Munchausen's Syndrome by Proxy and Its Professional Participants

Zitelli, Basil J.; Seltman, Miriam F.; Shannon, Rose Mary

doi:10.1001/archpedi.1987.04460100073029

Cited by 84 publications

(13 citation statements)

References 21 publications

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“…Since the original report, further reports have appeared characterising this syndrome, which is nearly always perpetrated by the mother [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Characteristically the child presents with a factitious disorder, the symptoms and signs of which diminish when separated from the perpetrator.…”

Section: Discussionmentioning

confidence: 99%

“…This subtitle was apt as these cases remain difficult to identify with the victims at great risk of harm and cases still end in the death of the child. A characteristic presentation involves the child's mother inducing apnoea by deliberate upper airway obstruction, the child presenting to hospital with so-called apparent life threatening events (ALTEs), although other manifestations such as fictitious epilepsy or poisoning also occur [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The identification of these cases is fraught with difficulty and the findings at postmortem examination may be minimal or absent.…”

Section: Introductionmentioning

confidence: 99%

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Munchausen syndrome by proxy and intra-alveolar haemosiderin

Milroy

1999

International Journal of Legal Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Munchausen syndrome by proxy and intra-alveolar haemosiderin

Milroy

1999

International Journal of Legal Medicine

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“…The social and psychological aspects of MSBP for the pediatrician should not be underplayed; the strong countertransference (Zitelli, Seltman, & Shannon, 1987) and guilt that arise once the true situation is revealed are powerful influences on how we will view the next case. One published series estimated that 25% of the morbidity of children later uncovered to have factitious illness was attributable to the physician's actions to diagnose or treat the fabricated symptoms (Rosenberg, 1987).…”

Section: Just What Is Msbp?mentioning

confidence: 99%

The Forum

2001

Ethics & Behavior

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Case Vignette: Video Surveillance to Detect Munchausen Syndrome by Proxy. Dr. Doright, a pediatrician, is troubled by the case of a 2-year-old child who has experienced an unusual number of hospital admissions and extensive invasive medical work-ups without clear findings of illness or pathology. Dr. Doright suspects Munchausen syndrome by proxy and recalls a recent article by Hall and his colleagues describing the use of covert video monitoring to detect this insidious form of child abuse. Doright wonders whether the benefits of such an approach outweigh the ethical costs.Munchausen syndrome by proxy (MSBP) is a diagnosis of the late 20th century. It was first described in 1977 by Roy Meadow; the two cases he reported were the poisoning of a child through salt ingestion and the adulteration of urine samples to simulate urinary tract infections. Meadow emphasized the behavior of the mother as the unique feature of the cases: Both mothers appeared to enjoy the attention of the physicians, in effect assuming a sick role by proxy to establish a gratifying, if fabricated, relationship with the physicians. Since Meadow's initial report, the label of MSBP has been applied to a broad range of situations, from the overeager request by parents for consultation with specialists to frank attempts at infanticide by means of poisoning or smothering ). The syndrome has generated widespread attention in the pediatric literature-a search of the MEDLINE database for the term Munchausen's by proxy during the years 1977-1999 yielded over 330 articles-and the discussion of the syndrome has moved into the popular culture as well, with news programs and Internet sites devoted to taking positions for or against the validity and contemporary uses of the syndrome.The case presented earlier describes the fictional Dr. Doright as suspecting MSBP in a 2-year-old child and being tempted to use covert video surveillance (CVS) to evaluate his suspicion. The answer to Dr. Doright's quandary is both simple and complicated. The simple part of the answer is that if he reasonably suspects that there is harm occurring to this child, then he has a clear duty to take action to protect the child from harm. The complicated part of the answer is how Dr. Doright should go about evaluating his suspicions, what threshold he should use before he involves the state child protection services (CPS), and how we pediatricians ought to characterize MSBP. In the first half of this essay, I examine the use of CVS in the arti-206 THE FORUM Downloaded by [Laurentian University] at 05

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“…In the hospital they were very concerned about the child and supportive of staff as they searched for help for the child (Epstein etal., 1987;Light & Sheridan, 1990;Zitelli, Seltman, & Shannon, 1987). A review revealed that charts commonly note the mother's attentiveness, as in Case A: Jami, 18 months, has been readmitted to the hospital.…”

Section: Characteristics Of Familymentioning

confidence: 99%

Identifying and Responding to Munchausen Syndrome by Proxy

Pearl

1995

Early Child Development and Care

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Munchausen's Syndrome by Proxy and Its Professional Participants

Cited by 84 publications

References 21 publications

Munchausen syndrome by proxy and intra-alveolar haemosiderin

Munchausen syndrome by proxy and intra-alveolar haemosiderin

The Forum

Identifying and Responding to Munchausen Syndrome by Proxy

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