Festschrift to brandt steele
Web of deceit: A literature review of Munchausen syndrome by proxy

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Abstract

Munchausen syndrome by proxy (MSBP) is a form of child abuse wherein the mother falsifies illness in her child through simulation and/or production of illness, and presents the child for medical care, disclaiming knowledge as to etiology of the problem. From the literature, 117 eases of MSBP were reviewed. The most common presentations of MSBP were bleeding, seizures, central nervous system depression, apnea, diarrhea, vomiting, fever, and rash. Short-term morbidity rate was 100%; long-term morbidity rate was 8%. Mortality rate was 9%. Failure to thrive was associated with MSBP in 14% of cases. All perpetrators of MSBP were the mothers. The origins of this type of aberrant maternal behavior remain abstruse, as do the long-term psychological effects on the child victims. Guidelines for medical, social service, and legal management are provided.

Résumé

Le syndrome de Münchausen par procuration est une forme de maltraitance à l'égard d'enfants dans laquelle la mère provoque chez son enfant une maladie factice soit par simulation soit par production d'un réel état morbide; puis elle recherche pour l'enfant des soins médicaux tout en soulignant qu'elle n'a aucune idée de ce qui a pu causer la maladie. L'auteur a trouvé 117 cas rapportés dans la littérature. Les modes de présentation les plus fréquentes du syndrome de Münchausen par procuration sont des hémorragies, des convulsions, des troubles de la conscience, des apnées, des diarrhées, des vomissements, de la fièvre et des exanthèmes. Le taux de morbidité à court terme est de 100% et à long terme de 8%. Le taux de mortalité est de 9%. Dans le 14% des cas on trouve un retard staturo-pondéral en association avec le syndrome de Münchausen par procuration. Chaque fois dans ce syndrome le coupable est la mère. La raison de ce comportement maternel aberrant reste difficile à comprendre et les effets psychologiques à long terme sur l'enfant difficiles à apprécier. L'auteur fournit des directives pour la gestion médicale, sociale, et légale de ces cas.

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