Two Siblings with Recurrent Cardiorespiratory Arrest: Munchausen Syndrome by Proxy or Child Abuse?

Abstract

The terms "Munchausen syndrome by proxy" or "Polle syndrome" have been used to describe children who are victims of parentally induced or fabricated illness. This report gives case histories of two siblings (a 7-month-old girl and a 4-year-old boy) with recurrent episodes of cardiorespiratory arrest that were induced by a mother who skillfully resuscitated the children and who demonstrated model parental behavior. Polygraphic monitoring with hidden camera was used to determine that the episodes of cardiorespiratory arrest were parentally induced in the infant. The 4-year-old sibling had previously undergone multiple diagnostic and surgical procedures. After the diagnosis was made in the infant, and the mother was no longer permitted to be alone with the children, neither child had further episodes. A psychologic profile of the mother is presented, and special features of these two and other cases in the literature are reviewed. These cases represent a form of child abuse. A parentally induced illness should be considered in the differential diagnosis of unusual illnesses with bizarre features, even when the parent's behavior appears exemplary.

Three forms of factitious illness in children: When is it Munchausen syndrome by proxy?

“…They are characterized by active and direct efforts of the parent to induce dramatic symptoms of illness in the young child. Following Meadow's first descriptive account of two mothers falsifying blood and urine samples, dramatic reports followed of mothers putting blood on their infants, 14 , 16 injecting their children with excretions, 13 suffocating infants, 31 and poisoning them with everything from laxatives to barbiturates 1 , 9 , 12 , 15 , 18 , 30 , 31 , 32 , 36 , 39 . These cases are noteworthy for a maternal style in the hospital which appears above suspicion; almost all the mothers have been described as cooperative, concerned, loving, devoted, and trustworthy; many are nurses or other kinds of health professionals.…”

“…In the proxy version, on the other hand, the extreme life-threatening interventions of some parents (in all reported cases thus far, the mother) in their efforts to create believable illness are imposed on helpless, often preverbal, children with no ability to limit the damage inflicted. There are descriptions of children poisoned by their mothers, 1 , 9 , 12 , 15 , 18 , 30 , 32 , 36 , 39 injected with contaminated materials, 13 , 17 , 25 , 27 and even suffocated 31 . Meadow's data 21 and a review of 16 cases of parental poisonings did not describe single events but programs of considerable duration (1½ to 48 months) which often continued during the child's hospitalization.…”

Munchausen syndrome by proxy: Another women's disorder?

“…It is likely that subtle but no less significant histories of victimization in the form of oppression exist. For example, Leeder (1990) and Rosen et al (1983) described case histories of women with long histories of unusual illness, isolation, significant loneliness, and poor self-esteem.…”

“…For example, some may become “doctor addicts” (Libow & Schreier, 1986) or, in more extreme cases, develop adult Munchausen Syndrome. It is our hypothesis, based on examination of case studies reported in the literature (e.g., Chan et al, 1986; Leeder, 1990; Meadow, 1982; Rosen et al, 1983) and on our psychotherapy of women, that the women most vulnerable to developing MSP are those who have adopted, without question, their socially prescribed roles as nurturers and caretakers of others. These women’s needs are met primarily in the context of caring for others.…”

“…506, 507). Dissociation of affect has been described, in addition to a pervasive sense of emptiness (Rosen et al, 1983). In more than half of the cases reported in the literature, the mother herself had previously been diagnosed with adult Munchausen Syndrome, and had a history of physical illness similar to that of her child (Chan et al, 1986; Meadow, 1982).…”