Munchausen syndrome by proxy: Covert child abuse

The identification and management of illness induction syndrome

“…In this type of abuse, the disclosure of concerns to parents without first ensuring the child's safety, is known to put the child at immediate increased risk : the perpetrator may flee with the unprotected child or alternatively try to disprove the abuse explanation by producing symptoms using more dangerous means (Gray and Bentovim, 1994;Manthei et al, 1988). …”

“…Given the difficulties of collecting unequivocal medical evidence and managing IIS cases in ways that ensure the child is protected, careful consideration must be given to the issues of separation from and contact with the main carer (Manthei et al, 1988). In these types of cases the apparently most reasonable contact or communication arrangements can be used by the perpetrator for covert interference with the child, specimens or equipment, and are therefore fraught with danger.…”

“…However, to regard him as the innocent parent may be over simplistic (Gray and Bentovim, 1994;Griffith, 1988;Manthei et al, 1988). His lack of questioning about the reasons for sustained periods of illness and/or investigations in the absence of observed symptoms requires detailed exploration as part of a careful post-identification assessment.…”

“…The literature including that relating to management (Eminson and Postlethwaite, 1992;Griffith, 1988;Jones et al, 1986;Manthei et al, 1988;Masterson and Wilson, 1987;Neale et a], 1991 ;Rosenberg, 1987) offers important messages to professionals who are involved in these types of child abuse cases. In addition to following the local child protection procedures (HMSO, 1991) when suspicions are being raised about the possibility of illness or the sick role being induced in a child, the management of the case should be informed by documented information about the presenting symptoms indicative of induced illness, the characteristics of the perpetrator and family and the possible risks to the child's life, health and development.…”

“…It is important to assess whether family members believe the abuse has taken place and would be able to protect the child before considering any placement (Griffith, 1988;Manthei et al, 1988).…”