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Medical child abuse - Suspected Child Abuse
Other Resources UpToDate PubMed

Medical child abuse - Suspected Child Abuse

Contributors: Richard L. Barbano MD, PhD, Antoinette L. Laskey MD, MPH, MBA, FAAP
Other Resources UpToDate PubMed

Synopsis

Medical child abuse, or factitious disorder imposed on another person, is the infliction of illness or injury by one individual onto another. Formerly known as Munchausen syndrome by proxy, this terminology has fallen out of use due to its focus on the perpetrator. The term medical child abuse, conversely, focuses on the harm that comes to the child regardless of the motivation or intent of the perpetrator; even if the perpetrator does not mean to inflict harm, the fact is they do.

Clinical presentation can vary widely, as affected individuals can appear as injured or ill from any number of diseases, but commonly these patients are high utilizers of the health care system who have symptoms that are not well explained by a known medical condition. Children affected by medical child abuse can present with fabricated or inflicted medical illness by their caregiver, and they are consequentially subject to extensive medical testing and treatment.

There are different types of medical child abuse, including:
  • Exaggerated illness
  • Fabricated illness
  • Induced illness
Medical child abuse may involve one or more types, individually or simultaneously, with or without escalation over time.

Many patients will improve during hospital observation but worsen after discharge when they return to their abusive environment.

Related topics: factitious disorders, physical child abuse

Codes

ICD10CM:
F68.A – Factitious disorder imposed on another

SNOMEDCT:
95637005 – Munchausen syndrome by proxy

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Delusional disorder
  • Malingering
  • Factitious disorders
The differential diagnosis is broad, but consider disorders with intermittent signs and symptoms, especially rare or uncommon ones. Possibilities include:
  • Heavy metal poisoning (eg, Lead poisoning, Mercury poisoning, Arsenic poisoning)
  • Wilson disease
  • Hemochromatosis
  • Familial Mediterranean fever
  • Hemophilia (Hemophilia A, Hemophilia B)
  • Epilepsy (eg, Infantile spasms, Juvenile myoclonic epilepsy)
  • Inherited or Acquired immune deficiency syndrome
  • Mitochondrial disorders
  • Substance use disorders (see Addiction disorders)
  • Chronic pain syndromes, including Complex regional pain syndrome

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:03/05/2023
Last Updated:11/15/2023
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Medical child abuse - Suspected Child Abuse
A medical illustration showing key findings of Medical child abuse
Copyright © 2024 VisualDx®. All rights reserved.