Munchausen Syndrome by Proxy

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• Munchausen Syndrome by Proxy
• by Mary Lou Hutton

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The Article

• Ragaisis, K. (2004). When the system works
  rescuing a child from munchausen system by
  proxy. Journal of Child and Adolescent
  Psychiatric Nursing 17 (4) pp.173-177
• Retrieved Oct. 11, 2007 from the Pro
• Quest database.

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Did you ever see the movie the Sixth Sense?

• A child enters the room
• with a small toy chest in
• his hands. He thrusts it at his father, who
  seems stunned but takes it. The father is guided
  to open the chest, revealing a single video
  cassette. He puts in the VCR and his grief
  flattened expression thins out to horrified
  expression

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Sixth Sense (cont.)

• He watches his wife pouring chemical poison into
  their sick daughters soup.

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What Munchausen by Proxy Is?

• This is a form of child abuse when usually
  mothers deliberately induced or falsely reported
  illness in their children. The illness is
  fabricated via devious methods employed by a
  caring adult.
• This disease is a psychiatric disease on the
  mothers part.
• Sometimes the child will die.

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Baron Von Munchausen

• Lived in 18th century Germany
• He use to cause his own illnesses for attention.
• By Proxy-means the
• illnesses is caused by
• someone else.

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Indications

• Unexplained recurrent illness
• Symptoms do not fit the history and clinical exam
• Symptoms only occur in the presence of the
  caretaker (the mother)
• Mother seems very attached to the child, yet does
  not seem worried even if the treatments are
  painful to the child.
• Mother may have some previous (usually
  incomplete) training in nursing and medicine and
  attempts to create alliances with medical staff.

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The Case

• AS, a 3 year old boy was admitted for fever,
  dehydration, and unexplained convulsions.
• The mother repeatedly asked for seizure
  medication, even though there wasnt any evidence
  of seizures.
• The nurse later found remnants of pills in the
  bathroom sink. These pills were not provided by
  the nursing staff.

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The Case

• He was transferred to another hospital, which
  later discharged him. After a fight, the mother
  and son was moved to a shelter. No basis was
  found of why this child was sick, so the health
  care team suspected the mother, and followed up
  with a home care nurse.
• After a fight with the boyfriend, the mother and
  son was moved to a shelter.

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How the Mother was Caught

• The mother, in a shelter, called and said her son
  was sick, dehydrated, and not eating. She was
  very concerned.
• The home health care nurse was called, and
  evaluated the child. Her gut instinct and
  knowledge, she did not believe that this child
  was as sick as the mother claimed.
• The child had a diaper that was soaking wet and
  smelled like antibiotics.
• This data did not make sense.

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What happened to the child?

• The child was removed by Child Protective
  Services, and later custody was granted to his
  fathers family.
• The child was no longer sick, and considered as
  failure to thrive.
• In MSBP, the child usually gets better when not
  in the mothers care.

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Implications for Teachers

• We may come across a parent willing to have us
  be on their side. Many mothers with MSBP look
  for advocates.
• Document, document, document.
• Remember the safety of the child, depends on
  someone else in this disease.