Munchausen Syndrome By Proxy

Munchausen syndrome by proxy (MSBP) is a relatively uncommon form of child abuse in which a parent either induces or fabricates an illness in a child in order to secure for himself or herself prolonged contact with health care providers. 8 Children with MSBP may arrive at the emergency department with reported symptoms such as bleeding, seizures, altered mental status, apnea, diarrhea, vomiting, fever, rash, or multiple organ system involvement. These symptoms may result from administration of agents such as warfarin or ipecac.9 Often the cases are medically perplexing, and families frequently move from hospital to hospital, seemingly in search of diagnosis. Children with MSBP are often subject to multiple unnecessary tests as physicians seek to uncover the etiology of the disorder. The parent (biologic mother in 98 percent of cases) encourages the staff to do more diagnostic procedures and often seems uncharacteristically happy if a test is positive.

Social service and psychologic evaluation is mandatory in the evaluation and management of these children, who should be admitted to the hospital both to assure their safety and to institute needed therapy. Covert video surveillance has been used in some centers to document a parent's invasive actions. 10

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