Munchausen Syndrome By Proxy Research Articles

Munchausen by proxy in a family

Munchausen by proxy in a family

Development of a Risk-Stratification Tool for Medical Child Abuse in Failure to Thrive

To develop a risk-stratification tool to help identify medical child abuse (MCA) in children evaluated for failure to thrive (FTT). In this case-control study, the control group consisted of children who were seen in the pediatric gastroenterology department and diagnosed with FTT before the age of 5 years between 2000 and 2010. Cases were distinguished by having also been referred to the Child Advocacy Committee at the Cleveland Clinic Foundation (CCF) and/or reported to the Department of Child and Family Services by the CCF as a possible case of MCA. We used retrospective chart review to compare 17 cases of MCA with 68 controls. Classification-tree analysis was used to generate the risk-stratification tool. A risk-stratification tool, in the form of a classification tree, was developed and incorporated the following individual risk indicators: (1) ≥ 5 organ systems involved; (2) absence of serious congenital anomaly or confirmed genetic disorder; (3) ≥ 5 reported allergies; and (4) refusal of services from a multidisciplinary feeding team. Overall, the classification tree had a sensitivity of 100% and a specificity of 96%. The results of this study suggest that a diagnosis of MCA may be suspected in children with FTT on the basis of features in the initial presentation and clinical course. Using the proposed risk-stratification tool that incorporates these features might assist in earlier identification of medically abused children and reduce morbidity and mortality.

Development of a Risk-Stratification Tool for Medical Child Abuse in Failure to Thrive

Development of a Risk-Stratification Tool for Medical Child Abuse in Failure to Thrive

Otolaryngology fantastica: The ear, nose, and throat manifestations of munchausen's syndrome

Munchausen's syndrome (MS) is a form of severe, chronic, factitious disorder with physical symptoms. Some essential features define MS, such as recurrent, feigned, or simulated illness; peregrination (traveling or wandering); pseudologia fantastica; and drug abuse. Munchausen's syndrome by proxy (MSBP) classically involves a parent or other caregiver who inflicts injury or induces illness in a child. The aim of the present study was to summarize and study the main ear, nose, and throat (ENT) manifestations of MS and MSBP. A systematic literature review carried out in a tertiary university referral center. An appropriate string was run on PubMed to retrieve articles dealing with ENT manifestations of MS and MSBP. A double cross-check was performed on citations and full-text articles found using selected inclusion and exclusion criteria. In total, 24 articles were finally included in the study, describing 30 cases of MS or MSBP involving the ENT region; 15/30 (50%) cases involved the face, most often presenting as facial pain or facial swelling; and 7/30 (23.3%) cases presented with symptoms involving the ear. Six cases out of 30 (20%) were MSBP. MS and MSBP may present with symptoms involving the head and neck area, particularly the face and external ear canal. The ENT specialist should suspect MS in patients with strange and long-lasting symptoms, so as to avoid misdiagnosis and unnecessary treatments that waste time and money in the healthcare sector.

Factitious Disorder by Proxy in Educational Settings: A Review

Factitious disorder by proxy (FDP), historically known as Munchausen syndrome by proxy, is a diagnosis applied to parents and other caregivers who intentionally feign, exaggerate, and/or induce illness or injury in a child to get attention from health professionals and others. A review of the recent literature and our experience as consultants indicate clearly that FDP has emerged in educational settings as well. Variants of educational FDP include parents of children with real or fabricated physical disabilities who request excessive or unneeded school health services and parents who request extensive education-related evaluations for children who do not demonstrate any educational need. If such cases continue to emerge, school districts will be asked to test more students who do not have disabilities under the Individuals with Disabilities Education Act. Also, special educational directors will be weighing the cost of providing unneeded testing and educational services against the cost of defending themselves in litigation to prove that the testing and services are unnecessary. A table of guidelines is provided for school and other personnel confronted with repeated requests for unwarranted special education services. Suggestions for future research are included.

Munchausen Syndrome by Proxy: An Adult Dyad

Munchausen syndrome by proxy (MSBP) is a form of abuse in which an individual deliberately produces or feigns clinical illness in a person under his or her care. Although well-documented in the child and adolescent literature, few case reports document MSBP with an adult proxy. We describe two patients: (1) Ms. A, a 21-year-old female, with recurrent episodes of polymicrobial bacteremia of unknown etiology, and (2) Ms. B, a 23-year-old female, with a history of a recurrent painful rash involving the pudenda. In the first case, medical staff found in the patient’s bed a syringe with an uncapped needle that contained a cloudy substance that grew the same organisms found in her blood. In the second case, the rash responded to topical treatment but dramatically worsened on the day of planned discharge. When the mother’s visitation was restricted and supervised, the rash immediately improved. Although typically reported in pediatric patients, MSBP should be considered in adult dyads when a patient’s medical problems do not respond as expected to therapy, and a caretaker appears overly involved or attention-seeking. Victims may suffer from “Stockholm syndrome,” holding the caretaker in high regard despite danger, even at risk of death. Munchausen syndrome by proxy (MSBP) is a mental illness characterized by a caregiver—the perpetrator—deliberately producing or feigning physical or psychological signs or symptoms in another person—the victim—who is under the perpetrator’s care. 1 The perpetrator’s psychological needs are met through the attention he or she receives during medical evaluations of their charge, even as induced conditions and iatrogenic complications can cause victims significant morbidity and even mortality. While MSBP is well described in the pediatric literature, 2 only seven cases have been reported with adult victims, 3‐9 and in three of these cases, the perpetrator was the same person. We believe that MSBP with an adult victim is underrecognized. We present two such cases with the objective

A Case with Unexplained Bleeding from Multiple Sites: Munchausen Syndrome by Proxy

Munchausen syndrome by proxy (MBP) is an extreme form of child abuse where children were unnecessarily treated or investigated for medical conditions that were falsified by their caregivers. Here the authors report a 16-year-old female with the complaints of bleeding from multiple and unusual sites, including hemoptysis, hematuria, bloody tears, and bloody nipple discharge, all of which are only witnessed by her mother. Extensive investigation revealed no organic etiologies for bleeding. The diagnosis of MBP was put by a multidisciplinary team. The diagnosis of MBP must be kept in mind in conditions where there is no underlying organic pathology in a bleeding patient.

The overlap of metabolic/mitochondrial disease and Munchausen-by-proxy syndrome (MBPS)

The overlap of metabolic/mitochondrial disease and Munchausen-by-proxy syndrome (MBPS)

Caustic esophagitis in two siblings:Munchausen syndrome by proxy

Background and aim: Recurrent corrosive esophagitis is a rare condition among children and may be due to child abuse. The Munchausen Syndrome by Proxy (MSBP) is special form of child abuse with variety of symptoms. It has challenging diagnostic process and needs a high clinical suspicion. When it is identified by physician, institutional child protection team must involve into the management of the case. Case report: We present the two siblings with recurrent esopahigitis. One of them died due to severe gastrointestinal bleeding. Other had severe esophageal stricture and oral lesions. Their mother fed both of them with caustic material at various time intervals. Both babies were treated in our hospital several times with the admission of their mother. Conclusion: This is the probably the first case report of Munchausen Syndrome by Proxy (MSBP) with caustic material ingestion of two siblings. Determining the exact cause of such cases is very difficult and physician must suspect child abuse in this situation.

Pediatric condition falsification (Munchausen syndrome by Proxy) as a continuum of maternal factitious disorder (Munchausen syndrome)

Pediatric condition falsification (PCF), also known as Munchausen syndrome by Proxy or Medical Child Abuse, is a somewhat rare form of child abuse and neglect. Its association with a history of adult factitious disorder (AFD) or Munchausen syndrome in the perpetrator is also well known. Exogenous insulin injection to cause hypoglycemia both in the context of PCF and AFD has been reported in the literature. However, the coexistence of both conditions via insulin injection in the same family has not been reported in the literature. This paper presents a family, in which the mother was diagnosed with AFD and her three children with PCF perpetrated by their mother via exogenous insulin injection.

Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice

Every year, more than 400,000 infants are born to mothers who are depressed, which makes perinatal depression the most underdiagnosed obstetric complication in America. Postpartum depression leads to increased costs of medical care, inappropriate medical care, child abuse and neglect, discontinuation of breastfeeding, and family dysfunction and adversely affects early brain development. Pediatric practices, as medical homes, can establish a system to implement postpartum depression screening and to identify and use community resources for the treatment and referral of the depressed mother and support for the mother-child (dyad) relationship. This system would have a positive effect on the health and well-being of the infant and family. State chapters of the American Academy of Pediatrics, working with state Early Periodic Screening, Diagnosis, and Treatment (EPSDT) and maternal and child health programs, can increase awareness of the need for perinatal depression screening in the obstetric and pediatric periodicity of care schedules and ensure payment. Pediatricians must advocate for workforce development for professionals who care for very young children and for promotion of evidence-based interventions focused on healthy attachment and parent-child relationships.

Munchausen by proxy: The dark side of parental investment theory?

The parental investment hypothesis provides a parsimonious explanation for a wide range of sexually dimorphic traits and behaviors across countless species. In the human context, the hypothesis posits that in light of the differentially greater parental investment that human females provide to their offspring, they should be much more vested in the wellbeing of their children. Munchausen Syndrome by Proxy (MSbP) occurs when a caregiver feigns or causes a medical condition in a dependent (typically a child). In the great majority of cases, the biological mother is the perpetrator, which is thus deeply surprising from an evolutionary perspective. I propose that for a small sample of women (e.g., those suffering from specific personality disorders and who do not possess the necessary support from their husbands/partners), the parental investment hypothesis is usurped or subverted in the service of their narcissistic need for attention (especially from high-status male physicians). Hence, in the same way that infanticide can be explained from a Darwinian perspective (despite it being at first glance incongruent with kin selection theory), MSbP appears to be equally amenable to an evolutionary analysis. One can test the hypothesis by demonstrating that the sex-specificity of the disorder holds true irrespective of cultural setting and epoch. Furthermore, one can look at single-parental families (as a means of controlling for the otherwise differential access to children in dual-parent homes) to show that within this controlled environment, mothers will remain the greater perpetrators of MSbP.

Munchausen Syndrome by Proxy: A Spanish proposal of therapeutic management

This paper provides an analysis to establish a practical guideline in the therapeutic management and subsequent monitoring of Munchausen Syndrome by Proxy (MSP) adapted to the Spanish social and legal context and based on scientific literature published before December 2008. An interdisciplinary team made up of various professionals involved in caring for the child will design a therapeutic strategy and monitoring at different levels. In the field of mental health there must be a triple therapeutic approach: the child as a victim, the agent as abuser and the family as a whole. In terms of social work, the socio-familiar situation should be evaluated using different resources at a health care level. It is important to plan the time to confront the family to obtain their necessary collaboration. The monitoring plan will be collective at the hospital level and the child's primary pediatrician, in the medical and educational fields in those of mental health and social work. A therapeutic strategy and monitoring by an interdisciplinary team at the medical, social and mental health level, is proposed as a useful tool in the management of MSP. In this way, in some cases the removal of child from the family nucleus can be avoided.

Munchausen syndrome by proxy mimicking as Gaucher disease

Although rare, Munchausen syndrome by proxy (MBP) is a potentially life-threatening form of child abuse. Here, we report a 19-month-old female infant who presented with hepatosplenomegaly, anemia, thrombocytopenia, and recurrent septicemia. She was initially thought to have myelodysplastic syndrome. Further hematological and immunological investigations revealed no cause. beta-Glucosylceramidase enzyme activity on dried blood spot was suggestive of Gaucher disease. However, the enzyme level on cultured skin fibroblast was not consistent with Gaucher disease. The first hint about MBP was the recurrent sepsis with numerous gram negative rods. Furthermore, the mother's behavior and health history raised our suspicion about MBP. The child showed significant improvement after she was separated from the mother for a week. Finally, the mother confessed that she was spitting in local herbs and injecting it into the central line. This is, to our knowledge, the first report of MBP resembling in its presentation Gaucher disease. This case should alert the general and specialized pediatricians about MBP, as it may mimic metabolic diseases like Gaucher disease.

Munchausen Syndrome by Proxy

1. Patrick Brown, MD 2. Cheryl Tierney, MD, MPH 1. Baystate Medical Center Springfield, Mass Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR. Washington, DC: American Psychiatric Association; 2000:781– 783 Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in a Medical Setting. Stirling J and the Committee on Child Abuse and Neglect. Pediatrics. 2007;119 :1026– 1030[OpenUrl][1][Abstract/FREE Full Text][2] Munchausen Syndrome by Proxy. Hettler J. Pediatr Emerg Care. 2002;18 :371– 374[OpenUrl][3][CrossRef][4][PubMed][5][Web of Science][6] Different Interpretations of Munchausen Syndrome by Proxy. Meadow R. Child Abuse Neglect. 2002;26 :501– 508[OpenUrl][7][CrossRef][8][PubMed][9][Web of Science][10] The term Munchausen syndrome has long been recognized in adult patients who fabricate symptoms for the purpose of adopting the sick role and submitting themselves to unnecessary medical procedures. In pediatrics, this condition takes a different spin when a parent presents with a story of symptoms in his or her child, who then becomes the focus of medical investigation. Because the patient is not directing the signs and symptoms of the condition, the name of this condition is Munchausen syndrome by proxy (MSBP). MSBP was introduced in the medical literature in 1977 by … [1]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.issn%253D0031-4005%26rft.aulast%253DStirling%26rft.auinit1%253DJ.%26rft.volume%253D119%26rft.issue%253D5%26rft.spage%253D1026%26rft.epage%253D1030%26rft.atitle%253DBeyond%2BMunchausen%2BSyndrome%2Bby%2BProxy%253A%2BIdentification%2Band%2BTreatment%2Bof%2BChild%2BAbuse%2Bin%2Ba%2BMedical%2BSetting%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpeds.2007-0563%26rft_id%253Dinfo%253Apmid%252F17473106%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=119/5/1026&atom=%2Fpedsinreview%2F30%2F10%2F414.atom [3]: {openurl}?query=rft.jtitle%253DPediatric%2Bemergency%2Bcare%26rft.stitle%253DPediatr%2BEmerg%2BCare%26rft.aulast%253DHettler%26rft.auinit1%253DJ.%26rft.volume%253D18%26rft.issue%253D5%26rft.spage%253D371%26rft.epage%253D374%26rft.atitle%253DMunchausen%2Bsyndrome%2Bby%2Bproxy.%26rft_id%253Dinfo%253Adoi%252F10.1097%252F00006565-200210000-00012%26rft_id%253Dinfo%253Apmid%252F12395011%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/external-ref?access_num=10.1097/00006565-200210000-00012&link_type=DOI [5]: /lookup/external-ref?access_num=12395011&link_type=MED&atom=%2Fpedsinreview%2F30%2F10%2F414.atom [6]: /lookup/external-ref?access_num=000178625100011&link_type=ISI [7]: {openurl}?query=rft.jtitle%253DChild%2Babuse%2B%2526%2Bneglect%26rft.stitle%253DChild%2BAbuse%2BNegl%26rft.aulast%253DMeadow%26rft.auinit1%253DR.%26rft.volume%253D26%26rft.issue%253D5%26rft.spage%253D501%26rft.epage%253D508%26rft.atitle%253DDifferent%2Binterpretations%2Bof%2BMunchausen%2BSyndrome%2Bby%2BProxy.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0145-2134%252802%252900326-5%26rft_id%253Dinfo%253Apmid%252F12079086%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [8]: /lookup/external-ref?access_num=10.1016/S0145-2134(02)00326-5&link_type=DOI [9]: /lookup/external-ref?access_num=12079086&link_type=MED&atom=%2Fpedsinreview%2F30%2F10%2F414.atom [10]: /lookup/external-ref?access_num=000175949600006&link_type=ISI

Medical Child Abuse: Beyond Munchausen Syndrome by Proxy

Medical Child Abuse: Beyond Munchausen Syndrome by Proxy

Incredibly caring (DVD): a training resource for professionals in fabricated or induced illness (FII) in children by the Department for Children, Schools and Families, Radcliffe Publishing, 2009. Institutional use: ISBN‐10: 1 84619 137 8; ISBN‐13: 978 184619 137 4. Individual use: ISBN‐10: 1 84619 136 X; ISBN‐13: 978 184619 136 7

Incredibly caring (DVD): a training resource for professionals in fabricated or induced illness (FII) in children by the Department for Children, Schools and Families, Radcliffe Publishing, 2009. Institutional use: ISBN‐10: 1 84619 137 8; ISBN‐13: 978 184619 137 4. Individual use: ISBN‐10: 1 84619 136 X; ISBN‐13: 978 184619 136 7

Medical child abuse: beyond Munchausen syndrome by proxy

Acta PaediatricaVolume 98, Issue 9 p. 1542-1542 Medical child abuse: beyond Munchausen syndrome by proxy Göran Bodegård, Göran Bodegård goran.bodegard@comhem.seSearch for more papers by this author Göran Bodegård, Göran Bodegård goran.bodegard@comhem.seSearch for more papers by this author First published: 27 July 2009 https://doi.org/10.1111/j.1651-2227.2009.01363.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume98, Issue9September 2009Pages 1542-1542 RelatedInformation

“A Dignified and Caring Mother:”1 An Examination of Munchausen Syndrome by Proxy Case Law*

Beginning with 1990, this article identifies and comments on fifteen years of legal case law across the five national common law jurisdictions of Australia, Canada, New Zealand, the United Kingdom and the United States, addressing legal responses to Munchausen Syndrome by Proxy (MSBP). MSBP is a syndrome in which perpetrators either harm a child in their care or achieve harm through their insistence on medical tests and treatments for non-existent, fabricated or exaggerated conditions. Abuse may go on for some time, and sometimes this abuse results in the child's death. The discussion situates this body of reported cases, identified through keyword searches in the LexisNexis databases, within current academic and professional literatures. Primarily, this review finds that the open-textured attributes of syndrome evidence, coupled with the idealisation of mothering and the concomitant social revulsion and retributive impulse towards “bad mothers”, invites professionals to infuse alleged cases of MSBP with morality, gender attributions, and social judgements. While identifying and preventing child abuse is an important goal, the questions of conscious knowledge and volition in a psychiatrically disordered perpetrator and the nexus of professional expertise in attributing liability and assigning punishment and treatment options deserve a more nuanced consideration.

Munchausen Syndrome by Proxy: A pediatrician's observations.

Munchausen Syndrome by Proxy (MSP) is a disturbing diagnosis that should be considered when persistent signs and symptoms defy adequate explanation despite extensive testing. Insistence by a parent (often mother) that more, and particularly invasive investigations be pursued, should serve as a warning sign that MSP might be present. The primary care provider who has an existing, over-time, relationship with the child and family is in an important position to raise the question of MSP because this professional may be able to recognize larger dynamics at play between child and family that are less apparent to subspecialists who are focused on a narrow aspect of the evaluation. A confounding element to identifying MSP can also be at play when parent(s) have become proficient in the jargon and technical communication with which professionals on the healthcare team are most comfortable. This easily occurs in cases of MSP both because frequent hospitalizations offer ample opportunity for the articulate and inquisitive parent to pick up the ways of "medical-speak," and because the World Wide Web provides countless and effortlessly accessible sources of disease related information (albeit not always accurate or relevant to the diagnostic dilemma in question). An additional complicating factor in posing a risk for MSP is the child with a chronic illness, or one whose neonatal course has served to label the child as vulnerable.