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PEDIATRICS Vol. 113 No. 6 June 2004, pp. 1851-1852

Error in Munchausen by Proxy Defined

Herbert A. Schreier, MD
Department of Psychiatry
Children's Hospital Oakland
Oakland, CA 94609-1809

In an article I wrote, "Munchausen by Proxy Defined,"1 I quoted a study of the epidemiology of Munchausen by proxy (MBP) from England2 and extrapolated those results to the United States in an erroneous way. I compared the incidence reported in the under-16 population in England to the total population of the United States. Additionally, not all the cases reported in the incidence findings were MBP cases. Some were deliberate poisoning and suffocation outside of what we consider the dynamics of MBP, and some of the MBP cases were not suffocation or poisoning. Thus, I was in error in reporting the number of expected new cases of just suffocation and poisoning through MBP in the United States at 1200.The correct extrapolation for the more serious end of MBP in general should have been reported as 200 per year.

Not mentioned in my citing the article was that the reporting physicians were consultants in pediatrics and likely to have seen the more severe end of the spectrum, ie, hospital cases. It is of note that the literature reports that as many as 1% of asthma clinic attendees3 and 5% of allergy clinic patients4 are MBP cases. Additionally, in the McClure et al2 study, some countries saw 7 times the number of cases as others, raising the possibility that MBP was being missed in certain areas of the country.

The issue is whether MBP is rare. This was the conclusion of the British study, and certainly those of us working in the field have concurred that MBP is very much less common than other forms of child abuse. However, given the high morbidity and mortality rate (6% in the McClure et al study), it is likely that many cases will continue to be missed, and MBP continues to be a problem of grave importance to those of us charged with protecting children.

REFERENCES

  1. Schreier, H. Munchausen by proxy defined. Pediatrics.2002; 110 :985 –988[Free Full Text]
  2. McClure RJ, Davis PM, Meadow SR, Sibert JR. Epidemiology of Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Arch Dis Child.1996; 75 :57 –61[Abstract]
  3. Godding V, Kruth M. Compliance with treatment in asthma and Munchausen syndrome by proxy. Arch Dis Child.1991; 66 :956 –960[Abstract]
  4. Warner JO, Hathaway MJ. Allergic form of Meadow's syndrome (Munchausen by proxy). Arch Dis Child.1984; 59 :151 –156[Abstract]
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics



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