Munchausen’s by Proxy Syndrome

Munchausen’s Syndrome is a mental disorder in which people pretend to be ill by

lying about symptoms, mutilating themselves, or ingesting toxins. It was named for
Baron von Munchausen, an 18th-century German dignitary known for telling outlandish
stories. A vicious variant of the syndrome, Munchausen by proxy (MBPS), involves
parents who simulate illness in their children, playing a horrific game of wits with
doctors, nurses, and the entire medical system. No one really understands how and why
these conditions develop. Dr. Roy Meadow first used the term Munchausen by proxy in
1977.
Things such as poisoning by salt, sugar, alcohol, narcotics, expectorants,
laxatives, emetics, feces and pus are used to create “bacteriologically battered babies.”
Almost every disease can be faked. Mothers are usually the perpetrators. Daughters are
almost always the victims.
In the most severe instances, parents with MBPS may go to great lengths to make
their children sick. When cameras were placed in some children's hospital rooms,
mothers were filmed switching medications, injecting their children with urine to cause
an infection, or placing drops of blood in urine specimens. One mother was taped
injecting nail polish remover into her daughter's feeding tube. Another suffocated a child
to the point of unconsciousness then frantically rushed him to medical personnel for
attention. Some parents aggravate an existing problem, such as manipulating a wound so
that it doesn't heal. One parent discovered that scrubbing the child's skin with oven
cleaner would cause a baffling, long-lasting rash. There are many “fake” symptoms and
many ways to induce them.
“The techniques she must have used… Smothering to simulate asphyxia… Then
those terrible GI – gastrointestinal – problems and fevers… Now I realise it must have
been some sort of fecal matter. Poisoning [the child] with her own filth so that she’d get
an infection but it would be an autologous one – self-infection, so that no foreign
organism would show up on the blood tests.” (Kellerman et al, 1993)
The person with this disorder is usually a model mommy. They are often
charming and personable, with a background in medicine or a paramedical field, unusual
calmness in the face of disaster, and a hovering, protective nature.
 In 1984, after examining the backgrounds of thirty-two children with
manufactured epilepsy, it was found that the victims also had dead siblings (7 out of 32);
all of them died from crib death.
There are 2-4 MSBP cases per million and 1000 MSBP cases out of 2.5 million
child-abuse cases. MSBP has a 10% fatality rate and a 75% physical morbidity rate. 25-
30% of the time the victims are siblings. 90% of people with MSBP are the biological
mothers of the victims. Children under 5 years are most likely to die, but most of them
die before they are 3 years old.
Some warning signs are persistent or recurrent, unexplained illnesses; difference
between clinical findings and history; symptoms that don’t occur when the child is away
from the mother; an overly attentive mother; a child who is intolerant to medical
techniques; the mother is less concerned than the physicians and nurses; the mother has
previous medical experience (usually un-finished); a sibling has been the victim of MSBP
or unexplainable death; the child has been seen by multiple health professionals; the child
has excessive, unexplained school absences; the illness occurs only at home; and/or the
mother becomes attached to medical staff.
A child may die, develop chronic invalidism, experience permanent disfigurement
(destructive skeletal changes, limps, etc.), develop permanent impairment (mental
retardation, brain damage, blindness, etc.), have academic delays due to “chronic
absenteeism”, have delays in social development, view illness as a punishment, develop
MSBP as an adult, have a disturbed understanding of proper mother-child relationship, or
develop psychiatric disorders (usually Post Traumatic Stress).
Scientific studies have been unable to establish a clear psychological profile of the
people who perpetrate this abuse. In some cases, the mothers themselves were abused,
both physically and sexually, as children. Other theories say that MBPS is a cry for help
on the part of the mothers, who may be experiencing anxiety or depression or have
feelings of inadequacy as parents of young children. Some mothers may feel a sense of
acknowledgement when their child's doctor confirms their parenting skills.
Many cases of MSBP go undetected or there is suspicion with insufficient
evidence. A high index of suspicion is needed to make the diagnosis of MSBP. A
diagnosis of this disorder usually takes about 6 – 15 months, but it can take years. MSBP
is a medical diagnosis, which shouldn’t be diagnosed by a non-medical person.
Paediatricians and family practitioners are usually the ones who make this
diagnosis, because psychiatrists are not as knowledgeable on this disorder.
If MSBP is suspected, a multidisciplinary team consisting of a physician,
paediatric social worker, psychiatrist, paediatric nurse, child protective services (CPS)
worker or an institutional child abuse committee, an attorney and an ethicist, should be
used.
A diagnosis of MSBP is made if many symptoms can be shown to exist. However,
a genuine illness and MSBP may coexist.
Before making a diagnosis, the physician must obtain all medical records from all
sources. Close examination of the sibling’s medical records should also be done. Where
there are strong suspicions, it may be necessary for the team to create an environment in
which the mother will be likely to repeat her behaviour. Covert surveillance is one
important and effective method of monitoring the child and gathering further evidence at
the same time.
When abusive MBPS is suspected, health care providers are required by law to
report their concerns. However, medical personnel may be reluctant to get involved for
fear of litigation, because the syndrome is so hard to prove. After a parent or caregiver is
charged with MBPS, the victim's symptoms may increase as the person who is accused
attempts to prove the presence of the illness.
To stop the abuse and protect the child, the perpetrator should be confronted. They
may admit to the deception, but denial is more common.
The first step of after diagnosis will be to file a child abuse report. The child will receive
emergency removal to foster care. There will be juvenile court involvement and
psychological testing of the person with MBPS.
To treat a person with MBPS, they must consult with Forensic
Paediatrician. There must be a genuine admission to all the deceptions. They must
identify and correct antecedents of these behaviours. The situation must be monitored
closely and the children should be kept with the same doctor. There is no successful case
of treatment known.
 BIBLIOGRAPHY

Kellerman, J. (1993). Devil's waltz. New York City, NY: Bantam Books.

Huynh, K. T. (1998). Munchausen syndrome by proxy. retrieved Nov 09, 2004, from Physician
Assistant Program Web site:
http://www.medicine.uiowa.edu/pa/sresrch/Huynh/Huynh/sld001.htm.

Gavin, L. (2001). Munchausen by proxy syndrome. retrieved Nov 09, 2004, from KidsHealth for
Parents Web site: http://kidshealth.org/parent/general/sick/munchausen.html.