Medical Child Abuse

Medical Child Abuse (Munchausen Syndrome by Proxy)
1. Parent fabricates childhood illness resulting in unnecessary medical evaluation and treatment

Perpetrator is most commonly the patient's mother
Victim is most commonly a young child (typically before significant language development)
1. Older children may be home schooled in strict environments

Child presents for frequent atypical symptoms and signs
1. Multiple tests performed and all normal (or near normal) and non-diagnostic for specific conditions
Abuse tends to escalate overtime
1. More significant reported symptoms
2. Complications from evaluation, treatment or concurrent physical abuse
Parent (typically mother) is often sole witness to symptoms and signs
Attempt to correlate history with other care givers, teachers as well as child
1. Attempt to observe the child with parent absent
2. Attempt to ask child history with parent absent
3. Surveillance video (e.g. hospital setting) may be available to observe parent-child interaction when alone

Never inform family of investigation for Medical Child Abuse
1. High risk of perpetrator proving illness by escalating abuse to serious injury or death

Medical Child Abuse is a high risk condition for childhood morbidity and mortality
1. Keep the diagnosis in differential for extensive and recurrent workups for atypical presentations