When Münchhausen Syndrome by Proxy is suspected, professionals must intervene. Intervention must begin with a thorough examination of both the victim's and perpetrator's medical history. Other family members and relatives should be contacted to verify the presented history and to find out about any information that was purposefully omitted by the perpetrator. Relatives can both refute what the perpetrator has told medical staff and give the names of other medical facilities to which the victim may have been admitted. Questioning the victim may not provide much assistance. The child may either be too young to know if the illnesses have been induced, or the child may have grown up only knowing abuse and feel that it is normal behavior. If the victim needs to be admitted for medical care, the staff must remain vigilant in assuring the child's safety. All medications given and samples taken must be done by medical staff. The parent must not be allowed to handle any of these procedures.
If the medical staff feels they have sufficient evidence of child abuse, child protective services and the police should be notified. The perpetrator must also be confronted about the abuse. This should be handled very carefully. Confronted abusers may react in several different ways. Many will actually increase the amount of abuse to increase the severity of the illness in an attempt to prove that it is real. Other abusers may stop the abuse altogether. This is only a short-term reprieve however, because they are only waiting until they feel they are no longer in danger before starting the abuse again. Another option is that the abuser will physically relocate with the victim. They simply start over somewhere else where the medical and law enforcement personnel do not have any suspicions.
Regardless of how the offender reacts, their behavior compares to that of a drug abuser. The offender will seek to satisfy their need for attention and start abusing their child again.
When presented at the hospital, a 15-month-old child seemed irritable and had a temperature of 104 degrees. The mother reported bloody stools. A physical exam, urinalysis, and blood work all showed the patient was normal. The child had a nasogastric tube inserted, and underwent a Meckel scan, barium enema, and an upper colonic endoscopy. The tests all came back normal. After five days the bleeding stopped and the child was discharged. At the follow-up visit further bleeding was reported and the child was admitted to the intensive care unit in another hospital. No problems were identified and the child was discharged. Later, the child was admitted into a third hospital with the same complaint. A staff member recognized the mother and confronted her. The mother admitted to cutting her own legs and disconnecting the child's intravenous line to obtain blood for the diaper and the baby's mouth. This case was caught in time, preventing a general surgical consultation for which the child had been scheduled.
Münchhausen Syndrome by Proxy was suspected only after the second child in a family died after being admitted into the hospital. A third child was later admitted with symptoms of intractable vomiting and deteriorating mental status. An offhand comment about the family's puppies coughing and dying focused attention on the possibility of poisoning. An autopsy of the second child revealed 200 mL of arsenic in the gastric tract and arsenic in the liver. The discovery was made too late to prevent the third child from dying.
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