ABC of child abuse. Munchausen syndrome by proxy.
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Biomedical subjects
Publications and source records attributed to R Meadow.
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32 children and 4 adults had extensive investigation and treatment for epilepsy because of false seizures invented or induced by a relative, usually the mother. They also suffered needless hospital admissions and restriction of education and activities. Follow-up of the children suggests a danger of abnormal illness behaviour continuing into adult life. For a few young children seizures are really anoxic episodes caused by the parent. In some cases these lead to brain damage and death, and an important association with sudden unexplained death of infancy (cot death) is emerging.
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The terms Munchausen syndrome by proxy and Polle syndrome have both been used to describe the situation in which one person persistently fabricates illness on behalf of another (usually a mother on behalf of her child). However, investigation of the family records of the real life Baron von Munchausen in Germany reveal that Polle syndrome is an inappropriate title originally derived from incorrect information.
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Information is presented about 19 children, under age 7 years, from 17 families, whose mothers consistently gave fraudulent clinical histories and fabricated signs so causing them needless harmful medical investigations, hospital admissions, and treatment over periods of time ranging from a few months to 4 years. Episodes of bleeding, neurological abnormality, rashes, fevers, and abnormal urine were commonly simulated. Often the mothers had had previous nursing training and some had a history of fabricating symptoms or signs relating to themselves. Two children died. Of the 17 survivors, 8 were taken into care and the other 9 remained at home after arrangements had been made for their supervision. Study of these children and their families has enabled a list of warning signs to be compiled together with recommendations for dealing with suspected acts. The causes and the relationship of this form of behaviour to other forms of non-accidental injury, iatrogenic injury, and parental-induced illness are discussed.
Twenty-seven children with diurnal enuresis were studied in a double-blind randomised controlled trial of imipramine. Outcome was not related to such features as age, gender, maximum functional bladder capacity, or evidence of psychiatric disturbance. Although the condition in several children improved, no evidence emerged to suggest that imipramine was superior to placebo in the treatment of the condition.
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