Medical child abuse (Munchausen syndrome by proxy)
- Thomas A Roesler, MD
Thomas A Roesler, MD
- Professor of Psychiatry and Behavioral Sciences
- University of Washington School of Medicine
- Carole Jenny, MD, MBA, FAAP
Carole Jenny, MD, MBA, FAAP
- Professor of Pediatrics
- University of Washington School of Medicine
- Section Editors
- Daniel M Lindberg, MD
Daniel M Lindberg, MD
- Section Editor — Pediatric Psychosocial Emergencies
- Associate Professor of Emergency Medicine and Pediatrics
- University of Colorado Kempe Center
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The clinical features, diagnosis, and management of medical child abuse (MCA) with a focus on recognition and care of the affected child will be reviewed here.
Other forms of physical child abuse and neglect are discussed separately. (See "Physical child abuse: Recognition" and "Physical child abuse: Diagnostic evaluation and management" and "Child neglect and emotional maltreatment".)
Medical child abuse (MCA) refers to a child receiving unnecessary and harmful or potentially harmful medical care due to a caregiver's overt actions including exaggeration of symptoms, lying about the history or simulating physical findings (fabrication), or intentionally inducing illness in their child .
By contrast, acts of omission (failure to provide basic needs for a child such as food, clothing, education, and medical care) are usually labeled as "neglect." Hence, medical neglect indicates a caretaker acting in a way that a child does not receive appropriate health care. (See "Child neglect and emotional maltreatment".)
All of the following terms have been used to describe MCA [2-7]:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- American Psychiatric Association. Factitious disorder imposed on self. In: Diagnostic and Statistical Manual of Mental Disorders, 5th ed, American Psychiatric Publishing, Arlington 2013.
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- Denny SJ, Grant CC, Pinnock R. Epidemiology of Munchausen syndrome by proxy in New Zealand. J Paediatr Child Health 2001; 37:240.
- Warner JO, Hathaway MJ. Allergic form of Meadow's syndrome (Munchausen by proxy). Arch Dis Child 1984; 59:151.
- Guandolo VL. Munchausen syndrome by proxy: an outpatient challenge. Pediatrics 1985; 75:526.
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- Doughty K, Rood C, Patel A, et al. Neurological Manifestations of Medical Child Abuse. Pediatr Neurol 2016; 54:22.
- Rees P, Al-Hussaini A, Maguire S. Child abuse and fabricated or induced illness in the ENT setting: a systematic review. Clin Otolaryngol 2016.
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- Rabbone I, Galderisi A, Tinti D, et al. Case Report: When an Induced Illness Looks Like a Rare Disease. Pediatrics 2015; 136:e1361.
- Kosmach B, Tarbell S, Reyes J, Todo S. "Munchausen by proxy" syndrome in a small bowel transplant recipient. Transplant Proc 1996; 28:2790.
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- Meadow R. Management of Munchausen syndrome by proxy. Arch Dis Child 1985; 60:385.
- Hall DE, Eubanks L, Meyyazhagan LS, et al. Evaluation of covert video surveillance in the diagnosis of munchausen syndrome by proxy: lessons from 41 cases. Pediatrics 2000; 105:1305.
- Byard RW, Burnell RH. Covert video surveillance in Munchausen syndrome by proxy. Ethical compromise or essential technique? Med J Aust 1994; 160:352.
- Spying on mothers. Lancet 1994; 343:1373.
- Foreman DM, Farsides C. Ethical use of covert videoing techniques in detecting Munchausen syndrome by proxy. BMJ 1993; 307:611.
- Morley C. Concerns about using and interpreting covert video surveillance. BMJ 1998; 316:1603.
- Southall DP, Plunkett MC, Banks MW, et al. Covert video recordings of life-threatening child abuse: lessons for child protection. Pediatrics 1997; 100:735.
- Brown AN, Gonzalez GR, Wiester RT, et al. Care taker blogs in caregiver fabricated illness in a child: a window on the caretaker's thinking? Child Abuse Negl 2014; 38:488.
- Bools CN, Neale BA, Meadow SR. Co-morbidity associated with fabricated illness (Munchausen syndrome by proxy). Arch Dis Child 1992; 67:77.
- Libow JA. Munchausen by proxy victims in adulthood: a first look. Child Abuse Negl 1995; 19:1131.
- Allison TS. Proving medical child abuse: the time is now for Ohio to focus on the victim and not the abuser. J Law and Health 2012; 25:191. http://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1059&context=jlh (Accessed on September 29, 2015).
- Berg B, Jones DP. Outcome of psychiatric intervention in factitious illness by proxy (Munchausen's syndrome by proxy). Arch Dis Child 1999; 81:465.
- CLINICAL MANIFESTATIONS
- Patient features
- Perpetrator features
- Perpetrator actions
- Spectrum of illness
- - Mild
- - Moderate
- - Severe
- DIAGNOSTIC EVALUATION
- Moderate to severe
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR CONSULTATION WITH A MULTIDISCIPLINARY CHILD ABUSE TEAM
- Moderate and severe
- - Stop the abuse
- - Involve child protection agencies
- - Repair iatrogenic harm
- - Provide family support
- - Legal intervention