır ve özel bir şeklidir. Bir erişkin tarafından çocukta hastalık belirti ve bulgularının oluşturulması ile karakterize karmaşık ve potansiyel olarak ölümcül bir çocuk istismarı formudur. Sonuçta gereksiz tanısal işlemler, cerrahi girişimler ya da medikal tedavi nedeniyle çocukta ciddi tıbbi zararlar oluşur. Pek çok klinisyen fi ziksel veya cinsel istismarı oldukça iyi bilirken, Munchausen by proxy sendromu'nu tanımakta güçlük çeker. Tanı konulması ve ayırıcı tanı yapılmasında halen zorluklar vardır. Nadir, beklenmeyen bulgularla başvuran veya standart tedaviye cevap vermeyen her olguda Munchausen by proxy sendromu'dan şüphelenilmelidir. Tanı her olguya şüpheci yaklaşım ve özgün tanısal işlemler ile koyulabilir. Olguların multidisipliner bir ekip (Çocuk Koruma Birimi) tarafın-dan değerlendirilmesi şarttır. Bu derlemede Munchausen by proxy sendromu'nun epidemiyolojisi ve tanı basamakları tartışılacaktır. Anahtar Sözcükler: Çocuk, Çocuk istismarı, Munchausen by proxy sendromu ABSTRACTMunchausen syndrome by proxy is a very special and dangerous form of child abuse. It is characterized by a child with symptoms and signs of an illness that have been fabricated by an adult, usually the mother. Fabrication of those signs and symptoms leads to many unnecessary and painful investigations and treatments for the victim. Although many physicians are familiar with the sexual or physical abuse of children, they are unaware of this particular form of child abuse. Fortunately, awareness among pediatricians will increase as more cases are shared in the literature. Diffi culties remain in defi ning the condition, as well as in the detection and differentiation from other illness. Although it is a relatively rare form of child abuse, pediatricians need to have a high index of suspicion when faced with seemingly inexplicable fi ndings or treatment failures....

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Section: Prognoz Ve Tedavi̇unclassified

Munchausen Syndrome by Proxy; A Serious Child Abuse Form

İnce¹,

Yurdakök²

2014

Turkish J Pediatr Dis

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“…7 In a cohort study that had several methodologic limitations, including follow-up of only approximately 50% of the original sample identified, the factors associated with better outcomes for children who had been victimized included the following: (1) continuous positive input from the spouse and/or grandparents, (2) successful short-term foster care before returning to live with the offending caregiver, (3) the offender' s long-term therapeutic relationship with a social worker, (4) successful remarriage for the offending caregiver, (5) early adoption of the victim, and (6) long-term foster care placement. 49 It was not possible to determine the relative benefits for children of remaining with the abusing caregiver versus being separated. Among those children who were with the fabricator of the illness at the time of this study, children placed away from their mother, even temporarily, appeared to have a better outcome than those who did not experience this separation.…”

Section: Outcome If Reportedmentioning

confidence: 99%

“…28,49 Approximately 40% suffer further abuse, including other forms of maltreatment, such as physical and emotional abuse. 49 On the basis of Rosenberg' s review, 7 in 20% of the fatal cases the child had been returned home after the parents had been confronted about the suspicion of fabricated illness, and the child subsequently died. In a study in 54 children with a diagnosis of fabricated illness followed for 1 to 14 years, many of the children manifested other problems, including emotional and behavioral conditions, such as conduct disorders.…”

Section: Outcome If Reportedmentioning

confidence: 99%

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

Flaherty¹,

MacMillan²

2013

Pediatrics

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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.

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“…This is reflected in the range of disorders seen in victims including emotional disorders, school related problems, poor concentration, and school attendance. 7 Unfortunately, improving outcome by child protection intervention may be difficult if the abuse is not detected early. Statutory agencies, in the authors' experience, are more likely to intervene decisively if there is physical or sexual abuse, or neglect of a young infant.…”

Section: Morbidity and Mortality In Fabricated Seizuresmentioning

confidence: 99%

Fits, faints, or fatal fantasy? Fabricated seizures and child abuse

Barber

2002

Archives of Disease in Childhood

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Follow up of victims of fabricated illness (Munchausen syndrome by proxy).

Cited by 86 publications

References 19 publications

Munchausen Syndrome by Proxy; A Serious Child Abuse Form

Munchausen Syndrome by Proxy; A Serious Child Abuse Form

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

Fits, faints, or fatal fantasy? Fabricated seizures and child abuse

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