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Munchausen Syndrome by Proxy (Medical Child Abuse), Pediatric

Christopher C. Stewart, MD Reviewed 10/2018
 


BASICS

DESCRIPTION

  • The term medical child abuse (MCA) focuses on potential or real harm to a child, regardless of the caretaker’s motivations. MCA is the preferred term for the spectrum of caretaker be...

DIAGNOSIS

HISTORY

MCA should be considered when 
  • Symptoms and signs described are incongruous with patient’s appearance or are seen only when the caregiver is present.

  • Diagnostic tests fail to confirm th...

TREATMENT

  • Mild:

    • Recommended consultation with a child abuse specialist to help differentiate from a case of simply an anxious parent. The physician should avoid giving in to irrational demands for test...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Psychological treatment for caretaker and child if appropriate

  • Long-term follow-up is necessary for both victim and caregiver.

  • Watch for recurrence of original pres...

ADDITIONAL READING

  • Bass C, Glaser D. Early recognition and management of fabricated or induced illness in children. Lancet.  2014;383(9926):1412–1421. [View Abstract on OvidInsights]

  • Brown P, Tier...

CODES

ICD9

301.51 Chronic factitious illness with physical symptoms 

ICD10

  • F68.12 Factitious disorder w predom physical signs and symptoms

  • F68.13 Factitious disord w comb psych and physcl signs and sympto...

FAQ

  • Q: When should MCA be reported to child abuse authorities?

  • A: When there is reasonable suspicion (note: not certainty) that a child is coming to harm due to the actions of a caregiver. When suspici...

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