Fabricated or induced illness in the oral cavity in children. A systematic review and personal experience

Abstract

IntroductionMünchausen syndrome by proxy (MSBP) describes a pattern in which a caregiver induces a disease in a child. The symptoms may manifest in the oral cavity.Material and methodsPubMed was researched for articles between 1990-2014, presenting manifestations of MSPB, following PRISMA 2009 guidelines, and an in-house case of MSBP with oral manifestations was presented.ReviewAmong 66 articles presenting MSBP symptoms, four included descriptions of oral lesions in five children. They included: tooth loss, ulcerations and ulcers on oral mucosa, scars due to old, healed lesions, bleeding, black tongue, polysialia, and discolouration and swelling in the lips. Münchausen syndrome by proxy with participation of the mother was diagnosed in four cases.CaseA 13-year-old girl was hospitalised because of a non-healing ulcer of the septum, loose and lost mandibular teeth, skin lesions, and suspected immunodeficiency. She had been hospitalised numerous times at other facilities. Consultations and diagnostic tests did not confirm an organic disease. The patient and her mother agreed to undergo all examinations, and some symptoms ‘went away’ during the examinations. The behaviour of the patient and her mother during hospital stays, ambulatory care, and the psychiatric observations all pointed towards MPSB. They refused further treatment at the present facility.ConclusionsA dentist should take into account the potential ‘fabrication’ of symptoms in a child by the latter or by a caregiver. Consultations with a paediatrician or psychiatrist enable a diagnosis and treatment.

Cutaneous munchausen syndrome by proxy: A diagnostic challenge for dermatologist

“…[ 10 ] Most of the time, participation of many physicians with different areas of expertise is needed for both diagnosis and treatment. [ 2 3 5 ] In our case the child presented with recurrent blisters rupturing to form ulcers healing with postinflammatory hyperpigmentation, hypopigmentation, atrophic, and hypertrophic scars along with patchy cicatricial alopecia and ectropion of left eye. Because of the above presentation, she was misdiagnosed as a case of epidermolysis bullosa.…”

“…After ensuring safety of child, psychiatric and psychological treatment should be started for the culprit. [ 5 ] In the present case the child was hospitalized, mother was separated, and the family members were counselled regarding the course and nature of disease. The culprit mother was sent to psychiatric department where she was counselled and started on psychotherapy.…”

Síndrome de Münchausen por Procuração: Revisão Integrativa

“…A Síndrome de Münchausen por Procuração (SMP) é definida como uma doença induzida ou fabricada em uma criança pelo seu responsável (3,6,26,27,9,(16)(17)(18)20,21,24,25) , sendo que a mãe é a principal perpetradora, ou seja, a agressora (7,15,25) . A criança pode vir a contribuir com o infrator na fabricação da doença e pode se tornar um perpetrador futuramente (3,5,26) .…”

Apparent cyclic vaginal bleeding in a child: factitious disorder

“…In 85% of cases, the disease is initiated by the mother of the child, and less often by the father or other caregivers. This situation leads to unnecessary and invasive medical procedures and/or treatment ( 12 ). Females and males are victimized equally ( 13 , 14 ).…”

“…Females and males are victimized equally ( 13 , 14 ). The problem presents most often in small children up to 2 yr old and seldom older than 6 yr ( 12 , 15 ). Perpetrators may fabricate, exaggerate, and/or induce physical, psychological, behavioral, and/or mental health problems in the child.…”