Suffocation and poisoning?the hard-hitting side of Munchausen syndrome by proxy

Abstract

Munchausen syndrome by proxy (MSBP) is a severe and difficult to diagnose form of child abuse characterised by the simulation, aggravation or production of symptoms of illness in a child by an adult. MSBP often leads to multiple hospitalisations and has a high mortality and long-term morbidity. This study describes the cases of 5 families with 8 children affected who presented with unexplained neurological or gastrointestinal symptoms or even loss of consciousness. All were victims of poisoning or suffocation by their mothers. Two of those children died and were initially diagnosed as SIDS or natural death, respectively. They were only recognised as MSBP victims after another sibling had fallen ill with similar symptoms. The cases are discussed in consideration of the relevant literature. In addition warning signs of this forensically relevant syndrome and a strategy for the management of suspected MSBP cases are described.

A multicentre and prospective study of suspected cases of child physical abuse

“…The medico-legal community is more and more frequently presented with cases in which a differential diagnosis between accidental and deliberately inflicted trauma is crucial. Apart from the technical and methodological difficulties inherent to this kind of diagnosis, an additional problem which Europe (especially continental Europe) has to deal with, far more than the United States, Canada and the UK, is the lack of population studies, particularly from a clinical perspective: some forensic literature does exist on child abuse; however, it mainly focuses on case reports or autopsy findings [2,9,12,14,18,26].…”

δ-Storage pool disease: a pitfall in the forensic investigation of sudden anal blood loss in children: a case report

“…However, we wish to emphasize that in the diagnosis of abuse, an overall consideration of the situation remains the priority: the diagnosis of this disease may explain certain features, but there can still be an abuse situation in the background as a haemostatic disorder is known to aggravate the symptoms of sexual abuse and child abuse in general, including Munchausen syndrome by proxy [20].…”

The Importance of Biological Samples and Toxicological Analysis in Suspected Munchausen by Proxy Syndrome (MbPS) Cases [Munchausen by Proxy Sendromu (MbPS) Suphesi olgularinda Biyolojik Orneklerin ve Toksikolojik Analizin Onemi]

“…Özellikle bebeklerde, failin patolojik davranışını belgelemenin, anne çocuk ilişkisinin doğası gereği zorluklar içerdiği ortaya konulmuştur. Bu nedenle aynı evden birden fazla ölümle sonuçlanmış olgular bildirilmektedir [4]. Ayrıca tanı koyma aşaması ve sonrasında psikiyatrik konsültasyon, failin de kendisine zarar verme olasılığının önüne geçebileceğinden, uzmanların dikkat etmesi gereken bir durumdur [5].…”

“…Benzer bir araştırmanın sonuçlarına göre de ölüme en çok analjezikler [4,33], anti-koagulanlar [20,39] opioidler [36,41,43], antihistaminikler [4,18], hipotensifler [38,44], antispastikler [42], antidiyabetikler [41], frusamide [46], teofilin [4], amitriptilin [34,35] ve civadır [20]. Tablo Bu tür durumlarda, ölümle sonuçlanan olguların örnekleri ile tedavi altındaki olguların Üniversite ÇKM'leri ekip halinde çalışan, mağdur çocuğa bütüncül yaklaşan, tanı, tedavi ve izlem merkezleridir.…”