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Munchausen by Proxy: Clinical and Case Management Guidance
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Clinicians should consider the possibility of MBP in children with highly unusual clinical presentations, when clinical findings are unexpectedly inconsistent with the reports of the caregiver, and/or when a child’s response to standard treatments is surprising. One major misconception among clinicians is the idea that underlying disorders need to be ruled out in order for a conclusion of abuse or neglect to be made. In fact, children with genuine underlying medical, psychological or developmental problems are often the targets of this form of abuse and neglect. Victims may be directly harmed by the abuser’s induction behaviors, frequently undergo unnecessary and invasive evaluations and interventions, be kept out of appropriate school settings, miss social and developmental opportunities, and/or misperceive themselves to be excessively ill or disabled. Iatrogenic medical conditions may arise from unnecessary interventions and the child may become ill and/or permanently physically and/or mentally harmed as a result of well-intended diagnostic and treatment efforts. Any medical condition can be created, falsified or exaggerated. Additionally, falsified symptoms may be behavioral, psychiatric or educational. These guidelines provide education on terminology, warning signs and identification, assessment of abuse and psychopathology, reporting requirements, case management, treatment, and reunification. They are intended to provide guidance to medical providers, mandated reporters, child protective service workers, law enforcement, attorneys, therapists, and any professionals who may be involved with reporting, assessing and treating children impacted by MBP as well as their abusive caregiver(s). Published 2017.