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 the child. 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, secretly giving the child drugs to make the child throw up or have diarrhea, or using other tricks, such as infecting intravenous (given through a vein) lines to make the child appear or become ill.

These children are often hospitalized with groups of symptoms that don't quite fit any known disease. Frequently, the children are made to suffer through unnecessary tests, surgeries, or other uncomfortable procedures.

The 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 often seen as devoted and self-sacrificing, which can make medical professionals unlikely to suspect the diagnosis of Munchausen syndrome.

Her frequent visits unfortunately also make the child accessible to her so that she can induce further symptoms. Changes in the child's condition are almost never witnessed by hospital staff and almost always occur only in the mother's presence.

Munchausen syndrome occurs because of psychological problems in the adult, and is generally an attention-seeking behavior. The syndrome can be life-threatening for the child involved.

Symptoms

• 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 at home.
• The parent is overattentive or "too helpful."
• The parent is often involved in a health-care field, such as nursing.

Signs and tests

• Blood samples used for lab work do not match the patient's blood type.
• The presence of drugs or chemicals in blood, stool, or urine samples cannot be accounted for.

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. There is little information available about the best types of treatment or what the outcome will be. It usually requires years of psychiatric support.

Children may require medical care to treat injuries the parent inflicted, as well as psychiatric care to deal with depression, anxiety, and other conditions that can be provoked by child abuse. Some children may die from infections or other injuries inflicted by parents with Munchausen syndrome 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.

References

Johnson CF. Abuse and neglect of children. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 36.