Objective. In 1993, Children's Healthcare of Atlanta at Scottish Rite (formery Scottish Rite Children's Medical Center, Atlanta, GA) added facilities to perform inpatient covert video surveillance (CVS) of suspected cases of Munchausen syndrome by proxy (MSBP). Forty-one patients were monitored from 1993 to 1997. This study was performed to review our experience with these cases. How useful was video surveillance in making the diagnosis? What were the characteristics of families with children who were victims of MSBP?
Methodology. Medical, social work, security, and administrative records of all children who underwent covert video monitoring at Children's Healthcare of Atlanta at Scottish Rite from 1993 through 1997 were reviewed retrospectively by a team of physicians, risk managers, and social workers.
Results. A diagnosis of MSBP was made in 23 of 41 patients monitored. CVS was required to make the diagnosis in 13 (56.1%) of these 23, and supportive of the diagnosis in 5 (21.7%) cases. In 4 patients, this surveillance was instrumental in establishing innocence of the parents. MSBP was more common in Caucasian patients than in other ethnic groups seen at our hospital. Fifty-five percent of mothers gave a history of health care work or study, and another 25% had previously worked in day care. Although many of caretakers fit the profile of MSBP, such as excessive familiarity with medical staff, eagerness for invasive medical testing, and history of health care work, these characteristics were not sensitive indicators of MSBP in our study. Even when present, they were not sufficiently compelling to make the diagnosis.
Conclusions. CVS is required to make a definitive and timely diagnosis in most cases of MSBP. Without this medical diagnostic tool, many cases will go undetected, placing children at risk. All tertiary care children's hospitals should develop facilities to perform CVS in suspected cases.
- child abuse
- covert video surveillance
- factitious illness
- factitious illness by proxy
- Munchausen syndrome by proxy
Munchausen syndrome by proxy (MSBP), also called factitious illness by proxy,1,,2 is a form of child abuse in which a parent or guardian, usually the mother,3 fabricates or induces illness in a child. The condition, first reported by Meadow4 in 1977, is difficult to diagnose, because the caretakers of these children are adept at deceiving medical and mental health professionals.3,,5
Although many of these caretakers seem to enjoy the attention and sympathy they receive from their child's apparent illness, the motivations of those who induce or fabricate illness are complex and poorly understood. Studies of psychopathology and family dynamics in MSBP are few.6–9 Many of the mothers involved may suffer from a personality disorder.10,,11
The cost of medical care of these children is extremely high.12 When no cause for the patient's symptoms are found, physicians may order expensive or invasive tests searching for increasingly unlikely and rare diseases.13 In these situations, the physician inadvertently contributes to the abuse of the child.14,,15
It is extremely difficult to prove that a caretaker is fabricating or inducing an illness. Usually, the evidence is circumstantial. When actual proof is available, it is often obtained out of serendipity or carelessness on the caretaker's part, such as when a nurse catches a mother smothering a child. Occasionally an offending agent introduced by the caretaker can be detected by a blood test, but in most cases, and for many reasons, physicians are uncomfortable even raising the question of MSBP. Even when the physician is convinced of the diagnosis, some judges are reluctant to believe the condition exists.11,,16
These children are at considerable risk. Mortality rates of 9% to 10% have been reported.7 All mortality estimates, however, are limited by the fact that it is impossible to know the true number of cases in any population.
To assist in the diagnosis of these difficult cases, Children's Healthcare of Atlanta at Scottish Rite, a 165-bed tertiary care children's hospital in Atlanta, Georgia, established facilities and protocols for covert surveillance in suspected cases of MSBP using hidden video cameras and audio equipment. The availability of covert video surveillance (CVS) led to a large number of referrals for evaluation.
The purpose of this investigation was to review the results of our experience with CVS in the diagnosis of MSBP. How valuable was this monitoring? Was it necessary to establish the diagnosis? What were the characteristics of families of patients diagnosed as victims of MSBP?
A multidisciplinary team was assembled to consider the pros and cons of monitoring in each case before beginning CVS. The team consisted of the attending physician, representatives from nursing, social work, risk management, and security. Consulting physicians were also involved when appropriate. The team considered monitoring only when they believed MSBP was more likely than other diagnoses as an explanation for the child's presenting complaint. The primary goal was to protect the child. In some circumstances, surveillance was used when MSBP was believed to be unlikely, but no other explanation accounted for the patient's symptoms. Thus, the patients included in this report came from a highly selected population.
Audio equipment and multiple cameras allowed surveillance of all parts of the patient's room except the bathroom. Specific permission to monitor was included in the admission form for consent to treat given to families on admission to the hospital. Contained within this form is the statement, “Closed circuit monitoring of patient care may be used for educational or clinical purposes.” In addition, a sign at the entrance to the hospital informs visitors that this facility is monitored and recorded by hidden cameras. The families were not otherwise informed they were being monitored except when we confronted the caretaker with the diagnosis of MSBP. The local governmental department of family and children's services was notified and placed on call before monitoring, but typically took no action until a diagnosis was made or CVS completed. Team members normally met daily to review the patient's progress while monitoring continued.
Security officers monitored the patient and caretaker's activities continuously 24 hours a day and made hourly and, if necessary, more frequent entrees into a logbook. Security officers were chosen to perform this function because they had received training to monitor caretakers from a law enforcement point of view. In addition, physicians and nurses were too busy and costly, and local police officers were not able to take the time to perform this function during the study. Hospital security personnel were taught about MSBP by the clinicians involved and by the supervisor of security. In addition, the way in which MSBP might apply to individual cases was discussed with a representative from the security staff at team meetings.
If the officer noticed any unusual or dangerous behavior by the parent, he or she paged the floor nurse immediately to go to the patient's room to assess the situation and intervene if necessary to protect the child. In addition, the security officer notified the team. Shifts were rotated hourly so that the security officer could stay alert and react quickly should the caretaker harm the child. The hospital security supervisor reviewed relevant sections of the logbook and discussed them at team meetings.
This study was performed by chart review and was approved by the hospital institutional review board committee. Medical charts were obtained from all patients with suspected MSBP who were selected for CVS from May 1993 through July 1997. Social work, administrative, and security records, which are kept separately on suspected MSBP patients, were also reviewed. When possible, information was obtained from referring physicians and from other physicians involved in the patient's care. We did not have access to the parents' medical records. No attempt was made to hide the monitoring from the referring physicians. In most cases, the patient was referred to us specifically because CVS was available.
Patients were categorized by certainty of diagnosis (certain, probable, suspicious, or innocent). All data were reviewed by at least 2 physicians (including D.E.H., S.M., R.D.K., or the attending physician), a representative from social work (L.E.), and our risk management department (S.C.J.). All had to agree on the category of certainty of diagnosis before the patient was included in the study. The team also agreed on the other categories provided in the “Results” sections. All decisions were made retrospectively.
The diagnosis was considered certain when: 1) clear evidence of fabrication or inducement of disease was documented by video (for example, when a caretaker was observed injecting a substance into an intravenous line.); 2) a laboratory test confirmed inducement of symptoms (for example, when a laboratory test showed a high level of a sedative when the parent denied giving one to the patient); or 3) a reliable witness observed the caretaker inducing illness (as when a nurse observed a parent smothering a child with a pillow). In addition, physicians had to agree that no definable medical conditions could account for the severity or persistence of the child's symptoms.
Patients were classified as probable victims of MSBP when we had evidence to support the diagnosis but not enough to convince the team unequivocally.
Patients were classified in the suspicious, not provencategory when some evidence pointed to MSBP, but the preponderance of evidence was not convincing and judged not sufficient to justify legal action.
Patients were classified as not MSBP when video surveillance and clinical evaluation yielded no signs of fabrication or inducement of illness on the part of the caretakers, and other explanations for the patient's symptoms were found.
Patients were also divided into types of MSBP syndromes. Parents wereinducers if we found evidence that they induced disease directly (for example, by smothering or giving medication) but we could document no evidence of fabrication of symptoms. They were classified as fabricators if no inducement of disease was found, but they created disease by lying about the presence of symptoms or staging disease. (For example, 1 mother gagged herself and vomited. She then presented her vomit as the patient's. Another reported seizures that did not occur.) If evidence for both were found, parents were classified as inducers + fabricators.
Forty-one patients underwent CVS. After review by the means discussed above, 23 were classified as certain cases of MSBP. Of these, the video monitoring was required for diagnosis in 13 (56.1%), supportive in 5 (21.7%), and not needed in 5 (21.7%; Table 1).
For the 5 patients for whom the video surveillance was not required for diagnosis, MSBP was confirmed by laboratory tests (drug levels) in 2 patients,a observation by a staff member in 2,FNb and confession by the mother in 1 after confrontation.c In these patients, no definite evidence of inducement or fabrication was seen on video. CVS was used in these cases because the laboratory tests confirming the diagnosis had not yet returned or to provide additional support in court for the observations of nurses.
Of patients in the certain MSBP category, 10 of the caretakers were classified as fabricators and 2 as inducers. In 11 cases, evidence of both inducement and fabrication was discovered on video surveillance. The methods of injury varied (Table 2). All of the caretakers in the certain category were the patient's mothers.
For patients who created illness exclusively by fabrication, CVS was required for diagnosis in 80% (Table 3). Monitoring was also required for diagnosis in the 2 cases in which only inducement but no fabrication was found. In most patients, the attending physician was suspicious of MSBP, which, of course, led to the monitoring, but in 2 proven cases, the physicians were doubtful of the diagnosis before monitoring. In these cases, monitoring was used because no other diagnosis seemed to explain the patient's symptoms (Table 4). One case was a child with recurrent Escherichia coli sepsis. We observed his mother inject a substance into his intravenous line. She later admitted that she had been injecting her own urine. There was nothing about this mother's behavior that led us to suspect MSBP. CVS was begun only because we had no other explanation for the recurrent sepsis. In another case, a child with unexplained episodes of lethargy, the mother was observed placing chloral hydrate into her child's gastrostomy tube.
In many of the fabricators, the mothers' behavior on the hospital phone was notable. They would often tell outrageous lies about her child's condition to friends and relatives. For example, 1 mother stated that her child's doctors wanted to operate but that she wouldn't let them, when in fact we were trying to convince the family that the child was healthy. Another told family members over the phone that the child was having constant seizures. No seizures were observed. In addition, some mothers who seemed quite attentive to their child when health professionals were present seemed to ignore them when no one was there to watch.
In 4 cases, the parents seemed to be aware they were being monitored by video camera. They would look into the monitors, look around the room for cameras, or mention to each other that they were being observed or taped. In none of these patients did we reach a definitive diagnosis.
Apnea, persistent undiagnosed symptoms, and vomiting were the most common chief complaints in patients with a certain diagnosis (Table 5).
Eleven (55%) of the mothers whose work history was known gave a history of health care work or training. In 5 (25%), the mother worked in day care (nonparental, out-of-home, daytime child care facilities). In 4 (20%), no maternal history of day care or health care-related work was present, but in 1 of these, the father worked in health care (Table 6). Therefore, in 17 of 20 patients (85%) in whom the work history was known, either the mother or father worked or had training in a health care-related field or in day care. In 3 cases, the mother's work history was unknown (Table 6).
In all cases, the person who induced, fabricated, or staged illness was the mother.
Twelve (92%) fathers in the certain category whose work history was known worked in nonprofessional occupations or skilled labor (construction worker, brick layer, mechanic, truck driver, etc). One was a computer programmer, and in 10 cases, the father's work was unknown.
We were able to determine whether the patient had a medical home in 14 patients. A medical home was defined as a physician who had followed the patient for >1 month and was identified by the parent as the patient's regular physician. Seven had primary care physicians, and 2 used subspecialists as their primary source of care. Three were doctor shoppers, who moved from physician to physician, and 2 used the emergency department as their primary source of medical care. In 9, the primary source of medical care was unknown (Table 7).
Boys were more frequent victims of MSBP than girls by a slight margin (13 males and 10 girls), but this difference was not statistically significant.
The average age of patients diagnosed with MSBP was 26 months old, and the median was 18 months old. The mother's average age at the time of diagnosis was 24.8 years old, and the median age was 24 years old.
Medicaid was the most common insurer (Table 7).
In only 1 case was there a sibling death. This mother later confessed to having suffocated this child years earlier, after video monitoring led to the diagnosis of MSBP in a second child.
Eight (35%) of the 23 mothers in the certain MSBP category gave a history of sexual or other types of abuse as a child.
The presence of a documented medical illness was no guarantee that the patient was not a victim of MSBP. Seven (30%) of the 23 patients were believed to have clearly defined and diagnosed underlying medical problems (Table 8). In 16, no documented medical illness was detected.
An unusually large number (7/16) of patients diagnosed with MSBP had gastrostomy tubes.
The average duration of hospitalization before diagnosis was 3.87 days; the median was 3 days.
The average number of days videotaped for the 23 patients in the certain diagnosis category was 3.57 days; the median was 3 days.
Of patients diagnosed, 91.3% were Caucasian (Tables 9 and10). We compared this to the racial composition of admissions to Children's Healthcare of Atlanta at Scottish Rite for 1 year (1997). Racial composition for the complete study could not be obtained, but we do not believe any major changes occurred in the racial composition of patients admitted to the hospital during this time. We grouped patients into Caucasian and non-Caucasian groups. Patients in whom the ethnicity was unknown were eliminated from the analysis. (This assumes that the unknown races were missing at random.) Diagnosed MSBP patients were significantly more likely to be Caucasian than non-Caucasian (Table 10).
We reviewed our impressions of the mother and family with regard to characteristics that have been associated with MSBP12,,17,18 (Table 11). Although many of the families fit the usual stereotypes of MSBP, such as an enthusiasm for medical testing, an emotionally or physically distant father, and unusual closeness to medical staff, these were not uniformly observed, and we were unable to predict the certainty of diagnosis using these factors. Confidence intervals were calculated for the numbers involved (Table 11). In all cases, the confidence intervals overlapped with characteristics of patients in whom a diagnosis could not be made. Thus, no single characteristic was predictive of a certain diagnosis of MSBP.
Once the diagnosis of MSBP was made, the attending physician, usually accompanied by the social worker, law enforcement officials, or hospital security staff, confronted the mother. She was informed that we had concluded that she had induced, staged, or fabricated illness. We told her how we arrived at this conclusion. After this, 9 (45%) of 20 mothers confessed In 3, this information was not available.
In addition, 4 patients who underwent video surveillance because of a strong suspicion of MSBP were judged to be innocent after monitoring. In these cases, the monitoring showed an absence of fabrication, no evidence of inducement of disease, and we found medical documentation of a legitimate medical problem or reproduction of the child's symptoms on videotape. Numbers were too small to lead to definitive statements as to how these patients differed from the patients diagnosed with MSBP. In the first patient, an 8-month-old girl referred for evaluation of apnea, an episode of central apnea was observed on video and confirmed on an apnea monitor. Comprehensive drug screens were negative and no inducement or fabrication of illness was seen. In the second, a mother gave multiple diagnoses for her 7-year-old child, which her physician thought were fabrications. He suspected MSBP and referred her to us. During the hospitalization, we assembled the child's records from other caretakers and found that the mother's descriptions of diagnoses were accurate. On video monitoring, no fabrications or exaggerations of the child's symptoms were observed. In the third case, a mother was suspected of fabricating or inducing apneic episodes in her 1-year-old child. On CVS, the mother was noted to be overly anxious and frightened during false apnea alarms on the monitor in the room. However, she did not induce or fabricate the episodes. We concluded that the mother was excessively worried about her child but did not fabricate or induce disease. We decided that she needed education and reassurance rather than confrontation. In the final case, a 3-year-old boy had a history of recurrent apnea. This is such an unusual complaint at this age that we were highly suspicious of MSBP. His medical evaluation, including electroencephalogram and computed tomography of the head, was negative. Covert video monitoring was begun, but no apneic events were observed. The parents seemed appropriate at all times and did not fabricate, induce, or exaggerate symptoms. Rather than pursue a diagnosis of MSBP further by involving the local department of family and children's services, additional neurological evaluation was performed. During a subsequent admission, a video (not covert) electroencephalogram confirmed that he was experiencing seizures during the apneic episodes.
The stereotype of a MSBP mother is a female caretaker who has a history of health care work, does not have a good relationship with the father of the child, is unusually friendly with the medical staff, and seems unconcerned, even sympathetic, when the doctor is unable to make a diagnosis. She may seem unusually familiar with medical jargon and diseases. Although we found this to be true in many cases, a review ofTable 11 reveals that this type of pattern recognition is not sensitive enough for diagnosis. For example, only 12 of 23 mothers seemed to the medical staff to be unusually knowledgeable, and only 9 of 17 suggested tests to the doctor, and 8 of 17 suggested diagnoses. No consistent pattern of the mother's reaction to medical tests was noted, except that an unusually large number seemed to react positively to invasive procedures (10/14 in whom information was available). However, this observation alone was not enough to prove the diagnosis. It was not always true that the father was distant or uninvolved, at least as we could determine after a history, physical examination, social work consultation, and following the patient in the hospital. Only 9 of 20 mothers seemed unusually close to the medical staff or their physicians. Only 1 family had a history of another childhood death in the family.
We found that video surveillance was required to make the diagnosis in over half (56.1%) of patients with MSBP and supportive of the diagnosis in another 21.7%. Because most hospitals do not have the ability to perform CVS, this implies that most cases are missed or unproven, even when the physician suspects the diagnosis. MSBP is not as rare as many of the diseases routinely considered by physicians during the evaluation of these confusing patients.19
One could argue that the diagnosis would have been made later without video surveillance, and we cannot absolutely disprove this. However, given the reluctance of physicians to make the diagnosis, the tendency of patients to switch physicians once the diagnosis is suspected, and the difficulty in proving inducement or fabrication of disease without monitoring, we believe that most of these patients would have escaped detection.
CVS is especially useful for children who are the victims of fabrication of symptoms by their caretaker. In 8 of 10 of these, covert monitoring was required to make the diagnosis. It was also crucial in patients whose mothers, as best we could tell, did not fabricate disease but only induced it. It was required for diagnosis in 2 of 2 of these cases. Even when CVS was not required for diagnosis, it was helpful in court and provided additional evidence to convince the court system of the diagnosis.
As has been found in other studies, the mother is usually the fabricator or inducer of symptoms. This was true in all of our cases. In 1 case, the father was a health care worker, but the mother seemed to be the primary person involved in inducing or fabricating symptoms.
Several other findings stand out in our data:
As others have found,3 most of the mothers (55%) had a history of health care work or training in the past. A surprisingly large number (25%) worked in day care if they did not have a history of medical training or employment. To our knowledge, this has not been reported previously.
A large number of patients had gastrostomy tubes. Although we did not collect data on this specifically, our impression was that many of these children had a history of feeding problems or poor weight gain in the past. We can speculate that this may have been secondary to poor maternal interaction and even withholding of food. In addition, a gastrostomy tube is a superb site for the inducer to covertly administer medications that can produce symptoms. Others have reported similar problems with central venous catheters.20,,21
MSBP seems to be more common in Caucasian patients than in other ethnic groups seen at our hospital. Little information is available on the ethnicity of MSBP patients in the literature previously.
Many of the mothers reported a history of abuse as a child. We have no way of knowing whether this was a fabrication on their part or real.
Most of the fathers for whom we have data held nonprofessional occupations. Although we do not have precise data on this, they often worked long hours, the evening shift, or held 2 jobs, even when the parents' union was outwardly intact. One wonders whether the family was really close, or whether the mother was rewarded when the child was ill because the father spent more time with the family during the illness.
Our data show that the presence of a demonstrable medical disease does not eliminate the possibility of MSBP. In fact, previous encounters with the medical system and its perceived rewards may be the first step to fabrication or inducement of disease.
Our data are limited by the fact that it was retrospective in nature. In addition, the data regarding many of the characteristics of the mothers and families involved highly subjective decisions. We used only our judgment as clinicians to decide whether the mother seemed unusually savvy in her medical knowledge, whether the parents seemed close, etc. However, this is typically the way these attributes are assessed in busy clinical practice, so we believed that they would be useful. If these traits were obtained in a more methodical fashion, the results might have been different. These subjective judgements were not blinded as to the final diagnosis but were made before deciding whether a patient was placed into a diagnostic category such as certain MSBP, probable MSBP, etc. It is possible that our assessments of family characteristics were affected by our knowledge of the outcome of the video surveillance. If this were true, however, we believe that, rather than yielding new perspectives, the parents' characteristics would have conformed more to our preconceived notions of the typical MSBP parents, which tended to fit the stereotypes mentioned above.
We found that in only 1 of the 23 confirmed cases was there a history of sibling death. Other studies have reported much higher percentages of 11% to 67%.22–24 Perhaps CVS allowed us to detect cases earlier and prevented the deaths of some children.
Southall et al11 also reported on the value of CVS in detecting intentional suffocation. Our study differed in that it evaluated all children who underwent video surveillance for evaluation of suspected fabricated or induced disease, not just those suspected of induced apparent life-threatening events.
CVS has been the subject of some controversy25–31 Some have argued that it is unethical and an invasion of privacy. We believe that when MSBP is a strong diagnostic consideration, the beneficial, even life-saving aspects of this clinical tool outweigh concerns about privacy. As others have pointed out,18 many aspects of privacy are lost when one is admitted to the hospital for any reason. Doors are not locked, strangers are allowed to view the patient unclothed, and nurses wake the patient up in the middle of the night for vital signs. In addition, the monitoring is performed to protect the child, who is not in a position to provide consent for his or her own protection.
However, proper safeguards must be in place to protect the interests of the child's family. It is not appropriate to initiate CVS when a single staff member decides it is indicated. In our hospital, covert surveillance begins only after a multidisciplinary team agrees on the procedure. CVS requires an enormous commitment of time from physicians, nurses, social workers, and security officers. Insurance companies do not reimburse the hospital or caretakers for the resources used. In the United States, at least, it is unlikely that this procedure will be overused for this reason alone, ethical considerations notwithstanding.
It has been argued by some that this procedure has been used to entrap suspects, that videotapes obtained in this way may be taken out of context, and that the artificial conditions in the hospital lead to excess parental stress during which they may react in an atypical way.32 Defense lawyers may use these same arguments when the videotapes are shown in court. We will leave it to the court system to weigh the pros and cons of each case. They can decide, for example, whether a mother's attempts to suffocate her infant are taken out of context. We do not believe the hospital environment is sufficiently stressful to make a mother smother her child, fabricate or stage vomiting, or administer medications to create illness. Indeed, many of the mothers seem to thrive in the hospital environment and seem to prefer it to home.
In addition, CVS can support innocence as well as guilt. The caretakers of 4 of our patients who were suspected to be victims of MSBP were believed to be innocent after CVS. These were patients in whom there was a strong suspicion of MSBP before monitoring. In such cases, the surveillance may be used to protect parents from overzealous prosecution.
Our data support the fact that audio as well as video surveillance is important. Some of the mothers were heard coaching their child to have symptoms. Others told lies about their child's illness to family and friends when talking on the phone.
CVS does have limitations independent of the ethical considerations of a parent's right to privacy. Sometimes it is difficult to decide when to intervene. For example, a mother might be seen suffocating her child but the video might not be entirely convincing in court. Should one intervene to protect the child or wait for a more convincing video? These are questions that must be answered individually. One must weigh the immediate danger to the child against the long-term and often more serious risk of injury if the diagnosis is not proven. In addition, in some cases, the parents were suspicious that they were being monitored. This of course lessens the chance that fabrication or inducement of disease will be observed. Since this study was completed, we have installed newer, more difficult to detect equipment.
A first (and often missing) step in diagnosis is to consider MSBP as a cause of the patient's symptoms. In the cases investigated here, this was not a problem, because consideration of the diagnosis was required to be included in this study. Unfortunately, even in these cases, diagnosis in most cases would have been impossible, or at worst delayed, without video surveillance.
MSBP is not a rare disease. Many of these children eventually make their way to tertiary care centers because the diagnosis is elusive. A detailed medical history from the parents, which is the physician's most valuable tool in diagnosis for most illnesses, is rendered invalid in these cases. CVS then becomes a medical diagnostic procedure essential to diagnosis. Based on this data, we believe that all tertiary care children's hospitals should develop protocols and facilities to perform CVS to detect MSBP.
- Received September 2, 1999.
- Accepted January 19, 2000.
- Address correspondence to David E. Hall, MD, Children's Healthcare of Atlanta at Scottish Rite, 1001 Johnson Ferry Rd, Atlanta, GA 30342. E-mail:
FNa In the first, a child with a history of feeding problems and failure to thrive had 2 drug screens that were positive for benzodiazepines. We believe the mother was aware she was being monitored by covert surveillance. In the second, a urine test was positive for emetine (ipecac) in a child with otherwise unexplained vomiting. She may have given the medicine before admission.
↵FNb A nurse at a referring hospital observed the mother smothering her 18-month-old child. She was referred for further documentation of this but nothing occurred during CVS. When confronted later, the mother confessed to smothering the child. In the second case, a mother was observed administering what appeared to be an insecticide to her child by a nurse at a referring hospital. We saw no problems on video surveillance, but the nurse's testimony led to removal from the home. The child, who had a history of apnea, 2 cardiorespiratory arrests, and decreased muscle tone, became asymptomatic when removed from the parent.
FNc The mother presented us with an emesis basin containing what she said was her infant's vomit. We were suspicious that the mother was misleading us. The vomit had the exact composition of glucose and electrolytes as a commercial electrolyte solution available in the room. CVS was begun, but no further episodes of vomiting occurred. The mother was confronted and admitted she had staged the emesis by pouring an oral electrolyte solution into the emesis basin.
- MSBP =
- Munchausen syndrome by proxy •
- CVS =
- covert video surveillance
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- Copyright © 2000 American Academy of Pediatrics