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Abraham-Bizot A, Greco C, Quartier P, Loschi S, Soyeux E, Ikowsky T, Lambert AS, Reiter F, Mikaeloff Y, Kone-Paut I. Medical child abuse: Medical history and red flags in French adolescents. CHILD ABUSE & NEGLECT 2023; 146:106523. [PMID: 37950944 DOI: 10.1016/j.chiabu.2023.106523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Medical child abuse (MCA; or Munchausen syndrome by proxy) is a severe form of adult and medical maltreatment of children. Currently, few data on MCA in adolescents exist. OBJECTIVE To describe the clinical characteristics and medical history of children and adolescents aged 10 to 18 years with suspected or confirmed MCA in the pediatric hospital setting. METHODS We included patients aged 10 to 18 years who were seen in five tertiary care hospitals in the Paris area and identified by physician recall such as suspected MCA between 2015 and 2021. RESULTS We included 29 adolescents; the mean (SD) age was 12.9 (10.8-15.0) years at suspected diagnosis. Medical wandering was common, with a mean of 23 (12.8-33.2) alleged symptoms and 33 (9.2-56.8) specialized consultations in a mean of six different hospitals. The mean number of emergency visits was 11.8 (0-25.9) and radiologic exams 24.3 (5-43.6). Overall, 62 % (18/29) of the adolescents had an underlying organic pathology. The impact of MCA on quality of life was major, with a high rate of school dropout (96 %). The mean delay to the suspected diagnosis was 5.8 (2.6-9) years, and even when recognized, it was rarely the subject of a social or judiciary report (only 42 % of adolescents). In total, 50 % of the adolescents subsequently exhibited Munchausen syndrome. CONCLUSION Adolescent MCA is poorly known among the medical profession. Increasing awareness, education and knowledge of risk factors could contribute to better care.
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Affiliation(s)
- Alexia Abraham-Bizot
- Adolescent Medicine Department, APHP Hôpital Bicetre, Le Kremlin Bicêtre, France.
| | - Céline Greco
- Department of Pain and Palliative Care Unit, APHP, Hôpital Necker-Enfants Malades, F-75015 Paris, France; IMAGINE Institute, INSERM, U1163, Université Paris Cité, F-75015 Paris, France
| | - Pierre Quartier
- Pediatric Immunology-Hematology and Rheumatology Unit, RAISE Rare Disease Reference Centre, IMAGINE Institute, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université Paris Cité, France
| | - Solène Loschi
- Pediatric Emergency Department, APHP Hôpital Armand Trousseau - Sorbonne Université, INSERM UMR1153, Paris, France; Child protection Team, PEPS, APHP Hôpital Armand Trousseau - Sorbonne Université, France
| | - Esther Soyeux
- Department of Pain and Palliative Care Unit, APHP, Hôpital Robert Debré, Paris, France
| | - Tania Ikowsky
- Child protection Team, ESPER, APHP Hôpital Robert Debré, Paris, France
| | - Anne-Sophie Lambert
- Pediatric Endocrinology Department, APHP Hopital Bicetre, Le Kremlin Bicêtre, France
| | - Florence Reiter
- Pediatric Pain Unit, APHP Hôpital Armand Trousseau, Paris, France
| | - Yann Mikaeloff
- CESP, INSERM U1018, UFR Médecine, Université Paris-Saclay, F-91190 Gif-sur-Yvette, France; Child and adolescent protection Centre, APHP Hôpital Paul Brousse, Villejuif, France
| | - Isabelle Kone-Paut
- Pediatric rheumatology department and CEREMAIA, APHP Hôpital Bicêtre, Le Kremlin Bicêtre, France
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Vega S, Nienow SM, Huang MZ, Stover LB. Medical Child Welfare Task Force: A Multidisciplinary Approach to Identifying Medical Child Abuse. Pediatrics 2023; 151:190491. [PMID: 36655381 DOI: 10.1542/peds.2022-058926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 01/20/2023] Open
Abstract
Medical child abuse is a complex form of maltreatment with powerful and long-lasting impacts on the overall health of affected children. The complexity of this condition renders it challenging for clinicians to recognize its presence and intervene appropriately. The failure of medical systems to identify and deescalate care in this form of maltreatment can result in grievous patient harm. Although the medical literature provides limited guidance on how to address these multifaceted cases, several studies advocate for a multidisciplinary approach. Following a severe and chronic case of medical child abuse at our institution, deficits in response became clear within our hospital system. In reaction to these gaps, the Medical Child Welfare Task Force was developed to formalize education and multidisciplinary collaboration around medical child abuse. The support of institutional leadership and the involvement of multiple medical disciplines that commonly encounter these patients was vital to the implementation and long-term success of the endeavor. To facilitate case identification, education was provided to clinicians in a variety of forums. Moreover, we leveraged the electronic medical record to streamline our ability to monitor cases of medical child abuse and communicate the concerns and plan of care to other providers, both within and outside of our health system. A postimplementation survey determined that the establishment of a multidisciplinary team increased provider comfort and skill in identifying and managing cases of suspected medical child abuse.
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Affiliation(s)
- Sarah Vega
- Child Abuse Pediatrics Division.,Department of Pediatrics, University of California, San Diego, California
| | - Shalon M Nienow
- Child Abuse Pediatrics Division.,Department of Pediatrics, University of California, San Diego, California
| | - Maria Z Huang
- Pediatric Hospital Medicine Division, Rady Children's Hospital, San Diego, California.,Department of Pediatrics, University of California, San Diego, California
| | - Laurie Bernard Stover
- Pediatric Hospital Medicine Division, Rady Children's Hospital, San Diego, California.,Department of Pediatrics, University of California, San Diego, California
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Knowledge and Attitudes of Medical and Nursing Students in Greece Regarding Child Abuse and Neglect. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121978. [PMID: 36553420 PMCID: PMC9777413 DOI: 10.3390/children9121978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Data on the knowledge and attitudes of healthcare practitioners in training regarding child abuse and neglect (CAN) are scarce. The aim of this study was to investigate the knowledge and attitudes regarding CAN of medical and nursing students in Greek universities. We performed a questionnaire-based e-survey on a convenience sample of students and recruited 609 students (366 medical and 243 nursing). An unsatisfactory level of knowledge in the field was reported overall. Most of the students (92.2%) were aware of their future responsibility to protect vulnerable children and report suspected cases of CAN; at the same time, they were willing to obtain further education. Based on the above, appropriate training in the undergraduate curriculum should be developed in order to strengthen future healthcare practitioners and boost their confidence in dealing with suspected cases of CAN and protect children's welfare.
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Huang AC, Herdes RE, Yamin G, Kerner J. An Unusual Case of Thiamine Deficiency in a Total Parenteral Nutrition-Dependent Child Secondary to Munchausen by Proxy. JPGN REPORTS 2021; 2:e044. [PMID: 37206950 PMCID: PMC10191465 DOI: 10.1097/pg9.0000000000000044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/10/2020] [Indexed: 05/21/2023]
Affiliation(s)
- Alice C. Huang
- From the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Rachel E. Herdes
- From the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Ghiam Yamin
- Department of Radiology, Lucile Packard Children’s Hospital, Palo Alto, CA
| | - John Kerner
- From the Department of Pediatric Gastroenterology, Hepatology and Nutrition, Lucile Packard Children’s Hospital, Palo Alto, CA
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Abstract
Medical child abuse (MCA) continues to remain a challenging form of abuse to recognize, diagnose, and manage. The perpetrators of MCA have some common features that may heighten the suspicion that a child is the victim of MCA. Once suspected, the development of a multidisciplinary care plan that incorporates all subspecialists and health care providers involved in the child's care is essential. A structured approach to record review can clarify the concerns and discrepancies as well assist in potential future testimony. The use of overt or covert video surveillance systems are potential modalities to aid in making the diagnosis of MCA. If called to testify, it is helpful to understand the court system. Risks to the child from MCA are great and include a high level of long-term morbidity and mortality. Understanding this diagnosis and having a plan in place to address it when suspected can prevent further harm to the child. [Pediatr Ann. 2020;49(8):e354-e358.].
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Abstract
Munchausen syndrome and Munchausen syndrome by proxy are complex diseases that are difficult to diagnose and treat. To assist in this process, an overview of diagnostic criteria with common characteristics and red flags are discussed, with case studies illustrating identification and diagnosis of these disorders. Treatment options are addressed within the context of each of these complex syndromes. The provider's knowledge of diagnostic criteria and treatment options for Munchausen syndrome and Munchausen syndrome by proxy promotes better outcomes for patients. Without an early diagnosis and intervention, the patient is at high risk for severe complications, including organ failure and mortality.
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Affiliation(s)
- Brittany Abeln
- University of Arizona, College of Nursing, 1305 N. Martin Avenue, Tucson, AZ 85721, USA.
| | - Rene Love
- University of Arizona, College of Nursing, 1305 N. Martin Avenue, Tucson, AZ 85721, USA
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Moon LM, Childress KJ, Isaac R, Adeyemi-Fowode O. Medical Child Abuse: A Case Presenting as Anogenital Bleeding of Unknown Origin in an Older Child. J Pediatr Adolesc Gynecol 2018; 31:637-639. [PMID: 29990550 DOI: 10.1016/j.jpag.2018.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Medical child abuse is a challenging diagnosis to make, particularly in older children with unusual presenting symptoms. CASE A 7-year-old child with complex medical history presented with anogenital bleeding of unknown origin. Extensive laboratory testing, imaging studies, and diagnostic procedures were negative for any etiology. Forensic testing confirmed the blood in her underwear was a genetic match to the patient. Trial separation from the mother was diagnostic and therapeutic in this case. SUMMARY AND CONCLUSION Older children who are victims of medical child abuse might present in a variety of ways, and might even collaborate with the perpetrator in falsifying symptoms. It is important to keep medical child abuse on the differential when the patient's symptoms and work-up do not match.
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Affiliation(s)
- Lisa M Moon
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Krista J Childress
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Reena Isaac
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Oluyemisi Adeyemi-Fowode
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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