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Spectrum of parental behaviour in Munchausen syndrome by proxy (MSBP). *Adapted from Eminson and Postlethwaite.6
Source publication
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.
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...
Citations
... The sample size ranged from 19 21 to 1,200 47,48 participants. Regarding the professionals included, 24 studies with physicia ns 14,19,25,26,28,[30][31][32][34][35][36][37][42][43][44][45][46]49,51,57,59,61,63 , three studies with speech therapists 7,15,29 , 38 studies with denti sts 13,[16][17][18][19][20][21][22][23][24][25][26][27][28][32][33][34][35][36][37][38][39][40][41]45,47,48,[50][51][52][53][54][55][56][57][58]60,62 , and a study with psychologists (45). The year of publication of these studies ranged from 1978 43 to 2022 54,62 . ...
... Regarding the overall risk of bias, of the 52 studies included in this review, nine were classified as low risk of bias 7,29,36,37,41,51,54,60,62 , 28 were classified as moderate risk of bias [15][16][17][18]21,[23][24][25][26][30][31][32][33][34]36,39,40,[44][45][46]48,49,52,53,55,58,61,65 , and 15 as high risk of bias 14,19,20,22,27,35,38,42,43,47,50,56,57,59,63 (Appendix 3, available at: https://doi.org/10.48331/scielodata.159ACH). ...
... Regarding the identification or suspicion of cases of violence against children and adolescents, most studies were carried out with denti sts 13,[16][17][18][19][20][21][22][23][24][25][26][27][28][32][33][34][35][36][37][38][39][40][41]45,47,48,[50][51][52][53][54][55][56][57][58]60,62 and physicians 14,19,25,26,28,[30][31][32][34][35][36][37][42][43][44][45][46]49,51,57,59,61,63 . The professionals with the highest rates of suspicion, identification, and notification of cases were doctors and dentists. ...
This article aims to analyze the prevalence of reporting and notification of violence in children and adolescents in the work of clinical health professionals. The search was performed in six electronic databases and the gray literature for studies published until June 1, 2022. Estimates of interest were calculated using random effects meta-analyses. Two reviewers independently evaluated the potentially eligible studies according to the following criteria: cross-sectional studies carried out with health professionals who provided clinical care for children and adolescents and dealt with violence cases. Two reviewers extracted data on included trial characteristics, methods, and outcomes. Expectations of interest were transformed using random effects meta-analyses. The meta-analysis of the prevalence of reports of violence performed with 42 articles was 41%. The notification meta-analysis occurred with 39 articles and was 30%. About one in two health professionals face situations of violence against children and adolescents in their clinical practice (41%), and approximately one in three health professionals report the cases (30%).
... Physical abuse is most common in children under the age of five, and victims may visit PEDs with various symptoms [9,12,13]. In our study, physically abused patients had various skin lesions, fractures, internal organ injuries, central nervous system injuries, genital lesions, and out-of-hospital arrest, and 42 of them (46.6%) were under the age of five. ...
... In our study, 12 (3.2%) patients were admitted to PED with various complaints of recurrent bleeding and fever and 1 15/F Admissions with complaints of recurrent abdominal pain due to family pressure to get married 2 10/F Recurrent pseudoseizure admissions due to abuse by stepfather 3 4 m/M Admission due to being found with a bottle tied to his mouth on the patient bed in the emergency service observation room 4 17/M Admission due to recurrent cologne drinking as a result of trauma after sexual abuse 5 2/F Recurrent admissions of a home care patient with a tracheostomy who is weaned off the ventilator 6 9 m-2/M The same patient admitted with a pacifier string wrapped around his neck, and the patient had a clothesline wrapped around his neck 7 5/M Admission with a diaper on because the baby is not yet toilet trained 8 12/F Although had no complaint before sexual abuse, admitted for the last year due to incontinence 9 9/M Admission as a result of the teacher noticing that the father was punishing his child by pressing his child's legs with a spoon 10 14/F Admission with hallucinations that started with staying with uncle because school was closer to uncle's house 11 12/M Admission with adrenal crisis due to a diagnosis of adrenal insufficiency and lack of medication 12 16/F Diabetes mellitus diagnosis and admission with ketoacidosis due to lack of insulin administration 13 13/M Admission with epilepsy diagnosis and lack of medication 14 1/M Admission as a result of recurrent hematemesis complaint and contamination of the caregiver's blood into the child's mouth were diagnosed with MCA during the follow-up period. In cases where recurrent nose, mouth, and urinary bleeding are reported that are incompatible with the clinical findings, it would be beneficial for these patients to be hospitalized, to be diagnosed during the follow-up period, and to be monitored by the Child Protection Unit. ...
Child abuse and neglect includes any behavior that harms the child or hinders the child’s development. The aim of this study was to determine the demographic and clinical characteristics of patients with suspected child abuse or neglect in the pediatric emergency department. Between July 2017 and July 2022, patients admitted to our pediatric emergency department and consulted to the medical social services unit with a preliminary diagnosis of neglect and/or abuse were retrospectively scanned through the registry system. The patients were divided into five groups according to their victimization: physical, sexual, and emotional abuse; neglect; and medical child abuse (MCA)—Munchausen by proxy. A total of 371 children were included in the study. Two hundred twenty-two (59.8%) of the patients were female and the median age was 161 months [IQR (46–192)]. Then, 56.3% of the patients were in the adolescent age group. The most common admission time period was between 16.00 and 24.00 (n 163, 43.9%). Then, 24.2% of the patients were exposed to physical abuse, 8.8% to sexual abuse, 26.1% to emotional abuse, 50.4% to neglect, and 3.2% to MCA. One hundred eight (29.1%) patients were followed up as inpatients in the pediatric intensive care unit. Four of the patients (1%) had out-of-hospital cardiac arrest, and the deaths were in patients under 2 years of age.
Conclusion: Pediatric emergency departments are one of the important units visited by child maltreatment patients. Victimized children may reflect their silent screams with various clinical presentations. Infants are at the greatest risk of suffering serious or fatal injuries. Health professionals working in the emergency department have an important role in detecting, treating, and preventing recurrence of child neglect and abuse. What is Known:
• The pediatric emergency department is an important entry point in the health care system for children who experience maltreatment.
• It has a wide spectrum of physical, sexual, emotional abuse and neglect.
What is New:
• A high index of suspicion is required to diagnose cases of child maltreatment.
• Infants are at the greatest risk of suffering serious or fatal injuries.
... In our study, it was observed that there were admissions due to various skin lesions, fractures, internal organ injuries, central nervous system injuries, genital lesions and out-of-hospital arrest. Physical abuse is most common in children under the age of 5 (13). In our study, 42 (46.6%) ...
... Skull fractures may be due to abuse in childhood or may be accidental. The probability of abuse in skull fractures has been reported as 30% (13). In our study, 4 (1.0%) patients had skull fractures. ...
The aim of this study is to determine the demographic and clinical characteristics of patients suspected of child abuse or neglect in the pediatric emergency department and to draw attention to this issue, which poses a great threat to the development of children. Between July 1, 2017 and July 1, 2022, the files of 851 patients who were admitted to the emergency department of a tertiary children's hospital without a trauma center and reported to the medical social services unit with a preliminary diagnosis of neglect and/or abuse were retrospectively scanned through the registry system. The patients' age, gender, time period when they were admitted to the hospital, reason for admission, presence of recurrent admission for different reasons suggestive of maltreatment, physical examination findings, forensic reports, management of the patients, and outcome were recorded. The patients were divided into five groups according to their victimization: physical, sexual and emotional abuse, neglect and Medical Child Abuse (MCA) - Munchausen by Proxy. A total of 371 children who were found to have been subjected to child maltreatment were included in the study. 222 (59.8%) of the patients were female and the median age was 161 months [IQR (46–192)]. 56.3% of the patients were in the adolescent age group. The most common admission time period was between 16.00 and 24.00, 163 (43.9%). 24.2% of the patients were exposed to physical abuse, 8.8% to sexual abuse, 26.1% to emotional abuse, 50.4% to neglect, and 3.2% to MCA. 108 (29.1%) patients were followed up as inpatients in the pediatric intensive care unit. 4 of the patients (1%) had cardiac arrest outside the hospital, and the deaths were in patients under 2 years of age. Conclusion: Pediatric emergency departments are the units most frequently visited by patients suffering from child maltreatment. Victimized children may try to make their silent screams heard through different clinical presentations. Babies are at the greatest risk of suffering serious or fatal injuries. Health professionals working in the emergency department have an important role in detecting, treating and preventing recurrence of child neglect and abuse. Emergency department physicians must be able to hear these screams of patients while struggling with the dense crowd.
... There have been studies of the annual incidence of factitious disorder imposed on another in the general population in both the United Kingdom and New Zealand. In New Zealand, the annual incidence of factitious disorder imposed on another in children less than 16 years was found to be 2.0/100,000 (18 total cases) (Denny et al., 2001). In the United Kingdom, the annual incidence in children under 16 was 0.5/100,000 (128 total cases) (McClure et al., 1996). ...
... In Rosenberg's (1987), survey of 117 victims, there was a 9% mortality rate, and of the 54 victims of the disorder in the apnea survey, three index cases and five siblings were dead at the follow-up (Kravitz & Wilmott, 1990). McClure et al. (1996) found that 8 of 128 index cases in the United Kingdom were fatal (6.25%) while Denny et al. (2001) reported no fatalities in 18 index cases. Sheridan (2003) reviewed 451 reported cases of factitious disorder imposed on another and found a 6% mortality rate and 7% rate of long-term or permanent disability. ...
... Στη πλειοψηφία των περιστατικών το παιδί είναι συνήθως μικρότερο από 2 ετών και σπάνια μεγαλύτερο των 6 ετών, ενώ ο μέσος όρος ηλικίας όταν αποκαλύπτεται η κακοποίηση και πραγματοποιείται η διάγνωση είναι οι 39,8 μήνες, περίπου στα 3 χρόνια. Δεν είναι όμως λίγες οι υποθέσεις που έχουν καταγραφεί στις οποίες η ηλικία των παιδιών κατά τη διάρκεια της κακοποίησης/παραμέλησης έφτανε μέχρι και τα 16 έτη (Denny et al., 2001;Fulton, 2000). Από την άλλη πλευρά το μεγαλύτερο ηλικιακά θύμα εμπλέκεται ενεργά ή παθητικά στο παρουσιαζόμενο υγειονομικό προφίλ και στην εξαπάτηση των επαγγελματιών υγείας. ...
Η παρούσα εργασία πραγματεύεται το ζήτημα της παιδικής κακοποίησης και εστιάζει σε μία ειδική μορφή σωματικής κακοποίησης, το σύνδρομο Munchausen Δι’ Αντιπροσώπου.
Στο πρώτο μέρος της Πτυχιακής παρέχεται βιβλιογραφική ανασκόπηση για την ολιστική προσέγγιση του θεωρητικού υπόβαθρου καθώς και την αποτύπωση μίας ολοκληρωμένης εικόνας αυτού του κοινωνικού φαινομένου με απώτερο στόχο την ενδελεχή πληροφόρηση των κοινωνικών λειτουργών για την ιδιαίτερη φύση και πολυπλοκότητα του.
Στο δεύτερο μέρος ακολουθεί ερευνητική μελέτη στην οποία διερευνάται το επίπεδο γνώσης των κοινωνικών λειτουργών -στον ελλαδικό χώρο- αναφορικά με το συγκεκριμένο αυτό σπάνιο σύνδρομο και επιχειρείται μέσω της κλινικής τους εμπειρίας η επιβεβαίωση προηγούμενων ερευνητικών ευρημάτων συναφών μελετών στο εξωτερικό αλλά και πιθανή ανακάλυψη νέων ευρημάτων. Από μεθοδολογικής πλευράς χρησιμοποιήθηκε η μέθοδος του αυτο-συμπληρούμενου ερωτηματολογίου το οποίο απαντήθηκε από κοινωνικούς λειτουργούς Ιδιωτικού Τομέα, Δημοσίου Τομέα και ΜΚΟ διαφόρων περιοχών της Ελλάδας.
... Síndrome de Munchausen por procuração (MSBP), descrita pela primeira vez por Meadow em 1977, tem os mesmos propósitos relatados anteriormente, porém, é uma transferência desses desejos a um terceiro. Ela é definida por um abuso na infância cometido por um cuidador através da fabricação de doenças em uma criança com o objetivo de excessivo cuidado médico à vítima [2] . Os dados epidemiológicos raramente estão disponíveis, e, na maioria, são variáveis. ...
... A incidência de MSBP em crianças com menos de 16 anos foi de 2,0 /100.000 [2] ; MSBP mostrou uma prevalência de 0,53% [1] . ...
... de caso de proteção (ou porque a criança não estava mais em risco ou havia morrido) e as grandes diferenças regionais [3] ; e) O trauma pelos profissionais da saúde de aparições em tribunal, caso essa forma de abuso infantil seja notificada e avaliada em tribunal e necessite do comparecimento do médico; f ) Dificuldades nessa abordagem, principalmente para pediatras em ambientes remotos e/ou isolados; g) envolvimento de médicos não familiarizados com MSBP pode, em alguns casos, piorar o gerenciamento, pois esses cuidadores são notórios por "dividir" as equipes e gerar incertezas no diagnóstico [2] ; h) a falta de uma análise cuidadosa de toda a história médica e comportamentos da mãe-filho, pois é necessária uma equipe multidisciplinar bem treinada e consciente para diagnosticar [1] ; i) omissão pelos profissionais da saúde da doença factícia no diagnóstico diferencial [4] . ...
A disponibilidade de vários exames e procedimentos médicos, sintomas subjetivos resistentes ao tratamento, um desejo da classe médica de descartar todas as causas médicas potenciais e a falta de informação sobre a Síndrome de Munchausen por procuração (MSBP) são algumas das razões para um diagnóstico tardio. Objetivo: Realizar uma revisão sistemática da literatura sobre a importância da informação dos profissionais da saúde sobre a MSBP. Métodos: Uma revisão sistemática da literatura foi realizada, através da base de dados PUBMED. Foi utilizado o protocolo PRISMA para realização desta revisão. Resultados: Dos 117 artigos encontrados, 8 foram selecionados para o artigo. Discussão: Apesar de alguns estudos relatarem o aumento do conhecimento pelos profissionais da saúde sobre a MSBP, existe uma subestimação de casos. Conclusões: Um dos motivos para a subestimação é a falta de informação dos profissionais da área da saúde sobre essa síndrome.
... 12 A New Zealand study reported a higher rate of 2/100 000 but even this incidence is now regarded as an underestimate. 13 One study from Italy suggests that the previous epidemiological studies were the 'tip of the iceberg'. They identified 4 cases in 751 acute paediatric admissions (0.53%). ...
... Annelerin sağlık çalışanları ile birlikte olmaktan hoşlandıkları ve aralarındaki iyi iletişimin istismarın devamı konusunda bir motivasyon kaynağı olduğu düşünülmektedir. 11, 31,41,42,[46][47][48][49][50][51][52][53][54] Yapılan çalışmalarda Munchausen by Proxy Sendromu tanısı almış ailelerin % 40'ında evliliğe ilişkin problemler yaşandığı belirtilmiştir. Sağlık sorunlarının aile sisteminde ailenin işlevselliğini koruyan, çatışma ve problem durumlarını önleyen bir işlevinin olabileceği vurgulanmaktadır. ...
... Ancak doğumdan ergenlik dönemine kadar vakaların olduğu da belirtilmektedir. 31,37,42,43,47,50,[59][60][61][62] Küçük yaş grubu çocukların tercih edilmesinde bu çocukların yetişkin bakımına muhtaç olmalarının etken olduğu düşünülebilir. Bu yaş grubundaki çocukların kendilerini ve durumu ifade etme becerilerinin olmayışı veya yetersiz oluşu belirti ve bulguların daha rahat oluşturulmasına ve sendrom sürecinin uzamasına neden olabilmektedir. ...
ZET Çocukluk doğumdan 18 yaşa kadar olan süreci kapsayan bir dönemdir ve çocuğun bu dönemde korunup, sağlıklı gelişim göstermesi için uygun koşulların sağlanması ve desteklenmesi gerekir. Bu koşulların sağlanmasından birincil derecede sorumlu olan aile her zaman bu olumlu koşulları sağlama konusunda yeterli olamamakta, çocuk ve gelişimi üzerinde yarattığı olumsuz koşullarla ihmal ve istismara neden olabilmektedir. Çocuğun ihmal veya istismar edilmesinin, gelişim alanları üzerinde kısa ve uzun vadede kalıcı izler bıraktığı bilinmektedir. Çocuk ihmal ve istismarı farklı formlarda ortaya çıkabilir. 1977 yılında Meadow tarafından tanımlanan Munchausen by Proxy Sendromu (Bir Başkasına Yüklenen Yapay Bozukluk), çocuğun bakımından sorumlu olan yetişkinin çocukta hastalık belirti ve bulgularını yaratıp, çocuğu gereksiz tıbbi uygulamalara maruz bırakması olarak tanımlanan bir çocuk istismarı türüdür. İstismar süreci, çocuğun tıbbi tetkik ve müdahaleler, invazif işlemler sırasında fiziksel olarak kalıcı, hatta ölümcül de olabilecek pek çok durumla sonuçlanabilmektedir. Bu nedenle bu çalışmada Munchausen by Proxy Sendromu ile ilişkili etmenlerin, çocukların ve uygulayıcıların ortak özelliklerinin ortaya konulması amaçlanmıştır. Bu sendromun ortaya konmasının tanınması, önleyici çalışmalara yer verilmesi ve bundan sonra yapılacak çalışmalara yol göstermesi noktasında önemli olacağı düşünülmektedir. Abstract Childhood is the age span comprising the period from birth to 18 years of age. A childneeds protection, suitable conditions and support forhealthy development. Although parents are primarily responsible for the provision of these conditions, they sometimes fail in their responsibility and the resulting 1
... MCA was once believed to be a rare form of abuse, but surveys administered to pediatricians in recent decades have shown prevalence rates that range from 0.002% to 0.27% (Denny, Grant, & Pinnock, 2001;Light & Sheridan, 1990;McClure et al., 1996). Studies conducted in specialist settings or inter-disciplinary settings return the highest estimates: 1%-13% ( Ferrara et al., 2013;Godding & Kruth, 1991;Rahilly, 1991;Warner & Hathaway, 1984). ...
Introduction:
Little is known about the perpetrators of medical child abuse (MCA) which is often described as "Munchausen's syndrome by proxy" or "factitious disorder imposed on another". The demographic and clinical characteristics of these abusers have yet to be described in a sufficiently large sample. We aimed to address this issue through a systematic review of case reports and series in the professional literature.
Method:
A systematic search for case reports and series published since 1965 was undertaken using MEDLINE, Web of Science and EMBASE. 4100 database records were screened. A supplementary search was then conducted using GoogleScholar and reference lists of eligible studies. Our search yielded a total sample of 796 perpetrators: 309 from case reports and 487 from case series. Information extracted included demographic and clinical characteristics, in addition to methods of abuse and case outcomes.
Results:
Nearly all abusers were female (97.6%) and the victim's mother (95.6%). Most were married (75.8%). Mean caretaker age at the child's presentation was 27.6 years. Perpetrators were frequently reported to be in healthcare-related professions (45.6%), to have had obstetric complications (23.5%), or to have histories of childhood maltreatment (30%). The most common psychiatric diagnoses recorded were factitious disorder imposed on self (30.9%), personality disorder (18.6%), and depression (14.2%).
Conclusions:
From the largest analysis of MCA perpetrators to date, we provide several clinical recommendations. In particular, we urge clinicians to consider mothers with a personal history of childhood maltreatment, obstetric complications, and/or factitious disorder at heightened risk for MCA. Longitudinal studies are required to establish the true prognostic value of these factors as our method may have been vulnerable to publication bias.
... Annelerin sağlık çalışanları ile birlikte olmaktan hoşlandıkları ve aralarındaki iyi iletişimin istismarın devamı konusunda bir motivasyon kaynağı olduğu düşünülmektedir. 11, 31,41,42,[46][47][48][49][50][51][52][53][54] Yapılan çalışmalarda Munchausen by Proxy Sendromu tanısı almış ailelerin % 40'ında evliliğe ilişkin problemler yaşandığı belirtilmiştir. Sağlık sorunlarının aile sisteminde ailenin işlevselliğini koruyan, çatışma ve problem durumlarını önleyen bir işlevinin olabileceği vurgulanmaktadır. ...
... Ancak doğumdan ergenlik dönemine kadar vakaların olduğu da belirtilmektedir. 31,37,42,43,47,50,[59][60][61][62] Küçük yaş grubu çocukların tercih edilmesinde bu çocukların yetişkin bakımına muhtaç olmalarının etken olduğu düşünülebilir. Bu yaş grubundaki çocukların kendilerini ve durumu ifade etme becerilerinin olmayışı veya yetersiz oluşu belirti ve bulguların daha rahat oluşturulmasına ve sendrom sürecinin uzamasına neden olabilmektedir. ...
