Munchausen Syndrome by Proxy (MSBP) is a form of child abuse that occurs when a caregiver, usually the mother, fabricates or induces illness in a child. The caretaker repeatedly presents the child to a physician or hospital with a variety of symptoms including bleeding, vomiting, diarrhea, fever, lethargy, apnea, and seizures. The child victims are usually under the age of 3 years, but may be older; older children may become convinced by the caregiver that they have an illness or they may passively or actively participate with the caregiver in deceiving health professionals. The caregiver may falsely claim a child has experienced serious symptoms such as seizures, may contaminate test results to indicate illness, and/or may physically harm the child to produce symptoms.
Because the victim is a child, MSBP is considered a form of child abuse. The child victim may undergo repeated invasive and painful tests and examinations, be given unnecessary medications with negative side effects, or even be subjected to exploratory surgical procedures. Physicians dealing with young children rely heavily on the medical history provided by the caregiver, and in MSBP cases the caregiver misrepresents, exaggerates, or creates symptoms and incidences the child is not experiencing or has not naturally experienced. The caregiver may also have taken the child to several different physicians or hospitals that she does not include in her medical history for the child. The situation is further complicated by the fact that the caregiver is often intelligent, appears devoted to the child, may have had some medical training or experience, and is generally very cooperative with the medical personnel.
MSBP has been referred to by various names, including factitious illness by proxy, fictitious disorder by proxy, Meadow’s syndrome, and chronic nonaccidental poisoning. More recently, especially in the United Kingdom and Australia, it is being labeled fabricated or induced illness by caregivers (FIIC). This naming is due to some extent to the fact that MSBP has never been listed in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association as a clinical diagnosable disorder but Factitious Disorder by Proxy is listed in the current edition of the manual as a topic or classification for further study.
There continue to be significant differences of opinion on whether FIIC or MSBP exists, but there is considerable evidence that there are caregivers who do fabricate or induce illnesses in their children. There is video surveillance that has shown parents harming their children and then presenting the children as having unexplained medical conditions and who agree to unneeded medical procedures. In the literature, there are numerous documented cases in several countries where illnesses in children have been fabricated or induced by caregivers.
Incidence data on MSBP or FIIC is somewhat sketchy, but cases seem to be relatively rare. A rather thorough national survey in the United Kingdom in the mid-1990s (with every pediatrician in the United Kingdom being asked every month for 18 months if he or she had diagnosed a case) suggested that only about 50 new cases a year were diagnosed. An estimated 600 cases occurred in the United States in 1996, and in 2001, 18 cases per annum were reported in New Zealand. But however relatively rare FIIC may be, it has serious consequences for the child victims, including death, and makes it critical for practitioners to be able to identify the condition and take appropriate action to protect the child and obtain treatment for the perpetrator.
A major impediment to the diagnosis of MSBP or FIIC is the unwillingness or failure of professionals to consider the possibility that a parent could do something so detrimental to his or her child. However, once the diagnosis is suspected, it may require a multidisciplinary team that includes a child protective services worker, law enforcement officer, psychologist or psychiatrist, prosecutor, hospital social worker, and the child’s medical team to reach a firm diagnosis. The process requires a thorough review of present and past medical records, careful monitoring of the patient (with or without video surveillance) when any family member is present, and possibly separation of the child from the suspected parent. If the diagnosis is confirmed, the team undertakes the immediate steps necessary to ensure the child’s safety.
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