The early recognition and management of Munchausen by Proxy
Danya Glaser
Great Ormond Street Hospital London UK
Dr Danya Glaser, previously a developmental paediatrician, is Visiting Professor at University College London and Honorary Consultant Child & Adolescent Psychiatrist at Great Ormond Street Hospital for Children, London where she is currently working on the early recognition of fabricated or induced illness (Munchausen by Proxy). For many years she headed an integrated child protection service working respectively with the identification and treatment of emotional abuse; providing multidisciplinary court assessments as an expert witness; and a post protection team working with children who have been seriously maltreated and their current, often new carers. She was a member of the Family Justice Council for 6 years and chaired the Development Group for the NICE Guideline ‘When to Suspect Child Maltreatment’. Dr Glaser has taught, researched and written widely on various aspects of child maltreatment including sexual and emotional abuse, fabricated or induced illness; the effects of child maltreatment on the developing brain; and Attachment. Dr Glaser is a past president of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) and has chaired an adoption panel.
Abstract
The underlying dynamic in Munchausen by Proxy (MbP) is the mother's/parents’ need for a diagnosis and for the child to be recognised as ill, or as more ill than the child really is. Most cases of MbP can be recognised by... [ view full abstract ]
The underlying dynamic in Munchausen by Proxy (MbP) is the mother's/parents’ need for a diagnosis and for the child to be recognised as ill, or as more ill than the child really is. Most cases of MbP can be recognised by paediatricians who are perplexed by the presentation, which contains discrepancies between parental reports and independent observations of the child, regarding the child’s medical history and current health. Further investigations do not explain the discrepancies. However, doctors remain concerned about missing treatable causes.
This workshop will describe an approach which focusses on the child’s current health and functioning rather than on the mother’s mental health, behaviour and actions. First, all involved doctors investigate the child and agree about any verified illness. If the child’s reported symptoms still remain unexplained, the parents can be reassured that, even without an explanation, there is no life-threatening illness. No further investigations are required and the child and family will be helped to function better alongside the symptoms without the child being harmed. The implications of this ‘change of tack’ to a focus on the child’s functioning including school attendance, full mobilisation and appropriate eating, instead of pursuit of a diagnosis, need to be explored with the parents. The child and family also need help in constructing a narrative about this change. Involvement of mental health services is often required. Longer term monitoring of the maintenance of change is required by school and primary health.
If there is illness induction or deception, or the parents refuse this rehabilitation and insist on further investigations and ‘doctor shopping’, child protection is required, focusing on the parents’ unwillingness to support the child’s return to better functioning rather than on what the parents are ‘doing to the child’.
There will be interactive discussion about the obstacles to this approach.
Authors
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Danya Glaser
(Great Ormond Street Hospital London UK)
Topic Area
Physical and Emotional/Psychological Abuse and Neglect
Session
Workshop 3 » Session 2-Child Physical & Emotional Abuse (14:15 - Monday, 2nd October, South America Room)
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