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Medical Child Abuse Hidden in Pediatric Settings: Detection and Intervention

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Abstract

Medical child abuse, sometimes referred to as Munchausen Syndrome by Proxy or childhood factitious disorder, poses significant diagnostic, intervention, and ethical issues for medical and mental health practitioners alike. Psychologists working in pediatric hospitals and medical clinics should remain mindful of the health and ethical risks posed by these conditions, which are challenging to detect and treat. The surreptitious nature of the conditions and hazards they pose require an integrated medical, psychological, and child protective response. This article provides historical and clinical background on the condition along with tabular guides and recommendations to assist in detection and intervention.

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References

  • Adwallah, N., Vaughn, A., Franco, K., Munir, F., Sharaby, N., & Goldfarb, J. (2005). Munchausen by Proxy: A case, chart series, and literature review of older victims. Child Abuse and Neglect, 29, 931–941. https://doi.org/10.1016/jchiabu.2004.11.007.

    Article  Google Scholar 

  • Alexander, R. C. (2000). Medical treatment of Munchausen Syndrome by Proxy. In R. Reese (Ed.), Treatment of child abuse: Common ground for mental health, medical and legal practitioners (pp. 236–241). Baltimore, MD: Johns Hopkins University Press.

    Google Scholar 

  • Alexander, R., Smith, W., & Stevenson, R. (1990). Serial Munchausen by proxy. Pediatrics, 86, 581–585.

    CAS  PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

    Book  Google Scholar 

  • APSAC Taskforce. (2018). Munchausen by Proxy: Clinical and case management guidance. APSAC Advisor, 30, 8–31.

    Google Scholar 

  • Ayoub, C. C., Deutsch, R. M., & Kinscherff, R. (2000). Psychosocial management issues in Munchausen by Proxy. In R. Reese (Ed.), Treatment of child abuse: Common ground for mental health, medical and legal practitioners (pp. 226–235). Baltimore, MD: Johns Hopkins University Press.

    Google Scholar 

  • Bass, C., & Glaser, D. (2014). Early recognition and management of fabricated or induced illness in children. The Lancet, 383, 1412–1421. https://doi.org/10.1016/S0140-6736(13)6218-2.

    Article  Google Scholar 

  • Bass, C., & Jones, D. (2011). Psychopathology of perpetrators of fabricated or induced illness in children: Case series. British Journal of Psychiatry, 199, 113–118. https://doi.org/10.1192/bjp.bp.109.074088.

    Article  Google Scholar 

  • Bools, C. N., Neale, B. A., & Meadow, S. R. (1993). Follow up of victims of fabricated illness (Munchausen Syndrome by Proxy). Archives of Disease in Childhood, 69, 625–630.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Brown, A. N., Gonzalez, G. R., Wiester, R. T., Kelley, M. C., & Feldman, K. W. (2014). Caretaker blogs in caregiver fabricated illness in a child: A window on the caretaker’s thinking. Child Abuse and Neglect, 38, 488–497. https://doi.org/10.1016/j.chiabo.2013.12.002.

    Article  PubMed  Google Scholar 

  • Bursch, B. (2018). Child protective services management of cases of suspected child abuse/neglect due to factitious disorder imposed on another. APSAC Advisor, 30, 76–82.

    Google Scholar 

  • Cardona, L., & Asnes, A. G. (2019). Disclosure of caregiver-fabricated illness to a child: A team-based approach to communicating with pediatric patients. Clinical Child Psychology and Psychiatry. https://doi.org/10.1177/13591045188116122.

    Article  PubMed  Google Scholar 

  • Craft, A. W., & Hall, D. M. B. (2004). Munchausen Syndrome by Proxy and sudden infant death. British Medical Journal, 328, 1309.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Davis, P., Murtagh, U., & Glaser, D. (2019). 40 years of fabricated or induced illness (FII): Where next for paediatricians? Paper 1: Epidemiology and definition of FII. Archives of Diseases in Childhood, 104, 110–114. https://doi.org/10.1136/archdischild-2017-314319.

    Article  Google Scholar 

  • Doughty, K., Rood, C., Patel, A., Thackery, J. D., & Brink, F. W. (2016). Neurological manifestations of medical child abuse. Pediatric Neurology, 54, 22–28. https://doi.org/10.1016/j.pediatneurol.2015.09.010.

    Article  PubMed  Google Scholar 

  • Esernio-Jenssen, D., Alexander, R., Feldman, K., & Yorker, B. (2018). The influence of electronic and internet advances on Munchausen by Proxy. APSAC Advisor, 30, 83–91.

    Google Scholar 

  • Feldman, M. D. (2000). Munchausen by Internet: Detecting factitious illness and crisis on the Internet. Southern Medical Journal, 93, 669–672.

    Article  CAS  PubMed  Google Scholar 

  • Ferrara, P., Vitellli, O., Gatt, A., Liberatore, P., Binetti, P., & Stabile, A. (2013). Factitious disorders and Munchausen Syndrome: The tip of the iceberg. Journal of Child Health Care, 17, 366–374.

    Article  PubMed  Google Scholar 

  • Flaherty, E. G., MacMillan, H. L., & The Committee on Child Abuse and Neglect. (2013). Caregiver-fabricated illness in a child: A manifestation of child maltreatment. Pediatrics, 132, 590–597. https://doi.org/10.1542/peds.2013-2045.

    Article  PubMed  Google Scholar 

  • Flannery, M. T. (1998). First do no harm: The use of covert video surveillance to detect Munchausen Syndrome by Proxy: An unethical means of “preventing” child abuse. University of Michigan Journal of Law Reform, 32, 105–194.

    CAS  PubMed  Google Scholar 

  • Galvin, H. K., Newton, A. W., & Vandeven, A. M. (2005). Update on Munchausen Syndrome by Proxy. Current Opinions in Pediatrics, 17, 252–257.

    Article  Google Scholar 

  • Hymel, K. P., National Association of Medial Examiners, & The Committee of Child Abuse & Neglect. (2006). distinguishing sudden infant death syndrome from child abuse fatalities. Pediatrics, 118, 421–427.

    Article  PubMed  Google Scholar 

  • Katz, A. L., Webb, S. A., & Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice. Pediatrics, 138, e20161485.

    Article  PubMed  Google Scholar 

  • Kelly, M., & Wang, C. (2018). Diagnostic aid to identify simulation and/or induction: Abuse by pediatric condition falsification/caregiver illness in a child/medical child abuse. APSAC Advisor, 30, 32–52.

    Google Scholar 

  • Kinscherff, R., & Ayoub, C. C. (2000). Legal aspects of Munchausen by Proxy. In R. Reese (Ed.), Treatment of child abuse: Common ground for mental health, medical and legal practitioners (pp. 242–267). Baltimore, MD: Johns Hopkins University Press.

    Google Scholar 

  • Kinscherff, R., & Famularo, R. (1991). Extreme Munchausen by Proxy: The case for termination of parental rights. Juvenile Family Court, 42, 41–53.

    Article  Google Scholar 

  • Koocher, G. P., & Keith-Spiegel, P. C. (2016). Ethics in psychology and the mental health professions: Standards and cases (4th ed.). New York: Oxford University Press.

    Google Scholar 

  • Libow, J. A. (1994, August). Munchausen by Proxy victims in later life: Preliminary findings. Paper presented at 102nd Annual Convention of the American Psychological Association, Los Angeles, CA.

  • Libow, J. A. (1995). Munchausen by Proxy victims in adulthood: A first look. Child Abuse and Neglect, 19, 1131–1142. https://doi.org/10.1016/0145-2134(95)00073-H.

    Article  CAS  PubMed  Google Scholar 

  • Libow, J. A. (2002). Beyond collusion: Active illness falsification. Child Abuse and Neglect, 26, 525–536.

    Article  PubMed  Google Scholar 

  • Makar, A. F., & Squier, P. J. (1990). Munchausen Syndrome by Proxy. Pediatrics, 85, 370–373.

    CAS  PubMed  Google Scholar 

  • McClure, R. J., Davis, P. M., Meadow, S. R., & Silbert, J. R. (1996). Epidemiology of Munchausen Syndrome by Proxy, non-accidental poisoning, and non-accidental suffocation. Archives of Disease in Childhood, 75, 57–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • McGuire, T. L., & Feldman, K. W. (1989). Psychologic morbidity of children subjected to Munchausen Syndrome by Proxy. Pediatrics, 83, 289–292.

    CAS  PubMed  Google Scholar 

  • Meadow, R. (1977). Munchausen Syndrome by Proxy: The hinterland of child abuse. Lancet, 2, 2343–2345.

    Google Scholar 

  • Meadow, R. (1982). Munchausen Syndrome by Proxy. Archives of Disease in Childhood, 57, 92–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Pankratz, L. (2006). Persistent problems with the Munchausen Syndrome by Proxy label. Journal of the American Academy of Psychiatry and the Law, 34, 90–95.

    PubMed  Google Scholar 

  • Petska, H. W., Gordon, J. B., Jablonski, D., & Sheets, L. K. (2017). The intersection of medical child abuse and medical complexity. Pediatric Clinics of North America, 64, 253–264. https://doi.org/10.1016/jpd2016.08.06.

    Article  PubMed  Google Scholar 

  • Pulman, A., & Taylor, J. (2012). Munchausen by Internet: Current research and future directions. Journal of Medical Internet Research, 14, e115. https://doi.org/10.2196/jmir.2011.

    Article  PubMed  PubMed Central  Google Scholar 

  • Roesler, T. A., & Jenny, C. (2009). Medical child abuse: Beyond Munchausen Syndrome by Proxy. Elk Grove Village, IL: American Academy of Pediatrics.

    Google Scholar 

  • Rosenberg, D. A. (1987). Web of deceit: A literature review of Munchausen Syndrome by Proxy. Child Abuse and Neglect, 11, 547–563.

    Article  CAS  PubMed  Google Scholar 

  • Rosenberg, D. A. (2003). Munchausen Syndrome by Proxy. Child Abuse and Neglect, 27, 421–430. https://doi.org/10.1016/S1045-2134(03)00029-2.

    Article  PubMed  Google Scholar 

  • Sanders, M. J. (1995). Symptom coaching: Factitious Disorder by Proxy with older children. Clinical Psychology Review, 15, 423–442.

    Article  Google Scholar 

  • Sanders, M. J., & Bursch, B. (2002). Forensic assessment of illness falsification, Munchausen by Proxy, and factitious disorder, NOS. Child Maltreatment, 7, 112–124.

    Article  PubMed  Google Scholar 

  • Sanders, M. J., & Bursch, B. (2019). Psychological treatment of factitious disorder imposed on another/Munchausen by Proxy abuse. Journal of Clinical Psychology in Medical Settings. https://doi.org/10.1007/s10880-019-09630-6.

    Article  Google Scholar 

  • Schreier, H. (2002). Munchausen by Proxy defined. Pediatrics, 110, 985–988.

    Article  PubMed  Google Scholar 

  • Schreier, H. (2004). Munchausen by Proxy. Current Problems in Pediatric Adolescent Health Care, 34, 126–143.

    Article  PubMed  Google Scholar 

  • Schreier, H. A., & Bursch, B. (2018). Munchausen by Proxy in educational and mental health Settings. APSAC Advisor, 30, 61–65.

    Google Scholar 

  • Shaw, R. J., Dayal, S., Hartman, J. K., & DeMaso, D. R. (2008). Factitious disorder by proxy: Pediatric condition falsification. Harvard Review of Psychiatry, 16, 215–224.

    Article  PubMed  Google Scholar 

  • Sheridan, M. S. (2003). The deceit continues: An updated literature review of Munchausen by Proxy. Child Abuse and Neglect, 27, 431–451. https://doi.org/10.1016/S0145-2134(03)00030-9.

    Article  PubMed  Google Scholar 

  • Squires, J. E., & Squires, R. H. (2013). A review of Munchausen Syndrome by Proxy. Pediatric Annals, 42, 67–71. https://doi.org/10.3928/00904481-20130326-09.

    Article  PubMed  Google Scholar 

  • Stirling, J., & The Committee on Child Abuse and Neglect. (2007). Beyond Munchausen Syndrome by Proxy: Identification and treatment of child abuse in a medical setting. Pediatrics, 119, 1026–1030. https://doi.org/10.1542/peds.2007-0563.

    Article  PubMed  Google Scholar 

  • Sullivan, C. A., Francis, G. L., Bain, M. W., & Hartz, J. (1991). Munchausen Syndrome by Proxy. Clinical Pediatrics, 30, 112–116.

    Article  CAS  PubMed  Google Scholar 

  • Truman, T. L., & Ayoub, C. C. (2002). Considering suffocatory abuse and Munchausen Syndrome by Proxy in the evaluation of children experiencing apparent life-threatening events and sudden infant death syndrome. Child Maltreatment, 7, 138–148.

    Article  PubMed  Google Scholar 

  • Weber, M. C. (2018). Investigation of medical child abuse/factitious disorder imposed on another. APSAC Advisor, 30, 53–60.

    Google Scholar 

  • Yates, G., & Bass, C. (2017). The perpetrators of medical child abuse (Munchausen Syndrome By Proxy): A systematic review of 796 cases. Child Abuse and Neglect, 72, 45–53. https://doi.org/10.1016/j.chiabu.2017.07.008.

    Article  PubMed  Google Scholar 

  • Yin, S. (2010). Malicious use of pharmaceuticals in children. Journal of Pediatrics, 157, 832–836. https://doi.org/10.1016/j.jpeds.2010.05.040.

    Article  PubMed  Google Scholar 

  • Yorker, B. C. (1995). Covert video surveillance of Munchausen Syndrome by Proxy: Exigent circumstances exception. Health Matrix: Journal of Law and Medicine, 5, 325–346.

    CAS  Google Scholar 

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Authors and Affiliations

  1. Independent Practice, Honolulu, HI, USA

    Jeanne S. Hoffman

  2. Quincy College, Quincy, MA, USA

    Gerald P. Koocher

  3. Chestnut Hill, USA

    Gerald P. Koocher

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  1. Jeanne S. Hoffman
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  2. Gerald P. Koocher
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Correspondence to Gerald P. Koocher.

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Jeanne S. Hoffman and Gerald P. Koocher declare that they have no conflict of interest.

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Hoffman, J.S., Koocher, G.P. Medical Child Abuse Hidden in Pediatric Settings: Detection and Intervention. J Clin Psychol Med Settings 27, 753–765 (2020). https://doi.org/10.1007/s10880-019-09666-8

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