medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2011, Number 3

<< Back Next >>

Rev Invest Clin 2011; 63 (3)

Munchausen syndrome by proxy in Mexican children: Medical, social, psychological and legal aspects

Trejo-Hernández J, Loredo-Abdalá A, Orozco-Garibay JM

Language: English
References: 39
Page: 253-262
PDF size: 108.04 Kb.


ABSTRACT

Introduction. The Munchausen Syndrome by Proxy (MSP), is considered as an unusual less frequent variety of child abuse (CA). In this type of abuse the perpetrators purposely provide factitious information, tamper with specimens or actually induce an illness in a child. Nowadays, it is a clinical entity described in pediatrics as more frequently than before. Despite the fact of its presence worldwide, there are still problems in order to get an appropriate diagnostic. It is also difficult to handle both the clinical and legal aspects in various countries. Objective. Make our academic fellows aware of various pediatric, psychological, social and legal aspects of a series of cases attended at the Clínica de Atención Integral al Niño Maltratado from Instituto Nacional de Pediatría (CAINM-INP), Mexico [Integral Clinic of Attention for Abused Children, at National Institute of Pediatrics, Mexico]. Material and methods. From a series of 25 cases, 18 minors of age were considered with this syndrome since we found that they shared medical, psychological, social and legal characteristics. Results. 18 minors of age belonged to 14 families. 4 of those families had two affected children each one. These affected children were girls 13/18, predominant in children under six years in 10/18. Syndrome expression was distributed as follows: fever from a non determined origin, seizures, chronic diarrhea, hematuria, and probable sexual abuse. 14 children were hospitalized. In all cases, the aggressor was the mother. The psychological evaluation of six perpetrators revealed psychotic, histrionic, and compulsiveobsessive traits. The socio-economic condition was low in 50% of the cases. A legal demand was posed for seven patients in which all the children remained under the custody of the mother. Conclusions. In Mexico, reports of CA have increased within the last years according to experience. Some complex forms as MSP require the participation of an interdisciplinary team for both diagnosis and integral attention.


REFERENCES

  1. Galvin HK. Newton AW, Vandeven AM. Update of Munchausen syndrome by proxy. Curr Opin Pediatr 2005; 17: 252-57.

  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM IV). Washington DC: American Psychiatric Association; 1996, p. 483-7.

  3. Meadow R. Münchausen syndrome by proxy in the hinterland of child abuse. Lancet 1977; 31: 332-5.

  4. Feldman MD, Brown RM. Munchausen by proxy in an international context. Child Abuse & Neglect 2002; 26: 509-24.

  5. Sheridan MA. The deceit continues: an updated literature review of Munchausen Syndrome by Proxy. Child abuse & Neglect 2003; 27: 431-51.

  6. Goñi GT, Marínez RM, De la Cerda OF, Gómez TI. Síndrome de Munchausen por poderes. An Pediatr 2008; 68(6); 609-11.

  7. Catalina L, Mardomingo J. Síndrome de Munchausen por poderes: revisión de 35 casos de la literatura. An Esp Pediatr 1995; 42: 269-74.

  8. Fujiwaraa T, Okuyamaa M, Kasaharaa M, Nakamura A. Characteristics of hospital-based Munchausen Syndrome by Proxy in Japan. Child Abuse and Neglect 2008; 32: 503-09.

  9. Garrote N, Indart AJ, Puentes A, Smith M, Bagge P, Pérez CM. Síndrome de Munchausen por poder y manifestaciones de supuesto evento de aparente amenaza a la vida. Arch Argent Pediatr 2008; 106(1): 47-53.

  10. Guiraldes E, Bernard D, Trevino X, Larrain F. Factituius gastrointestinal hemorrhage in 3 school-age girls. Rev Méd Chil 1996; 123: 874-9.

  11. Loredo-Abdalá A, Carbajal RL, Sierra GQ, Skvirsky OD. Síndrome de Munchausen en niños: Informe de dos casos. Bol Med Hosp Infant Mex 1991; 48: 121-5.

  12. Montoya CM. Síndrome de Münchausen infantil inducido por adultos mediante intoxicaciones. Rev Med IMSS 2001; 39: 469-71.

  13. Trejo Hernández J, Pérez Espinosa JR, Loredo Abdalá A. Síndrome de Münchausen por poder. Enfermedades inducidas y/o fabricadas en el niño por un adulto. Comportamiento clínico de los menores y sus perpetradores. Acta Pediatr Mex 2002; 23(6): 412-3.

  14. Schreier H. Munchausen by proxy defined. Pediatrics 2002; 110: 985-8.

  15. Rosenberg DA. Web of deceit. A literature review of Munchausen syndrome by proxy. Child Abuse & Neglect 1987; 11: 547-63.

  16. McClure RJ, Davis PM, Meadow RS, Sibert JR. Epidemiology of Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Arch dis Child 1996; 75: 57-61.

  17. Valentine JL, Schexnayder S, Jones JG, Sturner WQ. Clinical and toxicological findings in two young siblings and autopsy in one sibling with multiple hospital admissions resulting in death. Evidence suggesting Münchausen syndrome by proxy. Am J Forensic Med Pathol 1997; 18: 276-81.

  18. Aranibar H, Cerda M. Hypoglycemic seizure in Munchausen by proxy syndrome. Pediatric Emergency Care 2005; 21: 378-79.

  19. Seferian EG. Polymicrobial bacteremia: A presentation of Munchausen syndrome by proxy. Clinical Pediatrics 1997; 36: 419-22.

  20. Salmon RF, Arant BS, Baum MG, Hogg RJ. Factitious hematuria with underlying renal abnormalities. Pediatrics 1988; 82(3): 377-9.

  21. Awadallah N, Vaughan A, Franco K, Sharaby N, Goldfarb. Munchausen by proxy: a case, chart series and literature review of older victims. Child Abuse and Neglect 2005: 29: 931-41.

  22. Bools CN, Neale BA, Meadow SR. Co-Morbidity associated with fabricated illness. (Munchausen syndrome by proxy). Arch Dis Child 1992; 67: 77-9.

  23. Lasher LJ, Feldman MD. Celiac disease as a manifestation of Munchausen by proxy. South Med J 2004; 97: 67-69.

  24. Schreier HA, Libow JA. Munchausen by proxy syndrome: a modern pediatric challenge. J Pediatr 1994; 125: S110-S115.

  25. Marcus A, Ammerman C, Bahro M, et al. Benzodiazepine administration induces exogenic psychosis: a case of child abuse. Child Abuse & Neglect 1995; 19: 833-36.

  26. Stirling J and Committee on Child Abuse and Neglect. Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in a Medical Setting. Pediatrics 2007; 119: 1026-30.

  27. Pompili M, Mancinelli I, Girardi P, Ruberto A, Tatarelli A. The importance of transference and countertransference in Munchausen Syndrome by proxy. Child abuse & Neglect 2003; 27: 353-5.

  28. Bools C, Neale B, Meadow RS. Munchausen syndrome by proxy: a study of psychopathology. Child Abuse & Neglect 1994; 18: 773-88.

  29. Marcus A, Ammermann C, Klein M, Schmidt MH. Munchausen syndrome by proxy and factitious illness: symptomathology parent child interaction and psychopathology of the parents. Eur Child Adolesc Psychiatry 1995; 4: 229-36.

  30. Schreier HA. Factitious presentation of psychiatric disorder: When is it Munchausen by proxy? Child Psychology & Psychiatry Review 1997; 2(3): 108-15.

  31. Polledri P. Munchausen syndrome by proxy and perversion of the maternal instinct. The Journal of Forensic Psychiatry 1996: 7(3); 551-62.

  32. Schreier HA. Munchausen by proxy. Curr Probl Pediatr Adolescent Health Care 2004; 34: 126-43.

  33. Hall DE, Meyyazhagan S, Kenney RD, Johnson SC. Evaluation of Covert Video Surveillance in the Diagnosis of Munchausen Syndrome by Proxy: Lessons from 41 Cases. Pediatrics 2000; 105: 1305-12.

  34. Perea MA, Loredo AA, Trejo HJ, Monroy VA. Responsabilidad del pediatra ante la Norma Oficial Mexicana NOM-190- SSA1-1999. Prestación de Servicios de Salud. Criterios para la Atención Médica de la Violencia Familiar. Rev Mex Pediatr 2002; 69: 37-40.

  35. Academia Mexicana de Pediatría. Novedades Clínicas y Jurídicas del Maltrato Infantil. Programa de Actualización Continua en Pediatría. México: Editorial Intersistemas; 2004.

  36. Donald T, Jureidini J. Munchausen Syndrome by Proxy. Child abuse in the medical system. Arch Pediatr Adolesc Med 1996; 150: 753-8.

  37. Eminson M, Jureidini J. Concerns about research and prevention strategies in Munchausen Syndrome by Proxy (MSBP) abuse. Child Abuse & Neglect 2003; 27: 413-20.

  38. Sanders M. Hospital protocol for the evaluation of Munchausen by proxy. Clin Child Psychol Psychiatry 1999; 4: 379-91.

  39. Loredo AA, Trejo HJ, García PC, López NGE, Perea MA, Gómez JM, Casimiro VA, et al. La Clínica de Atención Integral al Niño Maltratado: Implementación de una estrategia de aplicación nacional en investigación, docencia y asistencia. Bol Med Hosp Infant Mex 2009; 66: 283-92.




2020     |     www.medigraphic.com