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

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