Munchausen syndrome by proxy: a case report

Knowledge and management of Münchausen's Syndrome by proxy: a survey conducted through the compilation of a questionnaire by pediatricians belonging to the Italian Society of Pediatrics

BACKGROUND

Munchausen syndrome by proxy represent forms of abuse with long-term psychiatric outcomes. Since the prevalence of Munchausen Syndrome by proxy is uncertain and underestimated, this study aimed to investigate and analyze the phenomenon through the compilation of an anonymous questionnaire that explores the knowledge of the phenomenon and above all its management.

METHODS

the study was conducted by sending an anonymous questionnaire to pediatricians who are part of the Italian Society of Pediatrics. The questionnaire consists of 18 multiple choice questions and was completed by 511 professionals.

RESULTS

The main results highlighted that the majority of doctors knows Münchausen Syndrome by proxy. However, when there is a strong suspicion of the syndrome, they mostly seek discussion with the parent or with another specialist instead of referring to the competent authorities.

CONCLUSIONS

starting from the consideration that timely diagnosis is fundamental for the protection of the child, we emphasize the urgency of enhancing the recognition and management of Munchausen Syndrome by Proxy. Early diagnosis, appropriate reporting, and collaboration with child protection authorities are essential in safeguarding the well-being of vulnerable individuals.

Where Reality and Fantasy Collide-Prolonged Fever to Munchausen Syndrome by Proxy

Background: Munchausen syndrome by proxy (MSBP) or factitious disorder imposed on another (FDIA) is a bizarre psychiatric entity, consisting of the fabrication of symptoms and alteration of laboratory tests by a caregiver. It is considered a serious form of child abuse. Alarm signs are frequent medical visits and strange symptoms that are never objectified during hospitalization. Methods: This case sets a bright light on how difficult the diagnosis and management of FDIA is and the severe consequences this disease has on a defenseless child. Results (Case report): A boy who is 3 years 8 months old first presented to our department in October 2022 for prolonged fever. We ruled out infections, malignancies, and autoimmune diseases. The patient kept coming back once every fortnight for the same reason-fever, every time associating it with something in particular and new-from painful joints to hemorrhagic complaints. Interestingly, with every new visit, the patient's medical history became more complex. The mother also developed an attachment relationship with the medical staff. During a 4-month period of repeated admissions, the child's symptoms were never objectified throughout hospitalization, and never consistent with the declared symptoms and test results. When the physician's attitude changed from empathic to distant, she never came back for check-ups. Conclusions: A pediatrician's work largely depends on good communication with the parents. When there is no medical explanation for declared symptoms, one might question the merit of the story.

Munchausen Syndrome by Proxy Presenting as Pharyngeal Dysphagia and Recurrent Mouth Ulcers: A Case Report

We report a Munchausen syndrome by proxy (MSBP) case, which presented as pharyngeal dysphagia and an acquired tracheoesophageal fistula (TEF). A six-month-old Saudi male presented with fever, persistent oral ulcers, intermittent bleeding from the ulcers, failure to thrive (FTT), poor appetite, and possible genetic disease. He had a history of recurring admissions due to infections, including those affecting the chest, ear, and bowel. Additionally, he tested positive for vancomycin-resistant enterococcus. There was no history of surgical procedures or blood transfusions. Due to the patient's nutritional status, a gastrostomy tube was inserted. The patient had recurrent bleeding from the tracheostomy tube during the hospital stay despite normal coagulation and platelet profile. Consequently, after diagnostic laryngoscopy, the otolaryngologist specialist pointed out that such retropharyngeal injuries are seen in patients with inflicted injuries, which is, in this case, caused by the mother, as she was the only one with the child during the recurrent bleeding episodes. Thus, we describe a clinical instance of MSBP, especially imitating pharyngeal dysphagia, leading to a delayed diagnosis. We advise adding MSBP to the possible diagnoses upon encountering pharyngeal dysphagia and oral ulcers.