Procedures, placement, and risks of further abuse after Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation

Abstract

Twenty seven (24%) children still had symptoms or signs as a result of the abuse at follow up; 108/120 were originally on a child protection register and 35/111 at follow up. Twenty nine per cent (34/118) of the perpetrators had been prosecuted and most convicted; 17% of the milder cases of Munchausen syndrome by proxy allowed home were reabused. Evidence in siblings suggests that in 50% of families with a suffocated child and 40% with non-accidental poisoning there would be further abuse, some fatal. Conclusions-This type of abuse is severe with high mortality, morbidity, family disruption, reabuse, and harm to siblings. A very cautious approach for child protection with reintroduction to home only if circumstances are especially favourable is advised. Paediatric follow up by an expert in child protection should also occur. (Arch Dis Child 1998;78:217-221)

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

“…36 Children who are victims of fabricated illness can suffer significant morbidity and mortality. 21,24,27,28,37 Mortality rates of 6% to 9% have been reported, and approximately the same percentage suffer long-term disability or permanent injury. 7,10,24 By definition, all victims suffer some short-term morbidity related to unnecessary procedures or treatments.…”

“…8 Siblings of children who are victims of fabricated illness are also frequently abused. 24,27,28 In 1 large series, 25% of the siblings had died and 61.3% of the siblings had illnesses similar to those of the victims of fabricated illness. 10 Although mothers are most commonly the offenders, fathers, grandparents, boyfriends, and child care providers have been found responsible.…”

“…In the 2-year surveillance study in the United Kingdom and the Republic of Ireland referred to previously, 24 approximately one-third of the children (46 of 119) were allowed to return home. 28 Approximately one-quarter of the children (27) still had signs or symptoms of abuse at follow-up. Only one-third of the children were placed in caregiving arrangements outside the control of the alleged offending parent.…”

“…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.…”

A case of Munchausen syndrome by proxy

“…The condition is often seen in families where many members have had serious medical disorders or sudden unexplained deaths. Most of the children affected by this disorder are under 5 years of age 4 and some of them get re-abused even after diagnosis 5 .…”