Munchausen's by Proxy?

[Patient]

I'm wondering if anyone can direct me to a FACTUAL website regarding this syndrome, if anyone has had direct contact with a Munchausen's patient.

A 2.5 year old nephew who has been 100% healthy since birth, got an ear infection over 2 months ago and since then has had febrile seizures of increasing severity. The mom is a stay-at-home mom who has a history of "just deciding" not to give various meds for whatever reason. If Dad doesn't do it himself, it doesn't get done.

The situation in a nutshell is this: child goes to hospital, all tests (EEG, spinal, MRI, CT scan) normal. No epilepsy, but febrile seizures due to ear infection. Funny that the ear infection only responds to antibiotics given by a pediatrician wielding a needle. Funny also that the seizures only respond to meds given in hospital or by father. As soon as child goes on oral meds, and father goes back to work, infection returns, and seizures escalate. Child is now on so many meds he has no normal baseline between seizures which are short lived in duration, but occur average 3x an hour.

The mother has other "issues", but has already been documented with bizarre harmful behavior regarding this child abd another one a year older. Primarily overfeeding to the point they both vomited several times a day and were 99 percentile for weight. Three different pediatricians told her she was "actively harming" the children, and it wasn't until they got old enough to refuse food that they got down to normal weight.

Everyone involved (including father) is becoming increasingly suspicious of the mother, but how to prove she is the one either actively harming the child, or actively neglecting treatment or "augmenting"?

[nurseangel47]

I don't suppose anyone has thought of hiding "nanny cameras" throughout her house somehow without her knowing about it? Just a thought.

I'm sorry you're going through this. Know it must be perplexing as well as stressful. Have you tried webmd site? http://www.webscape.md

[mvanz9999, RN]

The first one contains many links to many websites.

Factitious Disorders, Munchausen & Munchausen by Proxy Page

Nursing Spectrum- Career Fitness Online

Definitions and MBP / Munchausen by Proxy Basics

[Patient]

Wow. Some sites look at Munchausen's as an "illness", others... well, don't... like this paragraph:

MBP Confirmation-Disconfirmation Process

MBP is a recognized kind of maltreatment (abuse/neglect) - it is something someone does, NOT something someone "has" or "suffers from". It is behavior that one person deliberately perpetrates on another. For MBP to be confirmed, there must be:

(1) proof, through direct or circumstantial evidence (usually strong circumstantial evidence), that the suspected perpetrator has deliberately exaggerated and/or fabricated and/or induced a problem (physical and/or psychological-behavioral-mental health) regarding another person, and

(2) rationale that the behavior is consistent with MBP maltreatment, rather than something else.

There is no mental health test or evaluation that can rule MBP maltreatment in or out. There is no "profile" or combination of personal characteristics or traits that can determine whether someone is or is not an MBP perpetrator. The MBP confirmation-disconfirmation process involves the gathering and specialized evaluation of all possible information regarded suspected perpetrator(s), suspected victim(s), other children presently or formerly in the home - even if now adults or deceased, and sometimes others - depending on the case situation.

MBP physical and emotional victim risk results from medical and mental health interventions as well as from actual symptoms/illness induced by the perpetrator.

Although labeling a case MBP maltreatment may not be necessary in criminal cases, a confirmation of MBP maltreatment by or with the assistance of a credible MBP professional, and finding of MBP maltreatment in child protection courts, is extremely important. Child protection case plans must correspond to the kind of maltreatment that is confirmed. Appropriate MBP case plans include elements unique to MBP maltreatment - activities that must be successfully completed prior to consideration of reunification between victim and perpetrator, and other activities related to where the victim will live, other children in the home, contact between perpetrator and victim and potential victims, visitation with others, and other short and long term issues related to child protection.

****************************

Like so many mental health issues, there seem to be more opinions than answers. Nanny cameras are the obvious first line of defense though, and the family is currently trying to figure out how to get that done.

I suppose I was wondering if anyone has ever dealt with a Munchausen's patient up close, and if there is any "good" way of confronting the person. "Confrontation" is a really bad word, but someone has got to do something for this child before irreparable harm is done. The mother has been strangely apathetic about this child's illness. If any of her other children had so much as a bruise, she'd be on the roof about it. But not this one.

I'll keep on reading. Thanks for the replies!

[P_RN, ADN, RN]

Susan Smith is from the state I live in. I honestly don't believe she is afflicted with MBP anymore than my back door is. She found her children inconvenient and manufactured a story to rid herself of them.

[Patient]

GAG! I'm with you on the Susan Smith case. I lost track of it since I'm not in that state, but it was obvious from the start she killed her kids in order to try to keep a man in her life. "Evil" doesn't begin to describe that woman!

[S.T.A.C.E.Y, LPN]

This could be considered abuse, since you suspect something she is doing (or not doing) is causing harm to the child. I think a call to Child Welfare/Children's Aid might be in order... They have the authority to investigate it further than you can, and actually do something about it. If the child actually does develop a serious illness/injury, you won't be held liable (or feel guilty) for not reporting suspicion to the proper authorities. If child welfare finds nothing, you'll at least know you were acting in the best interests of the child.

[Patient]

I got the Patient Advocate involved on Thursday, and she was fantastic. Finally got all the specialists on the same page so the right hand and left hands are actually communicating. When the Mother found out a social worker was getting involved, she became frantic saying, "Why do we need a social worker? Are they coming to see what kind of mother I am?" Yeah, it's all about her all right. I'm getting more and more alarmed with every passing day. Do I have to be the one to do something that will have my brother's child taken away from him when he has done nothing wrong?

[CHATSDALE]

munchausons and munchausons by proxy are mental disorders but child[ren]

should not be left in her care

father not responsibile but may need to be with wife during recovery while children are cared for elsewhere

[NiteNurz79]

You sound like you have reason to suspect an imminent threat of harm to the child -

"The mother has other "issues", but has already been documented with bizarre harmful behavior regarding this child abd another one a year older."

Has anybody hotlined this situation? Does Dad work out of town, that he can't be the one to give all meds for a while? Is there another relative who can "give mom a break" and take the child for a week (to see what happens in another setting)? This isn't an issue like weight that can be corrected later on...brain injury is forever. Support Dad in doing whatever is necessary to protect this child. Risk hurting mom's feelings or making her mad? TOO BAD! The priority is the child.

If mom is somehow causing the problem, there must be a payoff. Does she not get attention at home when things go well? Do family/friends go to her aid because she is caring for a sick child but leave if the child looks well? Does she get to play the martyr role at church? Justify staying home? Ask yourself "What would be different for her if the child got better and stayed well?" then look at what she might think she loses if that happens. It's a complicated situation, but just keep putting the child first in all your decisions and you'll get though this.

[marshiana100]

I was wondering if it is possible for an adult to be a victim? My brother is a Vet in the care of a VA certified caregiver. For the last 25 years, we the family have care for him. In the 80's, he had his thyroid gland irradicated, and as a result was placed on a daily dose of synthroid of .25 mg. He was admitted to the VA last thurs with a diagnosis of hyperthyroidism. He has been receiving the same dosage and all TSH levels have been stable until the time of his hospitalization.

[justme1972]

That doesn't sound like Munchausen's by Proxy. That sounds more like ignorance.

The problem is that the mother is too ignorant (and I mean this not in a mean way) to know how to properly medicate the child understand medicinal compliance. That is her first problem.

She may sort of be a hypochondriac herself....sort of like a woman who is bipolar or other personality disorder, but insists her child of 4 is bipolar or has ADHD...so she shops around for a pediatrician equally ignorant enough to start the kid on meds with only what she tells him.

I would still do a social services report, because ignorance and being incapable of proper care that is leading to serious medical complications, while not abuse or neglect, is still harmful to the child.

Mom may need mandatory parenting classes in order to understand, as a mother, what she is supposed to do.

Meanwhile, I would encourage the Pediatrician to not only run a toxicology on the child, serum levels on all his prescribed meds, as well as heavy lead poisoning...b/c they are incredibly toxic but no one wants to think the worst, therefore Peds don't order tests on things like that until it's almost too late.

My other thought on the ear infection was meningitis. I knew of someone that was dead less than a month from initial contraction that started out as an ear infection.