Abstract
Purpose of review
The realization that caretakers could harm children by getting unnecessary and harmful or potentially harmful medical care began 40 years ago with the first paper on what Meadow called Munchausen by proxy. This article reviews the evolving understanding of this form of child abuse and discusses ongoing controversies including as follows: what to call it, whether it is rare or common, who gets the diagnosis, is there a profile of a perpetrator, is the motivation of the perpetrator important, and how treatable is the condition.
Recent findings
Several recent policy guidelines are available detailing current recommendations for evaluation and treatment. Pediatricians tend to conceptualize this phenomenon in child abuse terms and refer to it as medical child abuse (MCA). Mental health professionals continue to use the deceptive behavior of the perpetrator as the organizing principle.
Summary
Medical and mental health professionals are working together to develop treatment strategies. Clarity regarding the ongoing controversies suggests avenues for future research.
Similar content being viewed by others
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance
Roesler TA, Jenny C. Medical child abuse: beyond Munchausen syndrome by proxy. 1st ed. Elk Grove Village: American Academy of Pediatrics; 2009.
Meadow R. Munchausen syndrome by proxy: the hinterland of child abuse. Lancet. 1977;2:343–57.
Rosenberg DA. Web of deceit: a literature review of Munchausen syndrome by proxy. Child Abuse Negl. 1987;11:547–63.
Feldman KW, Hickmn RO. The central venous catheter as a source of medical chaos in Munchausen syndrome by proxy. J Pediatr Surg. 1998;33(4):634–27.
Rosen CL, Frost JD Jr, Glaze DG. Child abuse and recurrent infant apnea. J Pediatr. 1986;109(6):1065–7.
Meadow R. Suffocation, recurrent apnea, and sudden infant death. J Pediatr. 1990;117(3):351–7.
Doughty K, Rood C, Patel A, Thackery JD, Brink FW. Neurological manifestations of medical child abuse. Pediatr Neurol. 2016;54:22–8.
Ali-Panzarella AZ, Bryant TJ, Marcovitch H, Lewis JD. Medical child abuse (Munchausen syndrome by proxy): multidisciplinary approach from a pediatric gastroenterology perspective. Cur Gastroenterol Rep. 2017;19:14.
Alicandrei-Ciufelli M, Moretti V, Ruberto M, Monzani D, Ll C, Presutti L. Otolaryngology fantastica: the ear, nose and throat manifestations of Munchausen’s syndrome. Laryngoscope. 2012;122:51–7.
Foto-Özdemir D, Songül Yalçın S, Zeki A, Yurdakök K, Özusta S, Köse A, et al. Munchausen syndrome by proxy presented as respiratory arrest and thigh abscess: a case study and overview. Turk J Pediatr. 2013;55:37–343.
Al-Haidar FA. Munchausen syndrome by proxy and child’s rights. Saudi Med J. 2008;29(3):452–4.
Fujiwara T, Okuyama M, Kasahara M, Nakamura A. Differences of Munchausen syndrome by proxy according to predominant symptoms in Japan. Pediatr Int. 2008;50:537–40.
MClure RJ, Davis PM, Meadow SR, Silbert JR. Epidemiology of Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Arch Dis Child. 1996;75(1):57–61.
• Ferrara P, Vitelli O, Bottaro G, Gatto A, Liberatore P, Binetti P, et al. Factitious disorders and Munchausen syndrome: the tip of the iceberg. J Child Health Care. 2012;17(4):366–74. The authors reviewed every admission to a pediatric service to identify all types of factitious disorders. As such, it represents an attempt at a population-based inquiry the population being all hospital admissions.
• Alexander R, Ayoub C, Bursch B, Feldman K, Feldman MD, Glaser D, et al. Munchausen by proxy: clinical and case management guidance. APSAC Advisor. 2018;30(1):8–31. The American Professional Society on the Abuse of Children (APSAC) just published this consensus, i.e., across disciplines, set of guidelines. Consistent with its mission, it focuses on social service, psychological, and legal considerations.
• Flaherty EG, MacMillan HL. Caregiver-fabricated illness in a child: a manifestation of child maltreatment. Pediatrics. 2013;132(3):590–7. The American Academy of Pediatrics’ most recent statement about MCA.
• Bass C, Glaser D. Early recognition and management of fabricated or induced illness in children. Lancet. 2014;383:1412–21. Thoughtful recent review from the British perspective.
Squires JE, Squires RH Jr. Munchausen syndrome by proxy: ongoing clinical challenges. J Pediatr Gastroenterol Nutr. 2010;51(3):248–53.
Shaw RJ, Dayal S, Hartman JK, DeMaso DR. Factitious disorder by proxy: pediatric condition falsification. Harv Rev Psychiatry. 2008;16(4):215–24.
Roesler T, Jenny C. Medical child abuse (Munchausen by proxy). In: UpToDate, Post TW (ed), UpToDate, Waltham, MA. (Accessed on April 11th, 2018).
Bass C, Jones D. Psychopathology of perpetrators of fabricated or induced illness in children: case series. Br J Psychiatry. 2011;199(2):113–8.
• Yates G, Bass C. The perpetrators of medical child abuse (Munchausen Syndrome by Proxy)—a systematic review of 796 cases. Child Abuse Negl. 2017;72:45–53. This is the most comprehensive look at the characteristic of perpetrators of MCA.
American Psychiatric Association. Factitious disorder imposed on self. In: Diagnostic and statistical manual of mental disorders, 5th ed. American Psychiatric Publishing, Arlington; 2013.
Moreno-Arino M, Bayer A. Munchausen syndrome by proxy—illness fabricated by another in older people. Age Ageing. 2017;46:166–7.
McCulloch V, Feldman M. Munchausen by proxy by internet. Child Abuse Negl. 2011;35:965–6.
• Petska HW, Gordon JB, Jablonski D, Sheets LK. The intersection of medical child abuse and medical complexity. Pediatr Clin N Am. 2017;64:253–64. This is a sophisticated discussion of the difficulty distinguishing between medically complex truly ill children and equally complex non-ill children (i.e., MCA).
Greiner MV, Palusci VJ, Keeshin BR, Kearn SC, Sinal SH. A preliminary screening instrument for early detection of medical child abuse. Hosp Pediatr. 2013;3:39–44.
• Mash C, Frazier T, Nowacki A, Worley S, Goldfarb J. Development of a risk-stratification tool for medical child abuse in failure to thrive. Pediatrics. 2011;128(6):e1467–73. The research methodology represents a model for further studies. The authors describe three paths with varying specificity to distinguish between FTT and MCA.
Pickel S, Anderson C, Holliday MA. Thirsting and hyponatremic dehydration—a form of child abuse. Pediatrics. 1970;45(1):54–9.
Sanders MHJ. Hospital protocol for the evaluation OF Munchausen by Proxy. Clin Child Psychol and Psychiat. 1999;4(3):379–1.
• Weber M. Investigation of factitious disorder imposed on another or medical child abuse. APSAC Advisor. 2018;30(1):53–60. This paper discusses the largest series of investigations for possible prosecution currently in the literature. Among the 19 cases described, 7 caretakers were charged and found guilty after gastric feeding tubes were placed unnecessarily in their children.
• Roesler TA, Nassau JH, Rickerby ML, Laptook RS, DerMarderosian D, High PC Fam Process. 2018 online. The article is not specifically about MCA treatment but describes in detail the treatment process in a partial hospital program for multiple medical conditions that also frequently treats MCA.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Thomas A. Roesler declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Hospital Medicine
Rights and permissions
About this article
Cite this article
Roesler, T.A. Medical Child Abuse: What Have We Learned in 40 Years?. Curr Treat Options Peds 4, 363–372 (2018). https://doi.org/10.1007/s40746-018-0136-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40746-018-0136-x