February/March 2002Vol. 3, No. 2Journal Article Offers Overview of Munchausen Syndrome by Proxy

Munchausen syndrome by proxy (MSBP) is a form of child abuse which a parent induces real or apparent symptoms of a disease in a child. MSBP is hard to diagnose; not easily recognizable to health care professionals, judges, or jurors; and often requires covert video surveillance for proof.

In his article for Clinician Reviews, David Paulk, assistant professor and medical sciences coordinator at the Department of Physician Assistant Studies at Arcadia University, provides information about this serious, even lethal, form of child abuse and how clinicians are generally first-line advocates for at-risk children. Paulk also references many articles and other sources of information.

MSBP offenders are typically young, married mothers; according to research, MSBP parents are also medically knowledgeable. By forcing the child to be sick, the parent/caretaker derives satisfaction by being the surrogate patient (by proxy). The abused children are generally young--many younger than 1 year--and experiencer numerous hospitalizations, outpatient visits, and trips to the emergency room.

MSBP is a form of child abuse that requires preparation, unlike many other impulsive forms of physical abuse. As referenced by Paulk, a few commonly reported abuses in MSBP include:

Altering urine specimens and temperature charts (heating thermometer in warm liquid)
Drawing large amounts of blood
Forcing ingestion of foreign objects
Causing a rash with caustic substances to the skin
Tampering with catheters, lab specimens, hospital and/or legal documents
Adding salt to breast milk.

Health care providers are generally the first to interface with MSBP children and parents and should be aware of a possible MSBP diagnosis; this is difficult with the deception of the parent/caregiver. Providers who haven't dealt much with MSBP may consider consulting with a MSBP expert as needed for case management and/or testimony, as all suspicions of abuse and neglect must be reported. Paulk references some common MSBP characteristics:

Caretaker with previous medical experience/education
Caretaker with recent history of symptoms similar to the child's
Lab results that differ from the child's health
Siblings with similar episodes or causes of death
Poorly tolerated treatments (vomiting after taking oral medications, IV lines falling out, etc.).

There is a high mortality rate associated with MSBP, approximately 9 percent to 10 percent. Due to the difficulty in knowing for sure if a parent or caretaker is hurting the child, covert video surveillance is often used to obtain evidence. The practice is controversial and it is recommended that hospital facilities have covert video surveillance protocols in place. Legal concerns regarding this type of surveillance may be met with posting signs that hidden video monitoring is used.

Paulk's article can be found on the Web at http://primarycare.medscape.com/CPG/ClinReviews/2001/v11.n08/c1108.01.paul/c1108.01.paul-01.html. Clinician Reviews is a monthly publication by:

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