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