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Munchausen syndrome by proxy in the pediatric intensive care unit: An unusual mechanism
Lisa B. Kamerling1, Xaviera A. Black, Richard T. Fiser
1Department of Pediatrics, Wilford Hall Medical Center, Lackland Air Force Base, TX.
Abstract:
OBJECTIVE: To present a case of Munchausen syndrome by proxy (MSbP) by a previously unreported mechanism, discussing the occurrence of MSbP in patients in the pediatric intensive care unit (PICU) and the use of covert video surveillance in the diagnosis of MSbP. DESIGN: Report of one case of a child who was proven to be the victim of MSbP while hospitalized in a PICU. SETTING: A six-bed PICU in a military teaching hospital. PATIENTS: One patient hospitalized for evaluation of confusing symptoms, later shown to be the victim of MSbP while on mechanical ventilation in the PICU. The mechanism of MSbP was intentional tracheal extubation by the patient's mother. INTERVENTIONS: Covert video surveillance. MEASUREMENTS AND MAIN RESULTS: After initiation of covert video surveillance in the PICU, the diagnosis of MSbP was confirmed. The patient recovered with some physical sequelae. CONCLUSIONS: Children can be victims of MSbP even in a closely monitored PICU. Covert video surveillance was crucial to confirming the diagnosis.
Insights
Munchausen syndrome by proxy (MSbP) can occur in pediatric intensive care units (PICUs) via novel mechanisms like intentional extubation. Covert video surveillance proved crucial for diagnosing this form of medical child abuse.
Area of Science:
- Pediatrics
- Child Abuse
- Medical Ethics
Background:
- Munchausen syndrome by proxy (MSbP) is a form of medical child abuse where a caregiver fabricates or induces illness in a child.
- MSbP cases are challenging to diagnose, especially in high-acuity settings like the pediatric intensive care unit (PICU).
- Unreported mechanisms of MSbP continue to emerge, necessitating vigilance and advanced diagnostic tools.
Purpose of the Study:
- To report a unique case of MSbP involving intentional tracheal extubation in a mechanically ventilated PICU patient.
- To highlight the diagnostic utility of covert video surveillance in confirming MSbP.
- To discuss the occurrence and detection of MSbP in the PICU setting.
Main Methods:
- Case report of a child hospitalized in a PICU with unexplained symptoms.
- Implementation of covert video surveillance to monitor patient-caregiver interactions.
- Analysis of surveillance data to identify the mechanism of induced illness.
Main Results:
- Covert video surveillance confirmed the mother's intentional tracheal extubation of the patient.
- The diagnosis of Munchausen syndrome by proxy was established.
- The patient recovered with residual physical effects after intervention.
Conclusions:
- MSbP can occur even in highly monitored PICU environments.
- Intentional tracheal extubation represents a previously unreported mechanism of MSbP.
- Covert video surveillance is an effective and crucial tool for diagnosing MSbP in critical care settings.