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Munchausen's Syndrome by Proxy (MSP)

Munchausen's Syndrome refers to a psychiatric disorder where patients pretend to have illnesses, and therefore are subjected to many medical tests and surgical procedures. Of course, these would never have been performed if the patient had not tried to fabricate them. However, the most notorious patients have often had dozens of surgical procedures for factitious (false) symptoms. Thus, this is a form of self-mutilation.

Munchausen's Syndrome by Proxy (MSP) is a parenting disorder where parents, usually the mother, fabricate symptoms in their children, thus subjecting the child to unnecessary medical tests and/or surgical procedures. In some cases, the parents also inflict injury and can kill their children in the process. MSP is not rare in Apnea Programs. Apnea is the perfect disorder for MSP, because infants appear normal between episodes. Therefore, a parent can bring her baby to a medical facility, fabricate a history of an apparent life threatening event, and the baby will be admitted, many tests performed, sometimes even surgery (such as tracheostomomies) are performed. MSP parents can be quite good at this, often switching from doctor to doctor so that it is difficult for one individual to put it all together. There have been documented cases of MSP in apnea clinics. However, these are much rare than "true" infant apnea.

There is a profile of a parent who is likely to cause MSP. They are usually the mothers. They are often health professionals, especially nurses and respiratory therapists. They often are very friendly with health professionals and cooperative with medical procedures. They appear quite concerned about their child, and are sometimes described as overly concerned. Some psychiatrists believe that this is an attention-seeking behavior. Obviously, not all health professionals who are nice to deal with have MSP.

I would think that MSP is more likely a problem in Apnea programs than it is in babies who have died from SIDS. The diagnosis of MSP is difficult to make. Pediatricians are uncomfortable even suspecting someone of MSP. After all, in training, pediatricians are trained to listen to parents' histories of their children and to believe them. Confirmation of the diagnosis is very difficult. Covert video-surveillance has been used in some settings, but a court order is often required to do this without the parent's knowledge. When the diagnosis is made, the baby must usually be placed in protective custody and psychotherapy is used on the parents.

I hope this helps. Thank you.

Thomas G. Keens, M.D.
Childrens Hospital Los Angeles

Munchausen's Syndrome is the condition we name when a person makes himself ill purposely often to get the attention and friendship of medical personnel. For example, a person that secretly injects himself with his own germs into the blood stream to make themselves sick and needs to be hospitalized on a regular basis will often see the same medical staff who feel sorry for this person with this strange disease. This person and the staff become friendly. However, after this happens three or more times, people become suspicious and catch the person doing this to himself. Sometimes people will die from making themselves ill. Once someone who has Munchausen's Syndrome is identified, psychological and psychiatric intervention is necessary.

Now, Munchausen by proxy is when a parent makes their child ill on a recurrent basis. This is child abuse. These infants will usually come to medical attention with the complaint of stopping breathing (apnea) with a color change. If this complaint from the parent is not taken seriously, the parent will often make the infant more ill before they see the doctor. Frequently, the infant is brought into the emergency room by ambulance after getting resuscitated by the paramedics. It is true that sometimes these babies do not survive the damage induced by the parent (usually only one parent is inducing the injury and the other is unaware). If there is no autopsy or death scene investigation, these infants can wrongly be labeled as SIDS. This is not often the case.

Most often, the infant will have recurrent episodes of this "illness" and seek medical attention with the same complaint. Doctors are aware of this Syndrome and are looking for this type of pattern. There may also be signs from the parent or a type of attitude that go along with this type of abuse.

In its worst form Munchausen's by proxy results in the death or permanent damage of the child. In one case in upstate NY, the Hoyte family had 5 recurrent deaths in the children that were thought to be SIDS. Now, years later, the mother confessed to the murders. These deaths were thought to be SIDS at the time, but now would have undergone more careful investigation by both the police and the pathologist.

Because of these crazy people, when there is more than one SIDS death in a family, doctors become more concerned with the welfare of the new siblings. These infants will frequently undergo testing to look for medical problems and be placed on monitors at home. The family is looked at with some suspicion as well.

JDDeCristofaro, MD
SUNY @ Stony Brook, NY

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