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Tüfekçi Ö, Gözmen S, Yılmaz Ş, Hilkay Karapınar T, Çetin B, Burak Dursun O, Emiroğlu N, Ören H, Irken G. A case with unexplained bleeding from multiple sites: munchausen syndrome by proxy. Pediatr Hematol Oncol 2011; 28:439-43. [PMID: 21736476 DOI: 10.3109/08880018.2011.565493] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Munchausen syndrome by proxy (MBP) is an extreme form of child abuse where children were unnecessarily treated or investigated for medical conditions that were falsified by their caregivers. Here the authors report a 16-year-old female with the complaints of bleeding from multiple and unusual sites, including hemoptysis, hematuria, bloody tears, and bloody nipple discharge, all of which are only witnessed by her mother. Extensive investigation revealed no organic etiologies for bleeding. The diagnosis of MBP was put by a multidisciplinary team. The diagnosis of MBP must be kept in mind in conditions where there is no underlying organic pathology in a bleeding patient.
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Affiliation(s)
- Özlem Tüfekçi
- Department of Pediatric Hematology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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Abstract
This syndrome is associated with a high incidence of recidivism, morbidity, and mortality.
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Affiliation(s)
- Laura Criddle
- The Laurelwood Group in Scappoose, Oregan 97056, USA.
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Kucuker H, Demir T, Oral R. Pediatric condition falsification (Munchausen syndrome by Proxy) as a continuum of maternal factitious disorder (Munchausen syndrome). Pediatr Diabetes 2010; 11:572-8. [PMID: 20149125 DOI: 10.1111/j.1399-5448.2009.00631.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Pediatric condition falsification (PCF), also known as Munchausen syndrome by Proxy or Medical Child Abuse, is a somewhat rare form of child abuse and neglect. Its association with a history of adult factitious disorder (AFD) or Munchausen syndrome in the perpetrator is also well known. Exogenous insulin injection to cause hypoglycemia both in the context of PCF and AFD has been reported in the literature. However, the coexistence of both conditions via insulin injection in the same family has not been reported in the literature. This paper presents a family, in which the mother was diagnosed with AFD and her three children with PCF perpetrated by their mother via exogenous insulin injection.
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Affiliation(s)
- Hudaverdi Kucuker
- Department of Forensic Medicine, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey.
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Su E, Shoykhet M, Bell MJ. Severe hypernatremia in a hospitalized child: munchausen by proxy. Pediatr Neurol 2010; 43:270-3. [PMID: 20837306 PMCID: PMC3095029 DOI: 10.1016/j.pediatrneurol.2010.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 04/14/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
Abstract
An 8-week-old infant presented to a referring institution with profuse diarrhea and infectious enteritis for 1 week. He was initially treated for suspected Salmonella spp. sepsis and meningitis, because the organism was found in the stool, but the child's illness progressed, manifested by paroxysmal profuse diarrhea and increased urine output. After several weeks, he suffered a sagittal venous thrombosis and intracranial hemorrhage. Subsequently the child was transferred to a tertiary center for intestinal evaluation. The patient's diarrhea and excessive diuresis resolved, and his sodium normalized soon after transfer. Four days later, however, after his mother arrived, he immediately developed severe hypernatremia (serum sodium concentration [Na(+)] = 214 mEq/L), with resumption of diarrhea and excessive diuresis. A gastric aspirate during the crisis demonstrated an extremely high sodium content, [Na(+)] = 1416 mEq/L, consistent with salt intoxication. Surveillance of the mother revealed that she manipulated the indwelling nasogastric tube; confronted, she admitted to salt administration. This case describes one of the ways that Munchausen syndrome by proxy can manifest with profound neurologic sequelae, and highlights the need for close observation and swift intervention when sufficient cause is present.
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Affiliation(s)
- Erik Su
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Michael Shoykhet
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA,Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Michael J. Bell
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA,Department of Neurological Surgery, Children’s Hospital of Pittsburgh, Pittsburgh, PA,Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA
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Abstract
In 1977, Roy Meadow, a pediatric nephrologist, first described a condition he subsequently coined Munchausen syndrome by proxy. The classic form involves a parent or other caregiver who inflicts injury or induces illness in a child, deceive the treating physician with fictitious or exaggerated information, and perpetrate the trick for months or years. A related form of pathology is more insidious and more common but also damaging. It involves parents who fabricate or exaggerate symptoms of illness in children, causing overly aggressive medical evaluations and interventions. The common thread is that the treating physician plays a role in inflicting the abuse upon the child. Failure to recognize the problem is common because the condition is often not included in the differential diagnosis of challenging or confusing clinical problems. We believe that a heightened "self-awareness" of the physician's role in Munchausen syndrome by proxy will prevent or reduce the morbidity and mortality associated with this diagnosis. In addition, we believe contemporary developments within the modern health care system likely facilitate this condition.
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Munchausen syndrome by proxy mimicking as Gaucher disease. Eur J Pediatr 2010; 169:1029-32. [PMID: 20039062 DOI: 10.1007/s00431-009-1127-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 12/07/2009] [Indexed: 10/20/2022]
Abstract
Although rare, Munchausen syndrome by proxy (MBP) is a potentially life-threatening form of child abuse. Here, we report a 19-month-old female infant who presented with hepatosplenomegaly, anemia, thrombocytopenia, and recurrent septicemia. She was initially thought to have myelodysplastic syndrome. Further hematological and immunological investigations revealed no cause. beta-Glucosylceramidase enzyme activity on dried blood spot was suggestive of Gaucher disease. However, the enzyme level on cultured skin fibroblast was not consistent with Gaucher disease. The first hint about MBP was the recurrent sepsis with numerous gram negative rods. Furthermore, the mother's behavior and health history raised our suspicion about MBP. The child showed significant improvement after she was separated from the mother for a week. Finally, the mother confessed that she was spitting in local herbs and injecting it into the central line. This is, to our knowledge, the first report of MBP resembling in its presentation Gaucher disease. This case should alert the general and specialized pediatricians about MBP, as it may mimic metabolic diseases like Gaucher disease.
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Annequin D. Syndrome de Münchausen par procuration (SMPP). Arch Pediatr 2010; 17:644. [DOI: 10.1016/s0929-693x(10)70039-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The ability to test stool for laxatives is an important part of patient care in some clinical circumstances. Some patients take or are given laxatives surreptitiously. Additionally, failure to take prescribed laxatives may result in treatment failure in children with constipation or encopresis. Although laboratory methods have been available to identify many laxatives in the stool, tests are not available for detecting polyethylene glycol (PEG)-based laxatives. PEG-based laxatives are frequently used in the treatment of children with constipation. We developed a mass spectrometry (MS)-based analysis for detecting PEG in stool and verified the technique in an adult volunteer. We then piloted the assay on stools from children taking PEG for constipation versus children with diarrhea who were not taking PEG. Eleven subjects with diarrhea and 8 receiving PEG were enrolled. Nine of the children with diarrhea and 7 receiving PEG were evaluated by MS. All 3 subjects with PEG who had a stool osmolal gap determined had elevated gaps. Stools of all 7 subjects with PEG were positive for PEG by MS, whereas none of the 9 subjects with diarrhea had stool positive for PEG. This new MS methodology to test stool for PEG is described. It is likely to prove useful in the documentation of surreptitious PEG administration and in evaluation of PEG treatment failure.
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Landgraf M, Zahner L, Nickel P, Till H, Keller A, Geyer C, Schwanitz N, Gausche R, Schmutzer G, Brähler E, Kiess W. Kindesmisshandlung. Monatsschr Kinderheilkd 2009. [DOI: 10.1007/s00112-009-2129-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Modes de présentation inhabituels de la maltraitance. Arch Pediatr 2009; 16:940-2. [DOI: 10.1016/s0929-693x(09)74211-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Expect the unexpected: favourable outcome in Munchausen by proxy syndrome. Eur J Pediatr 2008; 167:1085-8. [PMID: 17987314 DOI: 10.1007/s00431-007-0627-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 10/03/2007] [Accepted: 10/03/2007] [Indexed: 10/22/2022]
Abstract
Munchausen by proxy syndrome (MBPS) is a form of child abuse wherein the mother fabricates or produces illness in her child. The condition is hard to diagnose and few successful interventions have been described. Long-term outcome is associated with high family disruption, reabuse, mortality and morbidity. We report on a six-month-old girl that experienced eight hospital admissions within five months. Symptoms of repeated vomiting, bloody diarrhoea and acute life-threatening events (ALTE) were never substantiated. Finally, blood in diapers and napkins presented by the mother was shown to be of maternal origin. When confronted, the mother agreed to psychiatric admission. Following five months of treatment, her mental state stabilised and she entered supported living. She remained separated from the child, who was given to the father and developed normally on close paediatric follow-up. We report a definite diagnosis and successful intervention in MBPS. The case highlights characteristic features of this entity and illustrates that a favourable outcome depends on early intervention with separation of the child and perpetrator, as well as concomitant long-term psychiatric treatment.
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Asnes AG, Shenoy A. The difficult pediatric encounter: insights and strategies for the pediatric practitioner. Pediatr Rev 2008; 29:e35-41. [PMID: 18515334 DOI: 10.1542/pir.29-6-e35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
PURPOSE OF REVIEW The authors discuss the significance of studies published over the previous year regarding assessment and treatment and prevention of child maltreatment, including physical and sexual abuse, inflicted traumatic brain injury, and child neglect. RECENT FINDINGS The evidence base for many forms of child abuse is growing. As clinicians begin to understand the factors which may increase child vulnerability to abuse, more sophisticated and focused prevention efforts are being implemented. In response to a very public reprimand by the General Medical Council of two child abuse pediatricians, which was felt by many to be unwarranted, the UK government re-emphasized its commitment to the protection of children. In the US, this well-publicized set of events has renewed the medical community's commitment to the recognition of child abuse pediatrics as a formal subspecialty. Several authors detail the short-term and long-term outcome of varying forms of abuse for children as they grow into adults, reinforcing the importance of community efforts to prevent abuse and support families during times of heightened stress such as the current war in Iraq. SUMMARY The short-term and long-term impact of child maltreatment is significant not only for individuals, but for families and communities where abuse is taking place. General pediatricians have an important role to play with families and in the community as advocates for the protection of children.
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Bursch B, Schreier HA, Ayoub CC, Libow JA, Sanders MJ, Yorker BC. Further thoughts on "Beyond Munchausen by proxy: identification and treatment of child abuse in a medical setting". Pediatrics 2008; 121:444-5; author reply 445. [PMID: 18245436 DOI: 10.1542/peds.2007-3068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Brenda Bursch
- Departments of Psychiatry and Biobehavioral Sciences and Pediatrics
David Geffen School of Medicine
University of California
Los Angeles, CA 90024
| | - Herbert A. Schreier
- Department of Child Psychiatry
Children's Hospital Oakland
Oakland, CA 94609
| | | | - Judith A. Libow
- Department of Psychiatry
Children's Hospital Oakland
Oakland, CA 94609
| | - Mary J. Sanders
- Department of Psychiatry and Behavioral Science
Stanford School of Medicine
Palo Alto, CA 94301
| | - Beatrice C. Yorker
- College of Health and Human Services
California State University
Los Angeles, CA 90032
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Feldman MD, Light MJ, Lasher LJ, Sheridan MS. Beyond Munchausen syndrome by proxy. Pediatrics 2007; 120:1217-8; author reply 1218. [PMID: 17974755 DOI: 10.1542/peds.2007-1917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Marc D. Feldman
- Department of Psychiatry and Behavioral Medicine
University of Alabama
Tuscaloosa, AL 35487
| | - Michael J. Light
- Department of Pediatrics
Miller School of Medicine
University of Miami
Miami, FL 33136
| | | | - Mary S. Sheridan
- Department of Social Work
Hawaii Pacific University
Honolulu, HI 96813
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