Munchausen Syndrome by Proxy (Medical Child Abuse)
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- 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.
- Excessive visits despite reassurance resulting in unnecessary tests or antibiotics
- 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
- 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.
- 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.
- 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.