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Munchausen syndrome by proxy: patterns of presentation to pediatric surgeons
S R Lacey1, C Cooper, D K Runyan
1Department of Surgery, University of North Carolina School of Medicine, Chapel Hill 27599-7210.
Insights
Munchausen syndrome by proxy (MSbP) involves parents fabricating or inducing illness in a child. Isolating the child from the parent is key to diagnosis, with symptom resolution confirming MSbP.
Area of Science:
- Pediatric Medicine
- Child Abuse
- Psychiatry
Background:
- Munchausen syndrome by proxy (MSbP) is a form of child abuse where a caregiver fabricates or induces illness in a child.
- This disorder is increasingly recognized, presenting diagnostic challenges for healthcare professionals.
Purpose of the Study:
- To review the experience of identifying and diagnosing MSbP in children presenting to a Pediatric Surgical Service.
- To identify patterns of presentation and effective diagnostic tools for MSbP.
Main Methods:
- Retrospective review of 10 children diagnosed with MSbP over a 5-year period at North Carolina Children's Hospital.
- Analysis of presenting symptoms, perpetrator behavior, and diagnostic interventions.
Main Results:
- Two distinct patterns of presentation were identified: apnea, seizures, and cyanosis in infants, and persistent diarrhea and vomiting in older children.
- The mother was the perpetrator in all cases. Isolation of the child from the parent was the most effective diagnostic tool, with symptom resolution confirming the diagnosis.
- Video telemetry and toxin screening were also utilized for diagnosis.
Conclusions:
- Awareness of MSbP presentation patterns and parental behavior is crucial for early diagnosis.
- Prompt diagnosis can prevent unnecessary and potentially harmful diagnostic and operative procedures.
- Parental absence leading to symptom resolution is a consistent indicator for diagnosing MSbP.
Abstract:
Munchausen syndrome by proxy is an increasingly reported insidious disorder in which illness in a child is fabricated and/or induced by the parent. Over a 5-year period at North Carolina Children's Hospital 10 such children were identified after having presented to the Pediatric Surgical Service. In reviewing this experience, we have identified two patterns of presentation. Apnea, seizures, and cyanosis comprised the pattern most frequently seen in infants. A history of persistent diarrhea and vomiting, although seen in two infants, was the more common pattern in older children. As they got older, four of the infants subsequently were noted to have the childhood pattern of symptoms. The mother was the perpetrator in all cases with the child's illnesses being induced by a number of different mechanisms. The most useful diagnostic tool proved to be isolation of the child from the parent. Resolution of symptoms in parental absence was a consistent finding especially in fabrication cases and was the key to diagnosis. Video telemetry confirmed the diagnosis in two infants and screens for toxins were diagnostic in three others. Awareness of patterns of presentation and parental behavior is critical to establishing an early diagnosis and avoiding needless diagnostic and operative procedures.