Paediatrics: Illness fabricated or induced by carers

Illness fabricated or induced by carers

This is an unusual form of child abuse. It was previously referred to as Munchausen syndrome by proxy (MSbP). The salient feature is that the child is harmed by being presented for medical attention with symptoms or signs that have been falsified by the carer.

• The child is the victim of the abuse and the perpetrator is the person who fabricates the illness.

• Existing mental health difficulties in the perpetrator (child’s natural mother in 90% of cases) have been described, but are not essential for the diagnosis.

Presentation

There is a wide spectrum of severity of presentation of harm:

• False medical story.

• Fabrication of signs, e.g. blood on clothing or nappy, or sugar in urine specimen.

The most serious presentations include fabrication of illness induced by poisoning or suffocation.

Symptoms

Children may present with one or more of a range of symptoms:

• Seizures, collapse, coma.

• Apnoea.

• Vomiting and diarrhoea.

• Failure to thrive.

• Polyuria and polydipsia.

• Purpura.

• Recurrent fever.

Diagnosis

• It is important to realize that the medical profession may potentially harm children because unnecessary investigations are undertaken.

• The diagnosis can be established when the child is separated from the perpetrator and should be considered when other investigations are persistently normal.

• Very careful attention should be paid to the medical history, particularly as to who witnessed events and when they occurred.

Seek an opinion from an experienced colleague, who should arrange a strategy meeting between health-care professionals to decide on what further action is necessary.