Medical Child Abuse Hidden in Pediatric Settings: Detection and Intervention
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Medical Child Abuse Hidden in Pediatric Settings: Detection and Intervention Jeanne S. Hoffman1 · Gerald P. Koocher2,3
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Medical child abuse, sometimes referred to as Munchausen Syndrome by Proxy or childhood factitious disorder, poses significant diagnostic, intervention, and ethical issues for medical and mental health practitioners alike. Psychologists working in pediatric hospitals and medical clinics should remain mindful of the health and ethical risks posed by these conditions, which are challenging to detect and treat. The surreptitious nature of the conditions and hazards they pose require an integrated medical, psychological, and child protective response. This article provides historical and clinical background on the condition along with tabular guides and recommendations to assist in detection and intervention. Keywords Ethics · Factitious disorder · Medical child abuse · Munchausen Syndrome by Proxy · Pediatric psychology One of the most troubling forms of psychopathology encountered in pediatric settings involves medical child abuse (MCA) where a parent, most commonly the mother, intentionally either induces symptoms or presents a false history of symptoms in her child resulting in clinical misdirection and unnecessary medical treatments. Typically observed types of falsification appear in Table 1 which is based on the excellent summary of the literature by APSAC Taskforce (2018). Such abuse can ripple beyond the parent’s abusive acts by triggering unneeded intrusive tests or arduous treatments that cause distress to the child. The parent initiates the abuse, but physicians can become unintentional contributors to this distress. Pediatric psychologists working in hospitals and multidisciplinary clinics typically have a primary role assisting in child and family coping with complex medical conditions as well as assessing and treating symptoms such as pain, depression, or anxiety. Psychologists’ and other mental health professionals’ presence on the care team may place them in a unique position to suspect or aid in detecting MCA, based on their professional skills, analytical abilities, * Gerald P. Koocher [email protected] 1
Independent Practice, Honolulu, HI, USA
2
Quincy College, Quincy, MA, USA
3
Chestnut Hill, USA
knowledge of typical presentations, and understanding of psychological responses to medical conditions. In addition, psychologists serving on care teams often have access to a wider range of behavioral data than other health professionals as a function of information elicited during patient encounters. Pediatricians and other health care providers generally presume the accuracy of history and presentation offered by patients’ parents, while psychologists’ observations typically involve a deeper look than the surface presentation of what is essentially self-report data. Examples might include noting the contrast between the content and affect shown during a particular narrative, developmentally
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