II. Definitions
- Medical Child Abuse (Munchausen Syndrome by Proxy)
- Parent fabricates childhood illness resulting in unnecessary medical evaluation and treatment
III. Epidemiology
- Perpetrator is most commonly the patient's mother
- Victim is most commonly a young child (typically before significant language development)
- Older children may be home schooled in strict environments
IV. HIstory
- Child presents for frequent atypical symptoms and signs
- Multiple tests performed and all normal (or near normal) and non-diagnostic for specific conditions
- Abuse tends to escalate overtime
- More significant reported symptoms
- Complications from evaluation, treatment or concurrent physical abuse
- Parent (typically mother) is often sole witness to symptoms and signs
- Attempt to correlate history with other care givers, teachers as well as child
- Attempt to observe the child with parent absent
- Attempt to ask child history with parent absent
- Surveillance video (e.g. hospital setting) may be available to observe parent-child interaction when alone
V. Management
- Never inform family of investigation for Medical Child Abuse
- High risk of perpetrator proving illness by escalating abuse to serious injury or death
VI. Prognosis
- Medical Child Abuse is a high risk condition for childhood morbidity and mortality
- Keep the diagnosis in differential for extensive and recurrent workups for atypical presentations
VII. References
- Pomeranz (2021) Crit Dec Emerg Med 35(1): 3-10
- Bass (2014) Lancet 383(9926): 1412-21 [PubMed]
- McClure (1996) Arch Dis Child 75(1): 57-61 [PubMed]