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Munchausen syndrome by proxy.

R L Koul1, A Chacko, Z Al-Lamki

  • 1Department of Child Health, College of Medicine, Sultan Qaboos University, Sultanate of Oman.

Saudi Medical Journal
|August 14, 2001
PubMed
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Munchausen syndrome by proxy, a form of child abuse, was identified in five Omani children. Diagnosis was delayed due to mothers fabricating medical histories, often involving excessive medication.

Area of Science:

  • Pediatric Medicine
  • Child Abuse and Neglect
  • Forensic Psychiatry

Background:

  • Munchausen syndrome by proxy (MSP) is a rare form of child abuse where a caregiver fabricates or induces illness in a child.
  • This study reports five cases of MSP from Oman, highlighting diagnostic challenges.

Observation:

  • Five children (3 female, 2 male) aged 1-11 years presented with fabricated illnesses.
  • Mothers consistently reported uncontrolled epilepsy, with carbamazepine being the most frequently administered antiepileptic drug.
  • One child experienced prolonged hospitalization (9 months) for presumed status epilepticus.

Findings:

  • Diagnosis of MSP took 1.5 to 6 years (mean 2.8 years) due to discrepancies between reported history and clinical presentation.
  • Carbamazepine levels in children were significantly above therapeutic ranges.

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  • Mothers were identified as the perpetrators in all reported cases.

    • Implications:

    • MSP is present in Oman but may be underrecognized, necessitating immediate attention for policy development.
    • Increased awareness within the medical community is crucial for identifying and managing MSP cases.
    • Establishing a national or regional child protection council is urgently needed to address this issue.