Medical Child Abuse

Aka: Medical Child Abuse, Munchausen Syndrome by Proxy

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II. Definitions

  1. Medical Child Abuse (Munchausen Syndrome by Proxy)
    1. Parent fabricates childhood illness resulting in unnecessary medical evaluation and treatment

III. Epidemiology

  1. Perpetrator is most commonly the patient's mother
  2. Victim is most commonly a young child (typically before significant language development)
    1. Older children may be home schooled in strict environments

IV. HIstory

  1. Child presents for frequent atypical symptoms and signs
    1. Multiple tests performed and all normal (or near normal) and non-diagnostic for specific conditions
  2. Abuse tends to escalate overtime
    1. More significant reported symptoms
    2. Complications from evaluation, treatment or concurrent physical abuse
  3. Parent (typically mother) is often sole witness to symptoms and signs
  4. Attempt to correlate history with other care givers, teachers as well as child
    1. Attempt to observe the child with parent absent
    2. Attempt to ask child history with parent absent
    3. Surveillance video (e.g. hospital setting) may be available to observe parent-child interaction when alone

V. Management

  1. Never inform family of investigation for Medical Child Abuse
    1. High risk of perpetrator proving illness by escalating abuse to serious injury or death

VI. Prognosis

  1. Medical Child Abuse is a high risk condition for childhood morbidity and mortality
    1. Keep the diagnosis in differential for extensive and recurrent workups for atypical presentations

VII. References

  1. Pomeranz (2021) Crit Dec Emerg Med 35(1): 3-10
  2. Bass (2014) Lancet 383(9926): 1412-21 [PubMed]
  3. McClure (1996) Arch Dis Child 75(1): 57-61 [PubMed]

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Ontology: Munchausen Syndrome by Proxy (C0085277)

Definition (MSH) A phenomenon in which symptoms of a disease are fabricated by an individual other than the patient causing unnecessary, and often painful, physical examinations and treatments. This syndrome is considered a form of CHILD ABUSE, since another individual, usually a parent, is the source of the fabrication of symptoms and presents the child for medical care.
Definition (PSY) A phenomenon in which symptoms of an acute illness are fabricated by an individual other than the patient (e.g., a caregiver or parent) resulting in habitual seeking of medical care.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D016735
SnomedCT 95637005, 394514002
English Munchausen Syndrome by Proxy, Meadow's syndrome, Munchausen syndrome by proxy, Münchausen syndrome by proxy, Munchausen syndrome by proxy (disorder), Münchausen syndrome by proxy (disorder), Munchausen's by proxy, munchausen proxy syndrome, munchausen by proxy syndrome, syndrome munchausen by proxy, munchausen syndrome proxy, munchausen's by proxy, Munchausen's by proxy (disorder), munchausen syndrome by proxy, munchausen's syndrome by proxy, munchausen syndrome by proxy (diagnosis)
Dutch Münchausen-by-proxy, Munchhausen by proxy-syndroom, Syndroom van Munchhausen by proxy
French Syndrome de Munchausen par procuration, Syndrome de Münchausen par procuration, Syndrome de Münchhausen par procuration
German Muenchhausen-by-proxy-Syndrom, Münchhausen-by-proxy-Syndrom
Italian Sindrome di Munchausen indotta da terzi, Sindrome di Munchausen per procura
Portuguese Síndrome de Münchausen por influência estranha, Síndrome de Munchausen Causada por Terceiro
Spanish Munchausen por poderes, síndrome de Münchhausen por delegación, trastorno ficticio por poder, síndrome de Münchhausen por delegación (trastorno), síndrome de Münchhausen por poder (trastorno), síndrome de Münchhausen por poder, trastorno facticio con síntomas físicos, Síndrome de Munchausen Causado por Tercero
Japanese 代理人によるミュンヒハウゼン症候群, ﾀﾞｲﾘﾆﾝﾆﾖﾙﾐｭﾝﾋﾊｳｾﾞﾝｼｮｳｺｳｸﾞﾝ
Swedish Munchhausens syndrom by proxy
Czech Münchhausenův syndrom v zastoupení, Munchhausenův syndrom v zastoupení, Münchhausenův syndrom by proxy
Finnish Münchausen by proxy -oireyhtymä
Russian MIUNKHAUZENA SINDROM, PERENESENNYI NA DRUGOGO, МЮНХАУЗЕНА СИНДРОМ, ПЕРЕНЕСЕННЫЙ НА ДРУГОГО
Polish Przeniesiony zespół Munchausena, Zastępczy zespół Munchausena, Zespół Munchausena by proxy, Zespół Munchausena przeniesiony, MSBP
Hungarian Münchausen-syndroma by proxy
Norwegian Munchhausens syndrom by proxy
Derived from the NIH UMLS (Unified Medical Language System)

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