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Medical Child Abuse (Munchausen Syndrome by Proxy): Multidisciplinary Approach from a Pediatric Gastroenterology
Andrea Z Ali-Panzarella1, Tamika J Bryant1, Hannah Marcovitch2
1Emory University School of Medicine, Atlanta, USA.
Insights
Diagnosing medical child abuse (factitious disorder imposed on another) requires a multidisciplinary approach. Pediatric gastroenterologists can play a key role in early identification of this complex condition.
Area of Science:
- Pediatrics
- Child Abuse
- Medical Diagnosis
Background:
- Medical child abuse, also known as factitious disorder imposed on another (FDIA) or Munchausen syndrome by proxy (MSP), presents diagnostic challenges.
- Early symptoms often manifest in pediatric gastroenterology, preceding formal diagnosis by months.
Purpose of the Study:
- To emphasize the necessity of a multidisciplinary strategy for diagnosing medical child abuse.
- To review clinical experiences with FDIA/MSP, focusing on presentations to pediatric gastroenterologists.
Main Methods:
- Literature review of recent articles on medical child abuse, primarily case reports.
- Analysis of clinical experience with suspected FDIA/MSP cases.
- Exploration of diagnostic challenges and the role of various healthcare and social agencies.
Main Results:
- Current literature on medical child abuse is limited, with a need for more research.
- A multidisciplinary approach involving hospital and non-hospital professionals is crucial for diagnosis.
- Social media is emerging as a tool for diagnosis, though data on long-term outcomes for victims and perpetrators are scarce.
- Pediatric gastroenterologists are frequently consulted before diagnosis, offering an opportunity for early intervention.
Conclusions:
- Diagnosing FDIA/MSP is complex, often involving piecing together historical and clinical inconsistencies.
- A comprehensive, multidisciplinary approach, including inpatient surveillance and input from various agencies, is essential for accurate diagnosis.
- Early recognition by pediatric gastroenterologists can facilitate timely intervention.
Purpose Of Review:
We highlight the need for a multidisciplinary approach to the diagnosis of medical child abuse, also known as factitious disorder imposed on another (FDIA) or Munchausen syndrome by proxy (MSP), and review our experience focusing on the variety of symptoms that often present to the pediatric gastroenterologist many months before the diagnosis is made.
Recent Findings:
Recent literature on medical child abuse, mostly case reports, is markedly limited, highlighting a need for increased research on this topic. Articles agree on the value of a multidisciplinary approach to these cases and the importance of involving professionals outside the hospital setting. Given the technology-dependent nature of our current society, the use of social media to aid in making the diagnosis has emerged. Review of the literature shows that there are almost no data on long-term outcomes of the victims or perpetrators of MSP. Making the diagnosis of MSP involves a complicated process of piecing together inconsistencies among the history, examination, and clinical presentation. The diagnosis remains difficult and is not often considered during early presentation of symptoms. Once MSP is suspected, it is important that a multidisciplinary process is used, incorporating input from various sources: the outpatient care structure, the hospital, non-hospital agencies such as school and child protective services, and non-traditional sources such as social media. In our experience, a multidisciplinary approach augmented by thoughtful inpatient surveillance provides the greatest opportunity for confirming or excluding MSP. Pediatric gastroenterology is one of the most common services consulted prior to diagnosis and presents an opportunity for early intervention.