Munchausen syndrome by proxy: a case report

Munchausen syndrome by proxy (MSBP) is a serious form of child abuse, which is characterized by a child with symptoms and signs of an illness that have been fabricated by the mother. Here, we present a case of MSBP, who at four months of age was brought to our hospital by her mother because of rectal bleeding. The patient underwent many invasive procedures until the diagnosis of MSBP was finally considered. The mother reported no rectal bleeding for almost a year, during follow-up at the well-child outpatient department. At 19 months of age, another episode of rectal bleeding occurred, when a bloody diaper was presented to the attending physicians. The blood group and DNA analysis of the blood in the diaper confirmed the diagnosis. The case was reported to the social services and the patient was placed in the custody of her father's sister. The mother is still undergoing treatment in our psychiatry department.     

Munchausen's syndrome by proxy: a case report of a girl with a recurrent factitious bleeding ear

This is a case report of a three-year-old girl with recurrent ear bleeding which was actually recurrent factitious symptomatology, perpetrated by the mother, which caused the child to undergo many harmful diagnostic procedures. This is a documented case, probably the first case reported in Latin America, and it is also the only one in which there is mention of the mother demonstrating interest in divulging the case. Munchausen's Syndrome by Proxy (MSBP) is a specific modality of child abuse. The mother, often the perpretator, affect concern and affection. The consequences are both psychological and physical and can determine child's death. Diagnosis is rarely considered.     

Epidemiology of Munchausen syndrome by proxy in New Zealand

OBJECTIVE: To determine the epidemiology of Munchausen syndrome by proxy (MSBP) in New Zealand and describe the effects of this condition on children and their paediatricians. METHODOLOGY: A mail-out survey was sent to all paediatricians in New Zealand in 1999. Paediatricians were asked to identify all cases of MSBP, non-accidental poisoning or non-accidental suffocation diagnosed or suspected in children less than 16 years of age that had been seen in the past 12 months. Those paediatricians who identified a case were then interviewed by telephone to ensure that identified cases were new cases and that they were unique. RESULTS: Responses were obtained from 148 (95%) of 156 practising paediatricians in New Zealand. Eighteen unique cases of MSBP were identified where the diagnosis had been made in the preceding 12 months. The incidence rate for MSBP in children aged less than 16 years was 2.0/100 000 children. Eleven (61%) of the 18 cases were referred to child protection agencies or the police. The mean time taken to diagnosis from initial presentation was 7 months in the cases referred to child protection agencies and 23 months in cases not referred. The median age at diagnosis was 2.7 years. The mother was the suspected perpetrator in all cases. Most children (72%) presented with multiple symptoms. Over half (55%) had an underlying chronic illness. The morbidity for the child in the majority of cases was not severe, and in nine (50%) cases it was noted that following diagnosis there was improvement or resolution of symptoms. Ten (56%) of the 18 paediatricians involved with cases reported experiencing considerable stress. CONCLUSIONS: The annual incidence in New Zealand of MSBP in children under 16 years is higher than that reported from other countries. Chronic illness is often associated with this condition. The morbidity for the majority of children was not severe and often improved with diagnosis. Paediatricians reported stress and difficulty in association with caring for children with this syndrome of child abuse.     

Serial Munchausen syndrome by proxy

Five cases of Munchausen syndrome by proxy (MSBP) are presented in which more than one child in the family was victimized. There was a high incidence of maternal psychiatric histories, marital difficulties, and Münchhausen syndrome in the mothers themselves. Seventy-one percent of the children in the families were known to be victims of MSBP; four of these children (31%) died. Multiple-child MSBP may reflect more significant maternal psychopathology than found in other cases of MSBP, or it may indicate the deteriorating consequences to the mother and other children in the family if this syndrome is not identified with the first child and effective interventions made.     

Syndrome de Münchhausen par procuration : à propos de deux nouvelles observations

Münchhausen's syndrome by proxy (MSBP) is a particular form of child abuse. The authors report the two first Tunisian cases of MSBP. The first one, a 19 months-old girl, was repeatedly hospitalized for coma which declines during hospitalization. Investigations were negative and she died after 8 months of evolution. Some months after the death, the elder sister presented the same symptoms. Specialized metabolic exams were negative. Toxicological analysis of the urine revealed Benzodiazepine and Phenobarbital. MSBP was retained. Repeated hospitalizations and negative investigations may suggest a case of MSBP.     

中国大陆首例儿童代理性孟乔森综合征北大核心CSCD

对2020年11月华中科技大学同济医学院附属同济医院儿科收治的1例代理性孟乔森综合征(MSBP)病例的临床资料进行回顾性分析。患儿,女,4岁4个月,因"胸骨后疼痛、腹痛1个月,加重伴多器官痛20 d"入院,自述"胸骨后反酸、疼痛,牙齿、食管、腹部等多部位均有疼痛",住院期间常诉多器官疼痛,其母多次诉患儿髋关节痛,夜间哭叫,难以行走。但体格检查无阳性体征,辅助检查无明显异常。结合患儿病史特点及照顾者的行为特点,临床诊断为MSBP。提示当临床遇有主诉复杂、严重、医学术语多,既往就诊频繁,而体格检查及辅助检查无明显异常,且照顾者就医及住院意向强烈的儿童,需考虑MSBP的可能。     

Differences of Munchausen syndrome by proxy according to predominant symptoms in Japan

Background: The purpose of the present paper was to investigate differing characteristics of Munchausen syndrome by proxy (MSBP) between subjects with predominantly physical symptoms and those with predominantly psychological symptoms.
Methods: A questionnaire survey was sent to 11 leading doctors in the child abuse field in Japan, each located in different hospital-based sites. Child abuse doctors answered questions regarding the characteristics of MSBP subjects for whom they had helped care. The differences of characteristics between groups were analyzed using Fisher's exact test for categorical variables and Mann-Whitney U -test for continuous variables.
Results: Among 21 reported MSBP subjects, 16 MSBP subjects with predominantly physical symptoms (PHY) and five MSBP subjects with predominantly psychological symptoms (PSY) were found. PHY were more likely to be produced, whereas PSY cases were more often simulated. PHY cases were more often life-threatening than PSY cases, but decisions made by the Child Guidance Center surrounding the custodial outcome of MSBP victims did not differ between PHY and PSY cases.
Conclusions: Social welfare services that need to decide on custody for MSBP victims should recognize the relatively high risk of life-threatening danger of PHY cases in their family of origin.     

Latina mothers' attributions, emotions, and reactions to the problem behaviors of their children with developmental disabilities

We examined the applicability of attribution theory to mothers' perceptions and reactions to their child's problem behavior. Participants were 149 Latina mothers of children with developmental disabilities who were interviewed regarding specific incidents in which their child exhibited a behavior problem. The findings indicate that most mothers viewed their child as not being responsible for the behavior problem. Furthermore, as predicted by attribution theory, mothers who ascribed relatively high responsibility to the child were significantly more likely to report negative emotions (anger and frustration) and aggressive/harsh behavioral reactions than mothers who ascribed low responsibility. Also. mothers were more likely to ascribe high responsibility to the child when the problem was characterized as a behavioral excess than as a behavioral deficit. The results provide support for the applicability of an attributional framework and may have important implications for helping parents in addressing the problem behaviors of their children with developmental disabilities.     

Munchausen Syndrome Presenting as Hemophilia: A Convenient and Economical “Steal” of Disease and Treatment

Munchausen's syndrome and Munchausen's syndrome by proxy (MSBP) can cause many conditions, including bleeding problems, seizures, failure to thrive and others. We report here an unusual case in which a mother presented to the hospital for her hemophiliac son's failure to thrive, subsequently for her own self-inflected mutilating wounds, and finally for self-induced simulation of her son's hemophiliac bleeding and arthritic complications.     

A developmental model of maternal and child contributions to disruptive conduct: the first six years

Background: The parent–child relationship is considered important for children’s future conscience, and conscience is seen as protecting them from disruptive behavior problems, but specific mechanisms of this developmental process are rarely studied. Methods: This multi‐trait multi‐method study examined, in a longitudinal design, paths linking early maternal responsiveness to the child with the child’s future conscience and disruptive behavior in 102 mother–child dyads. We tested a conceptual model where maternal responsiveness to the child, observed at 7 and 15 months, engenders a responsive stance in the child, observed at 25 and 38 months; that stance, in turn, becomes enduring and generalized, promoting multiple aspects of the child’s conscience, observed at 52 months. In turn, conscience serves as a protective factor from disruptive behavior problems, rated by mothers and fathers at 67 months. Results: The postulated paths were examined using sequential regressions and mediation effects were tested using bootstrapping analyses. Child responsive stance at 25–38 months fully mediated the link between maternal responsiveness in infancy and conscience at 52 months, and conscience fully mediated the link between child responsive stance and future disruptive behavior at 67 months. Conclusions: Examination of developmental links among early maternal behavior, the child’s responsive stance toward the mother, conscience, and disruptive behavior is a promising step toward elucidating mechanisms of children’s adaptive and maladaptive trajectories.     

Early identification of children with developmental disabilities

This paper provides an overview of research into early identification of children with developmental disabilities in child healthcare, especially those disabilities related to cognitive impairment. The review covers the following related topics: definition of the target group, the predictive value of developmental screening instruments and psychomotor tests, risk indexes, early intervention and evaluation of developmental screening programmes. Empirical research into child development and the predictive value of developmental tests is extensive. However, proportionally few, mostly cohort or case-control, studies focusing on evaluation of developmental screening programmes conducted within a clinical setting were found. Some sensitivity and most specificity rates reported fell within what is considered acceptable for developmental screening performed in the pre-school years, i.e. a sensitivity of more than 70% and a specificity between 70% and 80%. Overall, between 1-6% of the children screened were identified. Typically, most children with severe disabilities were identified prior to the screening or excluded from the studies reviewed. The shortcomings of developmental screening (instruments) and difficulties in early identification are discussed.     

Partial trisomy 13 with features similar to C syndrome

We report a case of partial trisomy 13 with trigonocephaly, upslant eyes, long smooth philtrum, polydactyly, agenesis of right kidney and mild developmental delay. In this family phenotypically normal mother had pericentric inversion of chromosome 13 and the child (proband) received recombinant 13 from the mother. Genetic counselling of the family for reproductive risks and testing siblings of the mother for detection of balanced carriers is essential.     

Early identification of children with developmental disabilities

This paper provides an overview of research into early identification of children with developmental disabilities in child healthcare, especially those disabilities related to cognitive impairment. The review covers the following related topics: definition of the target group, the predictive value of developmental screening instruments and psychomotor tests, risk indexes, early intervention and evaluation of developmental screening programmes. Empirical research into child development and the predictive value of developmental tests is extensive. However, proportionally few, mostly cohort or case-control, studies focusing on evaluation of developmental screening programmes conducted within a clinical setting were found. Some sensitivity and most specificity rates reported fell within what is considered acceptable for developmental screening performed in the pre-school years, i.e. a sensitivity of more than 70% and a specificity between 70% and 80%. Overall, between 1–6% of the children screened were identified.
Typically, most children with severe disabilities were identified prior to the screening or excluded from the studies reviewed. The shortcomings of developmental screening (instruments) and difficulties in early identification are discussed.     

Difference in mother-child interaction between preterm- and term-born preschoolers with and without disabilities

Aim: To investigate differences in the quality of mother–child interaction between preterm‐ and term‐born children at age 5, and to study the association of mother–child interaction with sociodemographic characteristics and child disability. Methods: Preterm children (n = 94), born at <30 weeks’ gestation and/or birth weight <1000 g, and term children (n = 84) were assessed at corrected age of 5 using a mother–child interaction observation. Disabilities were assessed using an intelligence test, behaviour questionnaires for parents and teachers, and motor and neurological examinations. Results: Mothers of preterm‐born children were less supportive of and more interfering with their children’s autonomy than mothers of term‐born children. This difference was only partly explained by sociodemographic factors. Dyads showed a lower quality of mother–child interaction if children had a severe disability, especially when mothers had a lower level of education. Conclusion: Five years after birth, mother–child interaction of very premature children and their mothers compared unfavourably with term children and their mothers. Mothers with sociodemographic disadvantages, raising a preterm child with severe disabilities, struggle most with giving adequate sensitive support for the autonomy development of their child. Focused specialized support for these at risk groups is warranted.     

Interactions Between Mothers and Their Infants with Developmental Disabilities:

This paper has two goals: to review the research related to interaction of mothers and their infants with developmental disabilities during play and to demonstrate the necessity of addressing this area in intervention programs. The scope of this review, therefore, is the analysis and integration of theoretical and empirical literature that relates to mother and their infants with developmental disabilities during play to provide new and more comprehensive avenues for programming and research in this area.     

High Prenatal and Postnatal Lead Exposure Associated Lead Encephalopathy in an Infant

An 11-month-old child presented with persistent seizures requiring ventilator support. The child had global developmental delay, was staying in the premises of battery manufacturing unit, had microcytic and hypochromic anemia with basophilic stripling on peripheral smear, lead line on radiograph of the long bones and BLL of 244 μg/dl. The CT scan of the brain revealed cerebral atrophy. The mother also had high BLL and lead line in the radiograph of the long bones. The child was managed with chelation therapy. Given the continuing lead exposure among occupational and general populations in India, this case study highlights the need for prompt environmental preventive actions as well as nutritional and preventive counseling for occupational populations.     

Disability and victimization in a national sample of children and youth

Although past research has found higher rates of violence, crime, and abuse among children with disabilities, most studies combine diverse forms of disability into one measure and assess exposure to only one particular type of victimization. Based on a representative national sample of 4,046 children aged 2-17 from the 2008 National Survey of Children's Exposure to Violence, the present study examines the associations between several different types of disability and past-year exposure to multiple forms of child victimization. Results suggest that attention-deficit disorder/attention-deficit with hyperactivity disorder elevates the risk for peer victimization and property crime, internalizing psychological disorders increase risk for both child maltreatment and sexual victimization, and developmental/learning disorders heighten risk only for property crime. In contrast, physical disability did not increase the risk for any type of victimization once confounding factors and co-occurring disabilities were controlled. It appears that disabilities associated with interpersonal and behavioral difficulties are most strongly associated with victimization risks.     

Attenuating growth in children with profound developmental disability: a new approach to an old dilemma

Caring for children with profound developmental disabilities can be difficult and demanding. For nonambulatory children with severe, combined neurologic and cognitive impairment, all the necessities of life must be provided by caregivers, usually parents, and these tasks become more difficult as the child grows to adolescence and adulthood. Many parents would like to continue caring for their child with special needs at home but find it difficult to do so as the child increases in size. If growth could be permanently arrested while the child was still small, both child and parent would likely benefit because this would facilitate the option of continued care in the home. Treatment of the child with high-dose estrogen, initiated at an early age, could provide this option. High-dose estrogen both inhibits growth and rapidly advances maturation of the epiphyseal growth plates, bringing about permanent attenuation in size after a relatively short period of treatment. We present a case report and discuss the medical and ethical considerations of such an intervention strategy. We suggest that after proper screening and informed consent, growth-attenuation therapy should be a therapeutic option available to these children should their parents request it.     

What are specific performance weaknesses?

The term "specific developmental disorder" means localized deficits in very different functions contrasting fit in the general otherwise normal performance level of a child. These disorders are mostly looked upon in a developmental context and differentiated from acquired neuropsychological syndromes (e.g. aphasia, apraxia). The most important clinically relevant disorders are: the specific reading disability, the specific dyscalculia, other specific learning disabilities, the specific developmental language disorder, the specific retardation in the motor development, and multiple developmental retardations. In a population of all patients treated in institutions for children and adolescents, 30% show specific developmental disorders with a predominance of boys. There is no correlation between dyslexia and social class but it does exist for specific developmental language disorder and motor retardation. As to the etiology of specific developmental disorders, genetic factors, congenital or acquired cerebral dysfunctions, maturation or developmental retardation and cognitive variables are discussed. The multifactor-approach seems to be the best way of understanding specific developmental disorders, which are difficult to prove.