This article discusses medical child abuse (MCA), a form of child abuse where caregivers fabricate or exaggerate a child's illness for external gain. It explores the history of the term, diagnostic criteria, common characteristics of perpetrators, and red flags that pediatricians should be aware of. The article emphasizes the importance of early recognition and intervention to protect children from further harm.
in 1951 by Richard Asher, who named it after Hieronymus Carl Friedrich Freiherr von Münchhausen , an eighteenth-century storyteller who retired from the military and became known for his fantastical “tall tales.” Asher) uses the term “factitious disorder imposed on self ,” which includes falsification of signs/symptoms or induction of injury or disease in the absence of obvious external rewards. The behavior cannot be better explained by another mental disorder .
Gavril clarified that MCA is not caused by a caregiver’s anxiety about the child’s potential illness or concern that subtle symptoms may be dismissed by medical providers. “A caregiver may exaggerate a child’s symptoms every now and then to try to get what they perceive as the best care for their child,” she said. “But if you see a pattern of exaggerated symptoms over a long period of time — that’s more consistent with MCA, and you should start being concerned.
The presence of an unusual disease is not, in and of itself, a red flag. “If a child has a track record of good health and suddenly presents with mysterious symptoms, that’s different from a child with a lifelong series of mysterious symptoms or one, two, or more unusual or treatment-resistant diseases,” Gavril noted. It’s also a red flag if the caregiver won’t allow a new pediatrician access to previous providers or records from other facilities or claims they’re inaccessible.
This was a case in which the mother wasn’t necessarily inducing the symptoms, but she was exaggerating, fabricating signs and symptoms in the child to promote multiple hospitalizations, procedures, and lab tests, and the child wasn’t getting sufficient nutrition, Gavril said. Shanghvi recommends “early involvement” of an MCA multidisciplinary team, which should include all the patient’s medical professionals and subspecialists, nurses, a child abuse specialist, a social worker, a psychologist, and legal/risk management professionals.
“You don’t need to have absolute proof that the child is being abused, only to meet the threshold of reasonable concern,” Gavril emphasized, adding, “thorough documentation is key.”
MEDICAL CHILD ABUSE CHILD ABUSE CAREGIVER PEDIATRICIAN DIAGNOSIS
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