Munchausen syndrome by proxy

Definition 
Munchausen syndrome by proxy is a form of child abuse in which a parent induces real or apparent symptoms of a disease in a child.

Causes, incidence, and risk factors 

This syndrome almost always involves a mother abusing her child by seeking unneeded medical attention for him or her. It is rare and poorly understood. The cause is unknown.

The mother may fake symptoms of illness in her child by adding blood to the child’s urine or stool, withholding food, falsifying fevers, surreptitiously giving emetics or cathartics to simulate Vomiting or diarrhea, or using other maneuvers (such as infecting IV lines to make the child appear or become ill).

These children are often hospitalized with groups of symptoms that don’t quite fit classical disease findings. Frequently, the children are made to suffer through unneccessary tests, surgeries, or other uncomfortable procedures.

The affected parent is usually very helpful in the hospital setting and is often appreciated by the nursing staff for the care she gives her child. She is commonly seen as devoted and unusually self-sacrificing, which can make medical professionals unlikely to suspect the diagnosis.

Her frequent visits unfortunately also make the child accessible to her so that she can induce further symptoms. Changes in physical exam or vital signs are almost never witnessed by hospital staff and almost always occur in presence of the mother.

Munchausen syndrome occurs because of psychological problems in the adult, and is generally an attention-seeking behavior. However, the syndrome can be life-threatening for the child involved because this unusual behavior can escalate to the point of severe physical harm or even death.

Symptoms  
Symptoms vary - see the discussion under the causes section.

Signs and tests 

     
  • The child’s symptoms do not fit a classical picture of illness or do not fit together well.  
  • The child’s symptoms improve at the hospital but reappear on return to the home.  
  • Blood in lab specimens does not match the patient’s blood type.  
  • The presence of drugs or chemicals in serum, stool, or urine samples cannot be accounted for.  
  • The parent is overattentive or “too helpful”, which raises suspicion in the face of other findings.  
  • The parent is often involved in a health-care field, such as nursing.

Treatment  

Once the syndrome is recognized, the child needs to be protected and removed from direct care of the parent. The affected parent should not be accused directly, but offered help.

Because this is a form of child abuse, the syndrome must be reported to the authorities. Psychiatric counseling will be recommended for the parent involved, but since the disorder is rare, very little is known about effective treatment.

Expectations (prognosis) 

This is a difficult disorder to treat in parents, with little information on the best types of care or outcomes. It usually requires years of psychiatric support.

Children may require medical care to treat the injuries which were inflicted and psychiatric care to deal with conditions like Depression or anxiety which can be provoked by child abuse. Some children may die from infections or other injuries inflicted by parents with Munchausen’s by proxy.

Complications 

The child can have complications from injuries, infections, medications, surgeries, or tests. Risk for psychological complications like Depression, anxiety, Post-traumatic Stress Disorder, and others is increased in survivors of child abuse.

Calling your health care provider 
This condition is diagnosed by the health care provider when the child is treated for various symptoms. If you find that you have urges to harm your child, seek psychiatric care immediately.

Prevention 
Recognition of Munchausen syndrome in the child-parent relationship can prevent continued abuse and unnecessary, expensive, and possibly dangerous medical testing.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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