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.
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Ahrens B, Rochholz G, Sachs HW, Schütz H (1995) Nachweis von Clozapin in Haaren nach etwa einjähriger Liegezeit im Erdgrab. Arch Kriminol 196:138–142
Asher R (1951) Munchausen’s syndrome. Lancet:339–341
Bader AA, Kerzner B (1999) Ipecac toxicity in “Munchausen syndrome by proxy”. Ther Drug Monit 21:259–260
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 117:193–203
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 137:147–151
Becroft DM, Lockett BK (1997) Intra-alveolar pulmonary siderophages in sudden infant death: a marker for previous imposed suffocation. Pathology 29:60–63
Bools CN (1996) Factitious illness by proxy. Br J Psychiatry 169:268–275
Bools CN, Neale BA; Meadow SR (1992) Co-morbidity associated with fabricated illness (Munchausen syndrome by proxy). Arch Dis Child 67:77–79
Bools CN, Neale BA, Meadow SR (1993) Follow up of victims of fabricated illness (Munchausen syndrome by proxy). Arch Dis Child 69:625–630
Bools CN, Neale BA, Meadow SR (1994) Munchausen syndrome by proxy: a study of psychopathology. Child Abuse Negl 18:773–788
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 83:119–121
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 9:749–750
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 78:217–221
DiMaio VJ (1988) SIDS or murder? Pediatrics 81:747–748
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 112:280–286
Emery JL, Chandra S, Gilbert-Barness EF (1988) Findings in child deaths registered as sudden infant death syndrome (SIDS) in Madison, Wisconsin. Pediatr Pathol 8:171–178
Epstein MA, Markowitz RL, Gallo DM, Holmes JW, Gryboski JD (1987) Munchausen syndrome by proxy: considerations in diagnosis and confirmation by video surveillance. Pediatrics 80:220–224
Kravitz RM, Wilmott RW (1990) Munchausen syndrome by proxy presenting as factitious apnoea. Clin Pediatr (Phila) 29:587–592
Krupinski M, Soyka M, Tutsch-Bauer E, Frank R (1995) Münchhausen-by-proxy-Syndrom: eine interdisziplinäre Herausforderung. Nervenheilkunde 14:348–356
Manikoth P, Subramanyan R, Menon S, Khusaiby SMA (1999) A child with cardiac arrhythmia and convulsions. Lancet 354:2046
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 75:57–61
Meadow R (1977) Munchausen syndrome by proxy. The hinterland of child abuse. Lancet ii:343–345
Meadow R (1982) Munchausen syndrome by proxy. Arch Dis Child 57:92–98
Meadow R (1990) Suffocation, recurrent apnea, and sudden infant death. J Pediatr 117:351–357
Meadow R (1995) What is, and what is not, Munchausen syndrome by proxy? Arch Dis Child 72:534–538
Meadow R (1998) Munchausen syndrome by proxy abuse perpetrated by men. Arch Dis Child 78:210–216
Milroy CM (1999) Munchausen syndrome by proxy and intra-alveolar haemosiderin. Int J Legal Med 112:309–312
Mitchell I, Brummitt J, DeForest J, Fisher G (1993) Apnea and factitious illness (Munchausen syndrome) by proxy. Pediatrics 92:810–814
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 116:344–349
Rosenberg DA (1987) Web of deceit: a literature review of Munchausen syndrome by proxy. Child Abuse Negl 11:547–563
Samuels MP, Southall DP (1992) Munchausen syndrome by proxy. Br J Hosp Med 47:759–762
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 97:902–906
Southall DP, Samuels MP (1993) Ethical use of covert videoing for potentially life threatening child abuse. BMJ 307:613–614
Sutphen JL, Saulsbury FT(1988) Intentional ipecac poisoning: Munchausen syndrome by proxy. Pediatrics 82:453–456
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 18:276–281
White ST (1985) Surreptitious warfarin ingestion. Child Abuse Negl 9:349–352
Wood PR, Fowlkes J, Holden P, Casto D (1989) Fever of unknown origin for six years: Munchausen syndrome by proxy. J Fam Pract 4:391–395
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The investigations reported in this manuscript were carried out in Münster.
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Vennemann, B., Bajanowski, T., Karger, B. et al. Suffocation and poisoning—the hard-hitting side of Munchausen syndrome by proxy. Int J Legal Med 119, 98–102 (2005). https://doi.org/10.1007/s00414-004-0496-6
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DOI: https://doi.org/10.1007/s00414-004-0496-6