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International Journal of Legal Medicine

, Volume 119, Issue 2, pp 98–102 | Cite as

Suffocation and poisoning—the hard-hitting side of Munchausen syndrome by proxy

  • B. VennemannEmail author
  • T. Bajanowski
  • B. Karger
  • H. Pfeiffer
  • H. Köhler
  • B. Brinkmann
Case Report

Abstract

Munchausen syndrome by proxy (MSBP) is a severe and difficult to diagnose form of child abuse characterised by the simulation, aggravation or production of symptoms of illness in a child by an adult. MSBP often leads to multiple hospitalisations and has a high mortality and long-term morbidity. This study describes the cases of 5 families with 8 children affected who presented with unexplained neurological or gastrointestinal symptoms or even loss of consciousness. All were victims of poisoning or suffocation by their mothers. Two of those children died and were initially diagnosed as SIDS or natural death, respectively. They were only recognised as MSBP victims after another sibling had fallen ill with similar symptoms. The cases are discussed in consideration of the relevant literature. In addition warning signs of this forensically relevant syndrome and a strategy for the management of suspected MSBP cases are described.

Keywords

Munchausen syndrome by proxy Factitious illness Child abuse Poisoning Suffocation 

References

  1. 1.
    Ahrens B, Rochholz G, Sachs HW, Schütz H (1995) Nachweis von Clozapin in Haaren nach etwa einjähriger Liegezeit im Erdgrab. Arch Kriminol 196:138–142PubMedGoogle Scholar
  2. 2.
    Asher R (1951) Munchausen’s syndrome. Lancet:339–341Google Scholar
  3. 3.
    Bader AA, Kerzner B (1999) Ipecac toxicity in “Munchausen syndrome by proxy”. Ther Drug Monit 21:259–260PubMedGoogle Scholar
  4. 4.
    Bajanowksi T, Ortmann C, Teige K, Wedekind H, Zack F, Rose I, Brinkmann B (2003) Pathological changes of the heart in sudden infant death. Int J Legal Med 117:193–203CrossRefPubMedGoogle Scholar
  5. 5.
    Bartsch C, Risse M, Schütz H, Weigand N, Weiler G (2003) Munchausen syndrome by proxy (MSBP): an extreme form of child abuse with a special forensic challenge. Forensic Sci Int 137:147–151PubMedGoogle Scholar
  6. 6.
    Becroft DM, Lockett BK (1997) Intra-alveolar pulmonary siderophages in sudden infant death: a marker for previous imposed suffocation. Pathology 29:60–63PubMedGoogle Scholar
  7. 7.
    Bools CN (1996) Factitious illness by proxy. Br J Psychiatry 169:268–275PubMedGoogle Scholar
  8. 8.
    Bools CN, Neale BA; Meadow SR (1992) Co-morbidity associated with fabricated illness (Munchausen syndrome by proxy). Arch Dis Child 67:77–79PubMedGoogle Scholar
  9. 9.
    Bools CN, Neale BA, Meadow SR (1993) Follow up of victims of fabricated illness (Munchausen syndrome by proxy). Arch Dis Child 69:625–630PubMedGoogle Scholar
  10. 10.
    Bools CN, Neale BA, Meadow SR (1994) Munchausen syndrome by proxy: a study of psychopathology. Child Abuse Negl 18:773–788PubMedGoogle Scholar
  11. 11.
    Carlson J, Fernlund P, Ivarsson SA et al. (1994) Munchausen syndrome by proxy: an unexpected cause of severe chronic diarrhoea in a child. Acta Paediatr 83:119–121PubMedGoogle Scholar
  12. 12.
    D’Avanzo M, Santinelli R, Tolone C, Bettinelli A, Bianchetti MG (1995) Concealed administration of frusemide simulating Bartter syndrome in a 4.5-year-old boy. Pediatr Nephrol 9:749–750PubMedGoogle Scholar
  13. 13.
    Davis P, McClure RJ, Rolfe K, Chessman N, Pearson S, Sibert JR, Meadow R (1998) Procedures, placement, and risks of further abuse after Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Arch Dis Child 78:217–221PubMedGoogle Scholar
  14. 14.
    DiMaio VJ (1988) SIDS or murder? Pediatrics 81:747–748PubMedGoogle Scholar
  15. 15.
    Dorandeu A, Perie G, Jouan H, Leroy B, Gray F, Durigon M (1999) Histological demonstration of haemosiderin deposits in lungs and liver from victims of chronic physical child abuse. Int J Legal Med 112:280–286CrossRefPubMedGoogle Scholar
  16. 16.
    Emery JL, Chandra S, Gilbert-Barness EF (1988) Findings in child deaths registered as sudden infant death syndrome (SIDS) in Madison, Wisconsin. Pediatr Pathol 8:171–178PubMedGoogle Scholar
  17. 17.
    Epstein MA, Markowitz RL, Gallo DM, Holmes JW, Gryboski JD (1987) Munchausen syndrome by proxy: considerations in diagnosis and confirmation by video surveillance. Pediatrics 80:220–224PubMedGoogle Scholar
  18. 18.
    Kravitz RM, Wilmott RW (1990) Munchausen syndrome by proxy presenting as factitious apnoea. Clin Pediatr (Phila) 29:587–592Google Scholar
  19. 19.
    Krupinski M, Soyka M, Tutsch-Bauer E, Frank R (1995) Münchhausen-by-proxy-Syndrom: eine interdisziplinäre Herausforderung. Nervenheilkunde 14:348–356Google Scholar
  20. 20.
    Manikoth P, Subramanyan R, Menon S, Khusaiby SMA (1999) A child with cardiac arrhythmia and convulsions. Lancet 354:2046CrossRefPubMedGoogle Scholar
  21. 21.
    McClure RJ, Davis PM, Meadow SR, Sibert JR (1996) Epidemiology of Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Arch Dis Child 75:57–61PubMedGoogle Scholar
  22. 22.
    Meadow R (1977) Munchausen syndrome by proxy. The hinterland of child abuse. Lancet ii:343–345CrossRefGoogle Scholar
  23. 23.
    Meadow R (1982) Munchausen syndrome by proxy. Arch Dis Child 57:92–98PubMedGoogle Scholar
  24. 24.
    Meadow R (1990) Suffocation, recurrent apnea, and sudden infant death. J Pediatr 117:351–357PubMedGoogle Scholar
  25. 25.
    Meadow R (1995) What is, and what is not, Munchausen syndrome by proxy? Arch Dis Child 72:534–538PubMedGoogle Scholar
  26. 26.
    Meadow R (1998) Munchausen syndrome by proxy abuse perpetrated by men. Arch Dis Child 78:210–216PubMedGoogle Scholar
  27. 27.
    Milroy CM (1999) Munchausen syndrome by proxy and intra-alveolar haemosiderin. Int J Legal Med 112:309–312CrossRefPubMedGoogle Scholar
  28. 28.
    Mitchell I, Brummitt J, DeForest J, Fisher G (1993) Apnea and factitious illness (Munchausen syndrome) by proxy. Pediatrics 92:810–814PubMedGoogle Scholar
  29. 29.
    Nishida N, Ikeda N, Kudo K, Tsuji A, Kiyoshima A (2002) Forensic significance of conduction system abnormalities as a precise cause of accidental death. Int J Legal Med 116:344–349PubMedGoogle Scholar
  30. 30.
    Rosenberg DA (1987) Web of deceit: a literature review of Munchausen syndrome by proxy. Child Abuse Negl 11:547–563CrossRefPubMedGoogle Scholar
  31. 31.
    Samuels MP, Southall DP (1992) Munchausen syndrome by proxy. Br J Hosp Med 47:759–762PubMedGoogle Scholar
  32. 32.
    Schneider DJ, Perez A, Knilans TE, Daniels SR, Bove KE, Bonnell H (1996) Clinical and pathological aspects of cardiomyopathy from ipecac administration in Munchausen’s syndrome by proxy. Pediatrics 97:902–906PubMedGoogle Scholar
  33. 33.
    Southall DP, Samuels MP (1993) Ethical use of covert videoing for potentially life threatening child abuse. BMJ 307:613–614PubMedGoogle Scholar
  34. 34.
    Sutphen JL, Saulsbury FT(1988) Intentional ipecac poisoning: Munchausen syndrome by proxy. Pediatrics 82:453–456PubMedGoogle Scholar
  35. 35.
    Valentine JL, Schexnayder S, Jones JG, Sturner WQ (1997) Clinical and toxicological findings in two young siblings and autopsy findings in one sibling with multiple hospital admissions resulting in death. Am J Forensic Med Pathol 18:276–281CrossRefPubMedGoogle Scholar
  36. 36.
    White ST (1985) Surreptitious warfarin ingestion. Child Abuse Negl 9:349–352CrossRefPubMedGoogle Scholar
  37. 37.
    Wood PR, Fowlkes J, Holden P, Casto D (1989) Fever of unknown origin for six years: Munchausen syndrome by proxy. J Fam Pract 4:391–395Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • B. Vennemann
    • 1
    Email author
  • T. Bajanowski
    • 3
  • B. Karger
    • 2
  • H. Pfeiffer
    • 2
  • H. Köhler
    • 2
  • B. Brinkmann
    • 2
  1. 1.Institut für RechtsmedizinUniversitätsklinikum FreiburgFreiburgGermany
  2. 2.Institut für RechtsmedizinUniversitätsklinikum MünsterMünsterGermany
  3. 3.Institut für RechtsmedizinUniversitätsklinikum Essen EssenGermany

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