Munchausen syndrome by proxy and intra-alveolar haemosiderin

Munchausen syndrome by proxy is characterised by the invention of a false history and/or the deliberate inducement of a factitious illness by parents in their child. First reported as a disorder of mothers, this syndrome is now recognised to have male perpetrators. One of the most common characteristic presentations is with the child allegedly suffering repeated apnoeic attacks. These are in fact deliberately induced episodes of upper airway obstruction. The children of these parents are at great risk of serious harm or death if not recognised. The identification of smothering at autopsy is fraught with difficulty and the presence of intra-alveolar haemosiderin has been claimed to be a marker of previous smothering. A case of Munchausen syndrome by proxy is presented where there were deliberate acts of repeated partial smothering and where the finding of intra-alveolar haemosiderin at autopsy provided additional supportive evidence of smothering.

Munchausen syndrome by proxy unmasked by nasal signs

The protean manifestations of child abuse continue to cause diagnostic difficulty. Recent observations of the high mortality in victims of Munchausen syndrome by proxy, and their siblings, reinforce the need for early diagnosis and appropriate intervention. We report the nasal manifestations which unmasked Munchausen syndrome by proxy in an infant who presented with intestinal and peri-orifical signs masquerading as Crohn's disease. The possibility of Munchausen syndrome by proxy should be considered in an infant with persistent nasal excoriation presenting as part of an undiagnosed illness.

Physical abuse of children. A retrospective review and an otolaryngology perspective

Child abuse is a common problem seen by practicing physicians. To further define the incidence and the type of head and neck injury in children referred for evaluation of child abuse, a 5-year retrospective study of 4340 patients was undertaken. Of these patients, 2950 (68%) were victims of sexual abuse, while 1390 (32%) were victims of physical abuse. Forty-nine percent of patients abused physically had evidence of injury to the head and neck region, while only 1% of the sexually abused children had injuries in the head and neck area. The age of the patients ranged from 1 day to 17 years, with a mean of 5.6 years. More than 150 of these children were under the age of 1 year; 180 patients were admitted. The average age of the admitted patients was 2.1 years. The alleged perpetrator, mechanism of injury, and location of injury were tabulated. There were 11 deaths in the series (1.6%). Child abuse has been defined in our institution as any injury inflicted on a child. Identification and reporting of suspected child abuse is required by law and essential for the well-being of the abused child. Recommendations are made concerning the evaluation of these children, their management, and the physician's legal responsibility to report suspected cases of child abuse.