Munchausen by Proxy (medical child abuse)
Munchausen by Proxy (also known as Factitious Disorder Imposed on Another, or FDIA) is a form of abuse and/or neglect in which a caregiver (usually the mother of a young child) fabricates, exaggerates, or induces illness in their victim for the purposes of attention and sympathy from medical professionals and/or those in their community. It may be the deadliest form of child abuse, with a fatality rate estimated to be between six and nine percent in published reports. Munchausen by Proxy, or MBP, is underreported, so it is difficult to know how many children are victimized by this type of abuse each year.
Though the terms are sometimes used interchangeably, Medical Child Abuse (MCA) is the act of physically and/or psychologically harming a child under the abuser’s care by fabricating, exaggerating, or inducing their illness or injury. Though FDIA is a psychiatric disorder that often underlies this type of abuse, the mental health of the perpetrator should be considered secondary to preserving the health and well-being of the child being harmed.
Warning Signs of Munchausen by Proxy (via APSAC)
According to the American Professional Society on the Abuse of Children (APSAC), here are some common signs of MBP maltreatment to watch out for:
- Reported symptoms or behaviors that are not congruent with observations. For example, the abuser says the child cannot eat, yet the child is observed eating without the adverse symptoms reported by the abuser.
- Discrepancy between the abuser’s reports of the child’s medical history and the medical record.
- Extensive medical assessments do not identify a medical explanation for the child’s reported problems.
- Unexplained worsening of symptoms or new symptoms that correlate with the abuser’s visitation or shortly thereafter.
- Laboratory findings that do not make medical sense; are clinically impossible or implausible; or identify chemicals, medications, or contaminants that should not be present.
- Symptoms resolve or improve when the child is separated and well protected from the influence and control of the abuser.
- Other individuals in the home of the caregiver have or have had unusual or unexplained illnesses or conditions.
- Animals in the home have unusual or unexplained illnesses or conditions—possibly similar to the child’s presentation (e.g., seizure disorder).
- Conditions or illnesses significantly improve or disappear in one child and then appear in another child; for example, when another child is born, she begins to have similar or other unexplained symptoms.
- Caregiver is reluctant to provide medical records, claims that past records are not available, or refuses to allow medical providers to discuss care with previous medical providers.
- The abuser reports that the other parent is not involved, does not want to be involved, and is not reachable.
- A parent, child, or other family member expresses concern about possible falsification or high-healthcare utilization.
- Observations of clear falsification or induction by the caregiver. This may take the form of false recounting of past medical recommendations, test or exam results, conditions, or diagnoses.
Munchausen by Proxy (APSAC Practice Guidelines 2017)
The full practice guidelines for professionals can be accessed here: http://bit.ly/2D86buP