Medical child abuse (Munchausen syndrome by proxy)
- Erin E Endom, MD
Erin E Endom, MD
- Assistant Professor of Pediatrics
- Baylor College 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
The epidemiology, clinical features, evaluation, and management of falsely reported or induced illness in a child (Munchausen by proxy) with a focus on recognition and care of the affected child will be reviewed here.
Factitious disorder (Munchausen syndrome) and other forms of physical child abuse and neglect are discussed separately. (See "Factitious disorder and Munchausen syndrome" and "Child neglect and emotional abuse" and "Physical abuse in children: Epidemiology and clinical manifestations" and "Physical abuse in children: Diagnostic evaluation and management" and "Child abuse: Evaluation and diagnosis of abusive head trauma in infants and children".)
The terminology used to describe this condition is confusing and somewhat controversial. We prefer medical child abuse because it focuses on the abused child.
In caring for children in whom fabrication or induction of symptoms by a caregiver is suspected, preoccupation with terminology should not get in the way of accurately describing what happened to the child (eg, induced apnea, factitious epilepsy, parental exaggeration of asthma symptoms) [1-4]. The evaluation should focus on whether the child has been abused, the manner in which the child was abused, and whether the child or his or her siblings are at risk for harm in the future [2,5]. (See 'Diagnostic evaluation' below.)
All of the following terms have been used to describe falsely reported or induced illness in a child (Munchausen syndrome by proxy) [5-8]:
- Meadow R. What is, and what is not, 'Munchausen syndrome by proxy'? Arch Dis Child 1995; 72:534.
- Meadow R. Different interpretations of Munchausen Syndrome by Proxy. Child Abuse Negl 2002; 26:501.
- Fisher GC, Mitchell I. Is Munchausen syndrome by proxy really a syndrome? Arch Dis Child 1995; 72:530.
- Morley CJ. Practical concerns about the diagnosis of Munchausen syndrome by proxy. Arch Dis Child 1995; 72:528.
- Flaherty EG, Macmillan HL, Committee On Child Abuse And Neglect. Caregiver-fabricated illness in a child: a manifestation of child maltreatment. Pediatrics 2013; 132:590.
- Meadow R, Lennert T. Munchausen by proxy or Polle syndrome: which term is correct? Pediatrics 1984; 74:554.
- Meadow R. Munchausen syndrome by proxy. The hinterland of child abuse. Lancet 1977; 2:343.
- Bass C, Glaser D. Early recognition and management of fabricated or induced illness in children. Lancet 2014; 383:1412.
- Factitious disorder by proxy. In: Diagnostic and Statistical Manual of Mental Disorders, 5th ed, American Psychiatric Association, 2013.
- Rosenberg DA. Web of deceit: a literature review of Munchausen syndrome by proxy. Child Abuse Negl 1987; 11:547.
- Ayoub CC, Alexander R, Beck D, et al. Position paper: definitional issues in Munchausen by proxy. Child Maltreat 2002; 7:105.
- McClure RJ, Davis PM, Meadow SR, Sibert JR. Epidemiology of Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Arch Dis Child 1996; 75:57.
- Denny SJ, Grant CC, Pinnock R. Epidemiology of Munchausen syndrome by proxy in New Zealand. J Paediatr Child Health 2001; 37:240.
- Bools C, Neale B, Meadow R. Munchausen syndrome by proxy: a study of psychopathology. Child Abuse Negl 1994; 18:773.
- Stirling J Jr, American Academy of Pediatrics Committee on Child Abuse and Neglect. Beyond Munchausen syndrome by proxy: identification and treatment of child abuse in a medical setting. Pediatrics 2007; 119:1026.
- Schreier H. Munchausen by proxy defined. Pediatrics 2002; 110:985.
- Lasher LJ. MBP overview and definitions. www.mbpexpert.com/definition.html (Accessed on November 27, 2012).
- Meadow R. Management of Munchausen syndrome by proxy. Arch Dis Child 1985; 60:385.
- Schreier HA, Libow JA. Munchausen by proxy syndrome: a modern pediatric challenge. J Pediatr 1994; 125:S110.
- Meadow R. Munchausen syndrome by proxy. Arch Dis Child 1982; 57:92.
- Sheridan MS. The deceit continues: an updated literature review of Munchausen Syndrome by Proxy. Child Abuse Negl 2003; 27:431.
- Souid AK, Keith DV, Cunningham AS. Munchausen syndrome by proxy. Clin Pediatr (Phila) 1998; 37:497.
- Bools CN, Neale BA, Meadow SR. Co-morbidity associated with fabricated illness (Munchausen syndrome by proxy). Arch Dis Child 1992; 67:77.
- Mullins ME, Cristofani CB, Warden CR, Cleary JF. Amitriptyline-associated seizures in a toddler with Munchausen-by-proxy. Pediatr Emerg Care 1999; 15:202.
- Schreier H. On the importance of motivation in Munchausen by Proxy: the case of Kathy Bush. Child Abuse Negl 2002; 26:537.
- 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.
- Meadow R. Non-accidental salt poisoning. Arch Dis Child 1993; 68:448.
- Coulthard MG, Haycock GB. Distinguishing between salt poisoning and hypernatraemic dehydration in children. BMJ 2003; 326:157.
- Kohl S, Pickering LK, Dupree E. Child abuse presenting as immunodeficiency disease. J Pediatr 1978; 93:466.
- Schreier HA. Factitious disorder by proxy in which the presenting problem is behavioral or psychiatric. J Am Acad Child Adolesc Psychiatry 2000; 39:668.
- Moszkowicz M, Bjørnholm KI. Factitious illness by proxy presenting as anorexia and polydipsia by proxy. Acta Paediatr 1998; 87:601.
- Brown P, Tierney C. Munchausen syndrome by proxy. Pediatr Rev 2009; 30:414.
- Oster JR, Materson BJ, Rogers AI. Laxative abuse syndrome. Am J Gastroenterol 1980; 74:451.
- 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.
- Woollcott P Jr, Aceto T Jr, Rutt C, et al. Doctor shopping with the child as proxy patient: a variant of child abuse. J Pediatr 1982; 101:297.
- Waller D, Eisenberg L. School refusal i nchildhood: a psychiatric-pedatric perspective. In: Out of School, Hersov L, Berg I. (Eds), Wiley, Chinchester 1980. p.209.
- Wessely S, Wardle CJ. Mass sociogenic illness by proxy: parentally reported epidemic in an elementary school. Br J Psychiatry 1990; 157:421.
- Warner JO, Hathaway MJ. Allergic form of Meadow's syndrome (Munchausen by proxy). Arch Dis Child 1984; 59:151.
- Meadow R. Mothering to death. Arch Dis Child 1999; 80:359.
- Rahman F, Young D, Whyte J. Mothering to death. Arch Dis Child 1999; 81:372.
- Eminson DM, Postlethwaite RJ. Factitious illness: recognition and management. Arch Dis Child 1992; 67:1510.
- Libow JA, Schreier HA. Three forms of factitious illness in children: when is it Munchausen syndrome by proxy? Am J Orthopsychiatry 1986; 56:602.
- Masterson J, Dunworth R, Williams N. Extreme illness exaggeration in pediatric patients: a variant of Munchausen's by Proxy? Am J Orthopsychiatry 1988; 58:188.
- Berg B, Jones DP. Outcome of psychiatric intervention in factitious illness by proxy (Munchausen's syndrome by proxy). Arch Dis Child 1999; 81:465.
- Davis P, McClure RJ, Rolfe K, et al. Procedures, placement, and risks of further abuse after Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Arch Dis Child 1998; 78:217.
- McGuire TL, Feldman KW. Psychologic morbidity of children subjected to Munchausen syndrome by proxy. Pediatrics 1989; 83:289.
- Bools CN, Neale BA, Meadow SR. Follow up of victims of fabricated illness (Munchausen syndrome by proxy). Arch Dis Child 1993; 69:625.
- Meadow R. ABC of child abuse. Munchausen syndrome by proxy. BMJ 1989; 299:248.