Top

Journal of Clinical Psychology in Medical Settings

Published in:

01-12-2020 | Child Abuse

Medical Child Abuse Hidden in Pediatric Settings: Detection and Intervention

Authors: Jeanne S. Hoffman, Gerald P. Koocher

Published in: Journal of Clinical Psychology in Medical Settings | Issue 4/2020

Abstract

Medical child abuse, sometimes referred to as Munchausen Syndrome by Proxy or childhood factitious disorder, poses significant diagnostic, intervention, and ethical issues for medical and mental health practitioners alike. Psychologists working in pediatric hospitals and medical clinics should remain mindful of the health and ethical risks posed by these conditions, which are challenging to detect and treat. The surreptitious nature of the conditions and hazards they pose require an integrated medical, psychological, and child protective response. This article provides historical and clinical background on the condition along with tabular guides and recommendations to assist in detection and intervention.

Adwallah, N., Vaughn, A., Franco, K., Munir, F., Sharaby, N., & Goldfarb, J. (2005). Munchausen by Proxy: A case, chart series, and literature review of older victims. Child Abuse and Neglect, 29, 931–941. https://doi.org/10.1016/jchiabu.2004.11.007.CrossRef

Alexander, R. C. (2000). Medical treatment of Munchausen Syndrome by Proxy. In R. Reese (Ed.), Treatment of child abuse: Common ground for mental health, medical and legal practitioners (pp. 236–241). Baltimore, MD: Johns Hopkins University Press.

Alexander, R., Smith, W., & Stevenson, R. (1990). Serial Munchausen by proxy. Pediatrics, 86, 581–585.PubMed

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.CrossRef

APSAC Taskforce. (2018). Munchausen by Proxy: Clinical and case management guidance. APSAC Advisor, 30, 8–31.

Ayoub, C. C., Deutsch, R. M., & Kinscherff, R. (2000). Psychosocial management issues in Munchausen by Proxy. In R. Reese (Ed.), Treatment of child abuse: Common ground for mental health, medical and legal practitioners (pp. 226–235). Baltimore, MD: Johns Hopkins University Press.

Bass, C., & Glaser, D. (2014). Early recognition and management of fabricated or induced illness in children. The Lancet, 383, 1412–1421. https://doi.org/10.1016/S0140-6736(13)6218-2.CrossRef

Bass, C., & Jones, D. (2011). Psychopathology of perpetrators of fabricated or induced illness in children: Case series. British Journal of Psychiatry, 199, 113–118. https://doi.org/10.1192/bjp.bp.109.074088.CrossRef

Bools, C. N., Neale, B. A., & Meadow, S. R. (1993). Follow up of victims of fabricated illness (Munchausen Syndrome by Proxy). Archives of Disease in Childhood, 69, 625–630.CrossRefPubMedPubMedCentral

Brown, A. N., Gonzalez, G. R., Wiester, R. T., Kelley, M. C., & Feldman, K. W. (2014). Caretaker blogs in caregiver fabricated illness in a child: A window on the caretaker’s thinking. Child Abuse and Neglect, 38, 488–497. https://doi.org/10.1016/j.chiabo.2013.12.002.CrossRefPubMed

Bursch, B. (2018). Child protective services management of cases of suspected child abuse/neglect due to factitious disorder imposed on another. APSAC Advisor, 30, 76–82.

Cardona, L., & Asnes, A. G. (2019). Disclosure of caregiver-fabricated illness to a child: A team-based approach to communicating with pediatric patients. Clinical Child Psychology and Psychiatry. https://doi.org/10.1177/13591045188116122.CrossRefPubMed

Craft, A. W., & Hall, D. M. B. (2004). Munchausen Syndrome by Proxy and sudden infant death. British Medical Journal, 328, 1309.CrossRefPubMedPubMedCentral

Davis, P., Murtagh, U., & Glaser, D. (2019). 40 years of fabricated or induced illness (FII): Where next for paediatricians? Paper 1: Epidemiology and definition of FII. Archives of Diseases in Childhood, 104, 110–114. https://doi.org/10.1136/archdischild-2017-314319.CrossRef

Doughty, K., Rood, C., Patel, A., Thackery, J. D., & Brink, F. W. (2016). Neurological manifestations of medical child abuse. Pediatric Neurology, 54, 22–28. https://doi.org/10.1016/j.pediatneurol.2015.09.010.CrossRefPubMed

Esernio-Jenssen, D., Alexander, R., Feldman, K., & Yorker, B. (2018). The influence of electronic and internet advances on Munchausen by Proxy. APSAC Advisor, 30, 83–91.

Feldman, M. D. (2000). Munchausen by Internet: Detecting factitious illness and crisis on the Internet. Southern Medical Journal, 93, 669–672.CrossRefPubMed

Ferrara, P., Vitellli, O., Gatt, A., Liberatore, P., Binetti, P., & Stabile, A. (2013). Factitious disorders and Munchausen Syndrome: The tip of the iceberg. Journal of Child Health Care, 17, 366–374.CrossRefPubMed

Flaherty, E. G., MacMillan, H. L., & The Committee on Child Abuse and Neglect. (2013). Caregiver-fabricated illness in a child: A manifestation of child maltreatment. Pediatrics, 132, 590–597. https://doi.org/10.1542/peds.2013-2045.CrossRefPubMed

Flannery, M. T. (1998). First do no harm: The use of covert video surveillance to detect Munchausen Syndrome by Proxy: An unethical means of “preventing” child abuse. University of Michigan Journal of Law Reform, 32, 105–194.PubMed

Galvin, H. K., Newton, A. W., & Vandeven, A. M. (2005). Update on Munchausen Syndrome by Proxy. Current Opinions in Pediatrics, 17, 252–257.CrossRef

Hymel, K. P., National Association of Medial Examiners, & The Committee of Child Abuse & Neglect. (2006). distinguishing sudden infant death syndrome from child abuse fatalities. Pediatrics, 118, 421–427.CrossRefPubMed

Katz, A. L., Webb, S. A., & Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice. Pediatrics, 138, e20161485.CrossRefPubMed

Kelly, M., & Wang, C. (2018). Diagnostic aid to identify simulation and/or induction: Abuse by pediatric condition falsification/caregiver illness in a child/medical child abuse. APSAC Advisor, 30, 32–52.

Kinscherff, R., & Ayoub, C. C. (2000). Legal aspects of Munchausen by Proxy. In R. Reese (Ed.), Treatment of child abuse: Common ground for mental health, medical and legal practitioners (pp. 242–267). Baltimore, MD: Johns Hopkins University Press.

Kinscherff, R., & Famularo, R. (1991). Extreme Munchausen by Proxy: The case for termination of parental rights. Juvenile Family Court, 42, 41–53.CrossRef

Koocher, G. P., & Keith-Spiegel, P. C. (2016). Ethics in psychology and the mental health professions: Standards and cases (4th ed.). New York: Oxford University Press.

Libow, J. A. (1994, August). Munchausen by Proxy victims in later life: Preliminary findings. Paper presented at 102nd Annual Convention of the American Psychological Association, Los Angeles, CA.

Libow, J. A. (1995). Munchausen by Proxy victims in adulthood: A first look. Child Abuse and Neglect, 19, 1131–1142. https://doi.org/10.1016/0145-2134(95)00073-H.CrossRefPubMed

Libow, J. A. (2002). Beyond collusion: Active illness falsification. Child Abuse and Neglect, 26, 525–536.CrossRefPubMed

Makar, A. F., & Squier, P. J. (1990). Munchausen Syndrome by Proxy. Pediatrics, 85, 370–373.PubMed

McClure, R. J., Davis, P. M., Meadow, S. R., & Silbert, J. R. (1996). Epidemiology of Munchausen Syndrome by Proxy, non-accidental poisoning, and non-accidental suffocation. Archives of Disease in Childhood, 75, 57–61.CrossRefPubMedPubMedCentral

McGuire, T. L., & Feldman, K. W. (1989). Psychologic morbidity of children subjected to Munchausen Syndrome by Proxy. Pediatrics, 83, 289–292.PubMed

Meadow, R. (1977). Munchausen Syndrome by Proxy: The hinterland of child abuse. Lancet, 2, 2343–2345.

Meadow, R. (1982). Munchausen Syndrome by Proxy. Archives of Disease in Childhood, 57, 92–98.CrossRefPubMedPubMedCentral

Pankratz, L. (2006). Persistent problems with the Munchausen Syndrome by Proxy label. Journal of the American Academy of Psychiatry and the Law, 34, 90–95.PubMed

Petska, H. W., Gordon, J. B., Jablonski, D., & Sheets, L. K. (2017). The intersection of medical child abuse and medical complexity. Pediatric Clinics of North America, 64, 253–264. https://doi.org/10.1016/jpd2016.08.06.CrossRefPubMed

Pulman, A., & Taylor, J. (2012). Munchausen by Internet: Current research and future directions. Journal of Medical Internet Research, 14, e115. https://doi.org/10.2196/jmir.2011.CrossRefPubMedPubMedCentral

Roesler, T. A., & Jenny, C. (2009). Medical child abuse: Beyond Munchausen Syndrome by Proxy. Elk Grove Village, IL: American Academy of Pediatrics.

Rosenberg, D. A. (1987). Web of deceit: A literature review of Munchausen Syndrome by Proxy. Child Abuse and Neglect, 11, 547–563.CrossRefPubMed

Rosenberg, D. A. (2003). Munchausen Syndrome by Proxy. Child Abuse and Neglect, 27, 421–430. https://doi.org/10.1016/S1045-2134(03)00029-2.CrossRefPubMed

Sanders, M. J. (1995). Symptom coaching: Factitious Disorder by Proxy with older children. Clinical Psychology Review, 15, 423–442.CrossRef

Sanders, M. J., & Bursch, B. (2002). Forensic assessment of illness falsification, Munchausen by Proxy, and factitious disorder, NOS. Child Maltreatment, 7, 112–124.CrossRefPubMed

Sanders, M. J., & Bursch, B. (2019). Psychological treatment of factitious disorder imposed on another/Munchausen by Proxy abuse. Journal of Clinical Psychology in Medical Settings. https://doi.org/10.1007/s10880-019-09630-6.CrossRef

Schreier, H. (2002). Munchausen by Proxy defined. Pediatrics, 110, 985–988.CrossRefPubMed

Schreier, H. (2004). Munchausen by Proxy. Current Problems in Pediatric Adolescent Health Care, 34, 126–143.CrossRefPubMed

Schreier, H. A., & Bursch, B. (2018). Munchausen by Proxy in educational and mental health Settings. APSAC Advisor, 30, 61–65.

Shaw, R. J., Dayal, S., Hartman, J. K., & DeMaso, D. R. (2008). Factitious disorder by proxy: Pediatric condition falsification. Harvard Review of Psychiatry, 16, 215–224.CrossRefPubMed

Sheridan, M. S. (2003). The deceit continues: An updated literature review of Munchausen by Proxy. Child Abuse and Neglect, 27, 431–451. https://doi.org/10.1016/S0145-2134(03)00030-9.CrossRefPubMed

Squires, J. E., & Squires, R. H. (2013). A review of Munchausen Syndrome by Proxy. Pediatric Annals, 42, 67–71. https://doi.org/10.3928/00904481-20130326-09.CrossRefPubMed

Stirling, J., & The Committee on Child Abuse and Neglect. (2007). Beyond Munchausen Syndrome by Proxy: Identification and treatment of child abuse in a medical setting. Pediatrics, 119, 1026–1030. https://doi.org/10.1542/peds.2007-0563.CrossRefPubMed

Sullivan, C. A., Francis, G. L., Bain, M. W., & Hartz, J. (1991). Munchausen Syndrome by Proxy. Clinical Pediatrics, 30, 112–116.CrossRefPubMed

Truman, T. L., & Ayoub, C. C. (2002). Considering suffocatory abuse and Munchausen Syndrome by Proxy in the evaluation of children experiencing apparent life-threatening events and sudden infant death syndrome. Child Maltreatment, 7, 138–148.CrossRefPubMed

Weber, M. C. (2018). Investigation of medical child abuse/factitious disorder imposed on another. APSAC Advisor, 30, 53–60.

Yates, G., & Bass, C. (2017). The perpetrators of medical child abuse (Munchausen Syndrome By Proxy): A systematic review of 796 cases. Child Abuse and Neglect, 72, 45–53. https://doi.org/10.1016/j.chiabu.2017.07.008.CrossRefPubMed

Yin, S. (2010). Malicious use of pharmaceuticals in children. Journal of Pediatrics, 157, 832–836. https://doi.org/10.1016/j.jpeds.2010.05.040.CrossRefPubMed

Yorker, B. C. (1995). Covert video surveillance of Munchausen Syndrome by Proxy: Exigent circumstances exception. Health Matrix: Journal of Law and Medicine, 5, 325–346.

Title: Medical Child Abuse Hidden in Pediatric Settings: Detection and Intervention
Authors: Jeanne S. Hoffman
Gerald P. Koocher
Publication date: 01-12-2020
Publisher: Springer US
Keywords: Child Abuse
Child Abuse
Published in: Journal of Clinical Psychology in Medical Settings / Issue 4/2020
Print ISSN: 1068-9583
Electronic ISSN: 1573-3572
DOI: https://doi.org/10.1007/s10880-019-09666-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Medical Child Abuse Hidden in Pediatric Settings: Detection and Intervention

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2020

Values-Based Behavioral Activation for Chronic Pain in Primary Care: A Pilot Study

The Combined Effect of Psychological and Relational Aspects on Cardiac Patient Activation

Examining Individual Differences in Wellbeing, Anxiety and Depression in Psoriasis Using a Clinically Modified Buddhist Psychological Model

The Effect of Expressive Writing on Postpartum Depression and Stress of Mothers with a Preterm Infant in NICU

Do Peer Recovery Specialists Improve Outcomes for Individuals with Substance Use Disorder in an Integrative Primary Care Setting? A Program Evaluation

Measurement-Based Care in the Veteran’s Health Administration: A Critique and Recommendations for Future Use in Mental Health Practice