Munchausen Syndrome by Proxy

Baystate Medical Center, Springfield, MA, USA.
Pediatrics in Review (Impact Factor: 0.82). 10/2009; 30(10):414-5; discussion 415. DOI: 10.1542/pir.30-10-414
Source: PubMed
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Available from: Cheryl Tierney, Jul 16, 2015
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    Preview · Article · Jan 2010 · Annales de Toxicologie Analytique
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    ABSTRACT: To develop a risk-stratification tool to help identify medical child abuse (MCA) in children evaluated for failure to thrive (FTT). In this case-control study, the control group consisted of children who were seen in the pediatric gastroenterology department and diagnosed with FTT before the age of 5 years between 2000 and 2010. Cases were distinguished by having also been referred to the Child Advocacy Committee at the Cleveland Clinic Foundation (CCF) and/or reported to the Department of Child and Family Services by the CCF as a possible case of MCA. We used retrospective chart review to compare 17 cases of MCA with 68 controls. Classification-tree analysis was used to generate the risk-stratification tool. A risk-stratification tool, in the form of a classification tree, was developed and incorporated the following individual risk indicators: (1) ≥ 5 organ systems involved; (2) absence of serious congenital anomaly or confirmed genetic disorder; (3) ≥ 5 reported allergies; and (4) refusal of services from a multidisciplinary feeding team. Overall, the classification tree had a sensitivity of 100% and a specificity of 96%. The results of this study suggest that a diagnosis of MCA may be suspected in children with FTT on the basis of features in the initial presentation and clinical course. Using the proposed risk-stratification tool that incorporates these features might assist in earlier identification of medically abused children and reduce morbidity and mortality.
    Preview · Article · Dec 2011 · PEDIATRICS
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    ABSTRACT: Caregiver-fabricated illness in a child is a form of child maltreatment caused by a caregiver who falsifies and/or induces a child's illness, leading to unnecessary and potentially harmful medical investigations and/or treatment. This condition can result in significant morbidity and mortality. Although caregiver-fabricated illness in a child has been widely known as Munchausen syndrome by proxy, there is ongoing discussion about alternative names, including pediatric condition falsification, factitious disorder (illness) by proxy, child abuse in the medical setting, and medical child abuse. Because it is a relatively uncommon form of maltreatment, pediatricians need to have a high index of suspicion when faced with a persistent or recurrent illness that cannot be explained and that results in multiple medical procedures or when there are discrepancies between the history, physical examination, and health of a child. This report updates the previous clinical report "Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in the Medical SETTING:" The authors discuss the need to agree on appropriate terminology, provide an update on published reports of new manifestations of fabricated medical conditions, and discuss approaches to assessment, diagnosis, and management, including how best to protect the child from further harm.
    Preview · Article · Aug 2013 · PEDIATRICS

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