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Journal article

The disease of deceit

Author:
GODFREY Kathryn
Journal article citation:
Nursing Times, 29.7.98, 1998, p.25.
Publisher:
Nursing Times

Discusses Munchausen's syndrome and Munchausen's syndrome by proxy.

Journal article

Malingering-by-proxy: need for child protection and guidance for reporting

Authors:
CHAFETZ Michael, DUFRENE Melissa
Journal article citation:
Child Abuse and Neglect, 38(11), 2014, pp.1755-1765.
Publisher:
Elsevier

The feigning of disabling illness for compensation at the direction or pressure by others is called malingering by proxy (MBP). Chafetz and Prentkowski (2011) suggested that MBP has the potential for real harm to the child. In a poster at the AACN scientific session in 2011, Chafetz and Binder (2011) pursued a case of MBP that showed the child had clearly suffered and failed to progress in the 6 years that had passed since she was first evaluated as an 11 year old. This article identifies three cases that compare and contrast effects of MBP, illustrating that child abuse and/or neglect can be a serious and reportable consequence of MBP behaviour. To illustrate how MBP behaviour can cause child abuse, we compare MBP behaviour with Munchausen Syndrome by Proxy (MSBP), another condition of volitional noncredible behaviour produced in a vulnerable person at the direction or pressure by others. Guidance criteria for reporting MBP as child abuse/neglect are introduced in this article. (Edited publisher abstract)

Journal article

Fabricated or induced illness in children: a narrative review of the literature

Author:
LAZENBATT Anne
Journal article citation:
Child Care in Practice, 19(1), 2013, pp.61-77.
Publisher:
Taylor and Francis

Fabricated or induced illness by carers (FII) occurs when a caregiver (in 93% of cases, the mother) misrepresents their child as ill either by fabricating, or much more rarely, producing symptoms and then presenting the child for medical care, disclaiming knowledge of the cause of the problem. Although FII is uncommon, it has high morbidity, and is often not recognised until the child has suffered a great deal, both physically, and emotionally. The growing body of literature on FII reflects the lack of clarity amongst professionals as to what constitutes FII, the difficulties involved in diagnosis, and the lack of research into psychotherapeutic intervention with perpetrators. This lack of clarity further complicates the identification, management and treatment of children suffering from FII and may result in many cases going undetected, with potentially life-threatening consequences for children. This paper highlights and discusses: the controversies and complexities of this condition, the risks to the child and how it affects children; the paucity of systematic research regarding what motivates mothers to harm their children by means of illness falsification; how the condition should be managed and treated for both mother and child; and implications for policy and practice.

Journal article

Malicious use of nonpharmaceuticals in children

Author:
YIN Shan
Journal article citation:
Child Abuse and Neglect, 35(11), November 2011, pp.924-929.
Publisher:
Elsevier

The US National Poison Data System is a database of all calls made to poison centres. Using data from the system, this retrospective study examined reported nonpharmaceutical (such as cleaning substances, cosmetics and pesticides) exposures involving children up to 7 years old, where the reason for exposure was coded as "malicious" (that is, resulting from another person's intent to harm the victim). The article reports on the analysis and results, covering age, gender, outcome and substances, with a table of the most commonly reported major category groups of nonpharmaceuticals and generic categories within each group. Over the period 2000 to 2008 a total of over 4,000 cases met the inclusion criteria, with an average of 450 cases of malicious administration of nonpharmaceuticals to young children being reported per year. The author concludes that malicious administration of nonpharmaceuticals is an important component of child maltreatment and that clinicians should consider the possibility of child abuse in such cases.

Book

Executive summary: Child EQ

Author:
NEATH PORT TALBOT SAFEGUARDING CHILDREN BOARD
Publisher:
Neath Port Talbot Safeguarding Children Board
Publication year:
2011
Pagination:
15p.
Place of publication:
Neath

This executive summary reports the serious case of review relating to Child EQ who was identified as being the victim of fabricated or induced illness. EQ was the first born child of a mother aged 20 years and a father aged 24 years. The mother was reported to be a childcare worker. Between the ages of 3 and 9½ months, Child EQ had 25 separate medical assessments including 8 admissions to hospital and 7 Out of Hours emergencies including presentations at A and E. The presenting concerns included vomiting, diarrhoea, skin rashes, possible lactose intolerance, wheezes and coughs, possible asthma. At 9 ½ months Child EQ was taken to hospital following a convulsion. A toxicology report revealed the presence of prescription medication, which would be for adult use only. Child EQ was then accommodated with foster carers with the parents’ agreement under section 20 of the Children Act 1989 and is safe and well. The parents were subsequently arrested although a police investigation was unable to establish a burden of proof sufficient to meet the thresholds for a criminal prosecution. The Serious Case Review commissioned by Neath Port Talbot Safeguarding Children Board recommended that the lessons from this case be disseminated to all staff through single and multi agency training on the issues involved with fabricated illness.

Journal article

Psychopathology of perpetrators of fabricated or induced illness in children: case series

Authors:
BASS Christopher, JONES David
Journal article citation:
British Journal of Psychiatry, 199(2), August 2011, pp.113-118.
Publisher:
Royal College of Psychiatrists

Munchausen's syndrome by proxy is a rare form of child abuse. However, little is known about the psychopathology of the perpetrators. This paper investigated the medical, psychiatric, social work and forensic records of mothers referred for detailed psychiatric assessment from 1996 to 2009. Participants included 28 individuals with a diagnosis of fabricated or induced illness were referred to the authors for detailed psychiatric assessment. Findings revealed that 57% had evidence of a current somatoform disorder, and factitious disorders were identified in 64%. There was evidence of pathological lying in 61%. A chronic somatoform disorder or factitious disorder was detected in almost two-thirds of the participants. Over half of the mothers exhibited pathological lying, in some dating from adolescence, and this often continued into adult life. The authors concluded that psychiatrists should always be aware of the potential impact of these illnesses on any dependent children.

Journal article Full text available online for free

A tough case to prove

Author:
GRIFFITHS Julie
Journal article citation:
Community Care, 10.6.10, 2010, pp.16-17.
Publisher:
Reed Business Information

Fabricated or induced illness, sometimes known as Munchausen syndrome by proxy, is a rare form of child abuse where the carer fakes or causes the symptoms of illness in a child. The author discusses this type of abuse, the difficulties of diagnosising fabricated or induced illness, and how to approach a suspected case.

Journal article

Beyond Munchausen by proxy: a proposed conceptualization for cases of recurring, unsubstantiated sexual abuse allegations

Author:
LINDAHL Mary W.
Journal article citation:
Journal of Child Sexual Abuse, 18(2), March 2009, pp.206-220.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

In the emerging literature, cases involving recurring, unsubstantiated allegations of child sexual abuse have generally been categorised as Munchausen by proxy. Recent scholars have recommended restricting the label to the original conceptualisation, involving purposeful deception motivated by psychological needs for medical attention. This leaves many cases unclassified that do not fit the Munchausen by proxy criteria, involve significant risks to the child, and ultimately fall outside of existing structures for Child Protective Services/legal intervention. This paper presents a reconceptualisation of such cases, proposing to label them “recurring sexual abuse allegation” cases. Defining the set of cases more clearly can aid child protection workers in their management and encourage research on prevalence, consequences to children, treatment strategies, and needed legal reforms.

Journal article

Recurrent caustic esophagitis: a clinical form of Munchausen syndrome by proxy

Authors:
CLIN Benedicte, et al
Journal article citation:
Child Abuse and Neglect, 33(5), May 2009, pp.293-295.
Publisher:
Elsevier

This short article is about Munchausen syndrome by proxy (MSBP) also known as illness fabricated or induced (FII). The authors report a case involving a 9 month old infant suffering from caustic oesophagitis following administration by the child's mother of an anti limescale agent in her food. The authors had not identified any other cases of poisoning with caustic substances in the medical literature.

Journal article

Characteristics of hospital-based Munchausen Syndrome by Proxy in Japan

Authors:
FUJIWARA Takeo, et al
Journal article citation:
Child Abuse and Neglect, 32(4), April 2008, pp.503-509.
Publisher:
Elsevier

This article explores characteristics of Munchausen Syndrome by Proxy (MSBP) in Japan, a country which provides an egalitarian, low cost, and easy-access health care system. 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 cases for whom they had helped care. Twenty-one MSBP cases (20 families) were reported. Characteristics of the victims included: no differences based on sex, 4.6 years of age on average when MSBP was confirmed, and an average of 1.9 years duration of MSBP abuse. Biological mothers were at least one of the perpetrators in 95% of cases. Among the 12 cases (57%) who remained with their families, 2 victims died. Only 5% of perpetrators had a medical background or relatives who engaged in healthcare work. There are similar features of MSBP cases between Japan and other English-speaking countries, such as the UK or the US. However, perpetrators of MSBP in Japan did not have a medical background. Easier access to hospital resources in Japan may give greater opportunities for perpetrators to obtain medical knowledge from doctors or nurses. The findings suggest that perpetrators of MSBP should not be assumed to possess a medical background in a country which provides universal medical care such as Japan. A contributory factor of MSBP may be the high frequency of medical consultations and equal level of accessibility of medical resources for Japanese citizens. Social welfare services that need to decide on custody for MSBP victims should recognize the relatively high risk of life-threatening danger in their family of origin. Further collaboration between hospital staff including paediatricians, nurses, medical social workers and staff at the social welfare services is needed to protect children from MSBP.

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