Munchausen Syndrome by Proxy (Medical Child Abuse)

Munchausen Syndrome by Proxy (Medical Child Abuse) is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

  • The term medical child abuse (MCA) focuses on potential or real harm to a child, regardless of the caretaker’s motivations. MCA is the preferred term for the spectrum of caretaker behaviors that includes the term Munchausen by proxy.
    • Often involves lying or providing false information in the medical setting
    • Results in symptoms of illness in a child that are exaggerated, fabricated, or induced by the actions of a caretaker. There is usually no underlying health disorder in the child.
    • Leads to harm to the child victim directly from a caretaker’s actions or through resulting repeated interactions with the medical care system, including unnecessary tests, medications, and surgeries
    • Symptoms often will decrease when the child is separated from the perpetrator.
  • MCA presents as a spectrum and can be categorized as mild, moderate, or severe.
    • Mild:
      • Excessive visits despite reassurance resulting in unnecessary tests or antibiotics
    • Moderate:
      • Disruptions in the life of a child from insistence by parent for medications, tests or exams despite negative workups
      • Child’s life not placed in danger but long-term negative consequences possible
    • Severe:
      • Potentially life-threatening to the child from parent-induced illness or interventions based on fabricated symptoms
      • Example: a mother smothering her child to produce cyanosis and altered consciousness
  • Known by many names, including the following:
    • “Pediatric condition falsification”
    • “Caregiver-fabricated illness in a child”
    • Doctor shopping
    • “Factitious disorder by proxy”
  • All refer to harm to children through medical care due to the actions of a caregiver.

Epidemiology

  • Rare, with estimated annual incidence of 0.4 to 1.2 per 100,000 in children <16 years of age although data lacking for less extreme or complex cases
  • Most victims are <5 years of age, but victims may often be older children.
  • Sometimes a true disability or medical condition may be present.
  • The mother is usually the perpetrator.
  • Often multisymptom presentations
  • The most commonly described symptoms include apnea, seizures, factitious fevers, feeding and GI problems, failure to thrive, behavioral problems, bleeding, and sepsis.
  • Presenting symptoms may present along a spectrum of severity from mild to fatal.
  • Symptoms may be present for years before factitious illness is considered and diagnosed.
  • Morbidity is significant; cases may be fatal, especially those involving surreptitious administration of medications, poisoning, or inducing apnea.

Etiology

  • The parent, most commonly the mother, exaggerates, fabricates, or induces the illnesses.
  • Caretaker often has somatoform or factitious disorders, as well as often having a history of criminal activity, substance abuse, self-harm, abuse.
  • The term Munchausen syndrome by proxy refers to specific instances where the caregiver is motivated by a desire for self-aggrandizement. As such, it only defines a subset of factitious illnesses.
  • There is no single clear profile of perpetrator, thus medical providers are advised to concentrate on the specific harm done and the patient’s safety rather than on the caregiver’s motives.

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Basics

Description

  • The term medical child abuse (MCA) focuses on potential or real harm to a child, regardless of the caretaker’s motivations. MCA is the preferred term for the spectrum of caretaker behaviors that includes the term Munchausen by proxy.
    • Often involves lying or providing false information in the medical setting
    • Results in symptoms of illness in a child that are exaggerated, fabricated, or induced by the actions of a caretaker. There is usually no underlying health disorder in the child.
    • Leads to harm to the child victim directly from a caretaker’s actions or through resulting repeated interactions with the medical care system, including unnecessary tests, medications, and surgeries
    • Symptoms often will decrease when the child is separated from the perpetrator.
  • MCA presents as a spectrum and can be categorized as mild, moderate, or severe.
    • Mild:
      • Excessive visits despite reassurance resulting in unnecessary tests or antibiotics
    • Moderate:
      • Disruptions in the life of a child from insistence by parent for medications, tests or exams despite negative workups
      • Child’s life not placed in danger but long-term negative consequences possible
    • Severe:
      • Potentially life-threatening to the child from parent-induced illness or interventions based on fabricated symptoms
      • Example: a mother smothering her child to produce cyanosis and altered consciousness
  • Known by many names, including the following:
    • “Pediatric condition falsification”
    • “Caregiver-fabricated illness in a child”
    • Doctor shopping
    • “Factitious disorder by proxy”
  • All refer to harm to children through medical care due to the actions of a caregiver.

Epidemiology

  • Rare, with estimated annual incidence of 0.4 to 1.2 per 100,000 in children <16 years of age although data lacking for less extreme or complex cases
  • Most victims are <5 years of age, but victims may often be older children.
  • Sometimes a true disability or medical condition may be present.
  • The mother is usually the perpetrator.
  • Often multisymptom presentations
  • The most commonly described symptoms include apnea, seizures, factitious fevers, feeding and GI problems, failure to thrive, behavioral problems, bleeding, and sepsis.
  • Presenting symptoms may present along a spectrum of severity from mild to fatal.
  • Symptoms may be present for years before factitious illness is considered and diagnosed.
  • Morbidity is significant; cases may be fatal, especially those involving surreptitious administration of medications, poisoning, or inducing apnea.

Etiology

  • The parent, most commonly the mother, exaggerates, fabricates, or induces the illnesses.
  • Caretaker often has somatoform or factitious disorders, as well as often having a history of criminal activity, substance abuse, self-harm, abuse.
  • The term Munchausen syndrome by proxy refers to specific instances where the caregiver is motivated by a desire for self-aggrandizement. As such, it only defines a subset of factitious illnesses.
  • There is no single clear profile of perpetrator, thus medical providers are advised to concentrate on the specific harm done and the patient’s safety rather than on the caregiver’s motives.

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