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[Munchausen syndrome]
K Vondrák1, F Schneiberg, A Kolský
1Klinika pediatrie IPVZ, Fakultní Thomayerova nemocnice, Praha.
Insights
This study observed five pediatric patients with Münchhausen syndrome and Münchausen syndrome by proxy, both forms of child abuse. Immobilization and preventing hand manipulation resolved hematuria in four cases, suggesting factitious disorder.
Area of Science:
- Pediatric Medicine
- Child Psychology
- Forensic Medicine
Background:
- Münchhausen syndrome and Münchausen syndrome by proxy are forms of child abuse.
- These syndromes are often underdiagnosed and considered rare.
Observation:
- Five pediatric patients (4 boys, 1 girl, aged 12-16) presented with macroscopic hematuria.
- Extensive invasive investigations failed to identify an organic cause for the hematuria.
- Four cases raised suspicion of Münchhausen syndrome, and one suggested Münchausen syndrome by proxy.
Findings:
- In four patients, macroscopic hematuria resolved after immobilization and prevention of hand manipulation, indicating Münchhausen syndrome.
- The fifth patient, presenting with recurrent hematuria, was diagnosed with Münchhausen syndrome by proxy.
Implications:
- The resolution of hematuria upon intervention supports the diagnosis of factitious disorder in these pediatric cases.
- The findings challenge the notion that Münchhausen syndrome and its proxy form are exceptionally rare in children.
- Early recognition and intervention are crucial for managing these complex cases of child abuse.
Abstract:
The authors present their own observation of five child patients with Münchhausen's syndrome and Münchausen's syndrome by proxy resp. Both these units are included in the wider framework of the syndrome of the battered child. Four boys and one girl are involved, aged 12-16 years. In all instances the reason for admission to hospital was macroscopic haematuria. The children were prior to hospitalization subjected to a series of various invasive examinations, incl. repeated examinations under anaesthesia to elucodate the cause of macroscopic haematuria. The uncommon course of the "disease" and results of the examinations led in four of the five children to suspicion of Münchhausen's syndrome. Based on this suspicion after immobilization of the patients associated with prevention of manipulation with the hands, macroscopic haematuria disappeared as well as haematuria in general. In the fifth patient Münchhausen's syndrome by proxy was involved. The patient was referred because of repeated attacks of macroscopic haematuria a renal biopsy. The authors analyze in more details the individual case-histories and in the conclusion to they raise their objections to the opinion that these two syndromes are extremely rare.