Although rare, doctors should learn to detect forms of a type of child abuse known as “Munchausen syndrome by proxy,” a factitious disorder whereby a parent fabricates a child’s illness to gain attention or psychological gratification.
The condition is named after Baron von Munchausen, an 18th century German who developed a reputation for falsifying stories about travel and life to gain attention. The symptoms may range in severity. At the mildest, a parent or caregiver may exaggerate stories of a child’s illness to the doctor. At worst, the mother — and it’s the mother in 85 percent of cases — will cause symptoms by harming her own child, usually by poison or suffocation.
The condition occurs in approximately two people per 100,000, according to the Cleveland Clinic.
In new research to guide physicians, Harriet MacMillan, a pediatrician and child psychiatrist at the Michael G. DeGroote School of Medicine, finds that many doctors are missing signs of the abuse. “It is probably more common than we realize,” MacMillan said in a statement.
The form of child abuse has been known by the psychological community since the late 1970s as Munchausen syndrome by proxy, though academics continue to wrestle with a better name for the condition, one that puts the focus on the victim, MacMillan said. The new research details the rare and obscure condition and advises doctors on physical and psychiatric symptoms, given that patients present with a variety of symptoms from bleeding to seizures to urinary tract infection — the panoply of childhood illnesses and ailments bringing a mother and child to the doctor’s office.
"It really comes down to conducting a very careful history and physical examination, with an emphasis on communication with all health care providers who have seen the child," MacMillan said. "It's important that we are thorough in seeking comprehensive information about contact with health care providers, while adhering to privacy legislation."
Although scientists don’t understand the underlying pathology of the condition, behavioral warning signs sometimes allow clinicians to detect deceitful interactions in the doctor’s office. In some cases, the patient’s reported condition and symptoms differ with diagnostic tests, or are reported by the mother but not witnessed by medical staff. Digging a little deeper into a medical mystery, a doctor might also find an unexplained illness or death in the family, usually of a child.
To detect such abuse, medical providers must communicate effectively with one another. "This is the type of condition where it is essential for clinicians to review medical records and speak with other healthcare providers to have complete information in conducting their assessment,” MacMillan said.
Source: MacMillian H. Caregiver-Fabricated Illness in a Child: A Manifestation of Child Maltreatment. Pediatrics. 2013.