Mumchausen by proxy involves a parent or guardian creating and using an supposed illness in a target person (usually a small child) for some form of psychological gain. Often the situation becomes a form of abuse, and the victim may be seriously harmed. Diagnosis may require a high level of suspicion and may be met with considerable resistance from family and colleagues.
Features:
(1) This involves the repetitive and intentional falsification by a parent or guardian of signs or symptoms in the victim.
(2) The parent or guardian derives some noneconomic benefit at the expense of the victim.
(3) Some perpetrators "doctor shop", while some maintain a constant relationship with one or more health care providers.
(4) Other adults may passively participate in the process, enabling the victimization.
(5) The perpetrator may be health care professional or may have a considerable medical knowledge.
(6) The parent or guardian may enjoy the role of being a devoted parent to a suffering child or family member.
(7) When confronted the parent or guardian usually vehemently denies an allegations of causing the victim's condition.
(8) The victim may be afraid or unwilling to report what is happening.
Clues:
(1) The illness does not conform to the expected presentation or follow the usual course.
(2) Signs and symptoms are not substantiated by objective laboratory or imaging findings.
(3) Failure of wounds to heal.
(4) Increased rates of infection in the absence of defect in host defenses, especially with unusual pathogens.
(5) Presence of other affected children in the family.
(6) The child becomes ill or worsens when the parent or guardian is present, with recovery when separated.
(7) Positive drug or toxicologic analysis for something not officially prescribed for the patient.
(8) The parent or guardian offering to maintain infusion lines, or noticed injecting something into an infusion line.
(9) Finding that the patient has been admitted to multiple hospitals and has been seen by multiple physicians.
(10) Signs and symptoms only seen by the parent or guardian.
(11) Lack of concern by the parent or guardian about the risks posed to the victim by tests or procedures.
(12) Tampering by the parent or guardian with specimens, documents or records.
(13) False allegations of sexual and physical abuse by the parent or guardian.
Levels of abuse involved:
(1) nonphysical: The perpetrator may lie about symptoms or manipulate specimens, but does not physically harm the victim.
(2) permissive: The perpetrator has the victim undergo multiple investigations or invasive procedures, with harm and discomfort to the victim.
(3) aggressive: The perpetrator intentionally does harm to the victim. This may involve injecting or administering drugs to induce illness, suffocating the child, or other physical abuse.
Evaluation of suspected cases:
(1) video surveillance of the victim while in the hospital (controversial)
(2) psychological evaluation of the perpetrator
(3) laboratory testing appropriate to the symptoms (insulin or C-reactive protein in hypoglycemia, thyroid hormone, etc.)
(4) analysis of any food or drink supplied by the suspected perpetrator
(5) analysis of any blood found in the victim's stool, wound dressings, etc, comparing to the victim's blood type
(6) contacting previous treating physicians and checking medical records at other hospitals
Differential diagnosis:
(1) overt abuse, including fabricating excuses to explain injuries
(2) an impoverished parent who falsifies symptoms in order to get assistance for a child
(3) parental depression or anxiety associated with care of a child with a serious illness
(4) familial inherited metabolic disorder
(5) fabricating illness to keep the child at home, to gain custody or for monetary gain (manipulative)
(6) delusional belief of the parent of illness in a child
Purpose: To identify clinical findings that may indicate the diagnosis of Munchausen syndrome by proxy.
Specialty: Pedatrics, Psychiatry
Objective: clinical diagnosis, including family history for genetics
ICD-10: F68.1,
