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Report: Watch for fabricated illness in children

Saturday August 31, 2013
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Although itís rare for parents to fabricate an illness in their children, physicians and other healthcare professionals need to be on the alert for this form of child abuse, according to a new report.

Caregiver-fabricated illness in a child often is unrecognized, according to Harriet MacMillan, MD, MSc, FRCPC, a pediatrician and child psychiatrist at the Michael G. DeGroote School of Medicine at McMaster University in Ontario.

"It is probably more common than we realize," MacMillan said in a news release. She conducts family violence research, including trials of interventions aimed at preventing child maltreatment and intimate partner violence.

MacMillan co-authored "Caregiver-Fabricated Illness in a Child: A Manifestation of Child Maltreatment," a clinical report by the American Academy of Pediatrics Committee on Child Abuse and Neglect appearing in the September issue of Pediatrics.

The condition can include a range of manifestations including physical and psychiatric symptoms, according to the report. Mortality rates for the condition are 6% to 9%, and long-term disability and permanent injury statistics are similar.

Although caregiver-fabricated illness in a child has been discussed since the 1980s as Munchausen syndrome by proxy (when a caregiver deliberately induces health problems in a child), there is an ongoing debate about alternative names. The new name puts the focus on the child rather than the motivations of the caregiver, according to MacMillan.

Because it is a relatively uncommon form of child abuse, pediatricians and clinicians need to be suspicious when they see a child with a persistent or recurrent illness that canít be explained, especially when the signs or symptoms do not seem credible, according to MacMillan.

The authors wrote there is no typical presentation, and a child might show up with anything from bleeding or seizures to a urinary tract infection or attention deficit hyperactivity disorder.

"It really comes down to conducting a very careful history and physical examination, with an emphasis on communication with all healthcare providers who have seen the child," MacMillan said in the release. "Itís important that we are thorough in seeking comprehensive information about contact with healthcare providers, while adhering to privacy legislation."

Communication among healthcare professionals is critical, she said, because a child could be seen in many different settings. "This is the type of condition where it is essential for clinicians to review medical records and speak with other healthcare providers to have complete information in conducting their assessment."

Clinical report: http://bit.ly/12ESr3T


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