Syndrome of Münchausen per procuration

See also: Münchausen

The Syndrome of Münchausen per procuration is a serious form of maltreatment to child during whom the adult who has in load the child causes in a way deliberated at his place of the health issues serious and repeated before leading it near a doctor.

Also called syndrome of Meadow, this syndrome describes the patients bringing their children in a repetitive way to the pediatric urgencies for symptoms which they have themselves provoqués.
It would be at the origin from 8 to 20% of the unexplained sudden deaths of the nourrisson.
He was discovered in 1977 by Sir Roy Meadow (St James University Hospital). It is impossible to quantify its real importance but, with the the United States, 1000 annual cases are indexed thanks to the systematic autopsy of sudden deaths of the infant. Sir Roy Meadow estimates to have had to deal with 400 cases.

In France, there does not exist Consensus on the reality of this syndrome and good number of pediatrists and psychiatrists cannot imagine Mère S inflicting such sufferings with their child and refuse to admit to have been thus mystifiés.
There remains however very difficult to make the difference between a child who choked himself all alone under his feather bed of that which died because one pressed a pillow on his face.

The Vidéo monitoring remains the average fastest diagnosis but it is contrary with the French right, which requires to warn the mothers of the existence of the material of monitoring. Reserves seem to delay its use.

Definitions

This syndrome is defined by the association of four criteria:

disease of the Child produced or simulated by one of the relative S
doctor visits repeated to obtain the realization of complementary examinations and the regulation of treatments
the responsible parents affirm not to know the cause of the symptoms
the symptoms regress when the child is separated from the responsible relative.

In its extreme form this syndrome can lead to major medical acts putting the vital prognosis concerned. In fact this syndrome appears to be the form extreme and pathological parental behavior analyzed by Eminson and Postlethwaite in term of desire of doctor visit: the normal parental behavior is defined by a desire to consult adapted to the clinical situation of the child and in adequacy with the opinion of the consulted doctor. With the excess of desire to consult by the parents, those invent symptoms or generate a disease in the child to lead the doctor to prescribe examinations and therapeutic.

All the social layers are concerned and in 90% of the cases it is about the biological mother. An important percentage of these women follow a medical or ancillary medical occupation (Médecin, Infirmière, Assistance-looking after, Social worker, etc) or have a bond with this medium.

They present a stereotyped behavior of " good mother particularly attentive with regard to her child and extremely present at the time of the hospital stays of this last ". They are generally less worry that the medical team and hold a speech of the medical type, not hesitating to suggest invasive complementary examinations or interventions chirurgicales.
These women are opened out in hospital medium by the fact that they are the object of admiration on behalf of the doctors and other parents. 30% of them suffer from a simple syndrome of Münchausen.

Clinical demonstrations

Any repeating pathology, having required multiple hospitalizations, negative complementary examinations or treatments without success, can be implied. The concept of brothers or sisters looked after for many rare diseases and/or of unexplained sudden death of the infant in the phratry are very evocative. The absence of symptomatology when the child is separated from the relative is a major element.

the Apnea S (asphyxiation is the first cause of death)
the Empoisonnement S: 2nd cause of death and the Ipéca is the poison more used
the bleedings create or simulated with maternal blood
the convulsions
Diarrhées, fevers, cutaneous eruptions

Supposed death rate would be from 15 to 20%

Etymology

The name derives from a baron de Münchhausen (Karl Friedrich Hieronymus Freiherr von Münchhausen, 1720 - 1797), to which incredible exploits written by Rudolf Raspe are allotted.

In 1951, Richard Asher was the first to describe a diagram of self-mutilation, where the patients invented stories of disease. Remembering the baron de Münchausen, Asher called this state the syndrome of Münchausen. In the beginning, this term was employed for all the fictitious disorders. Nowadays, it is considered that there exists a whole range of fictitious disorders, and the diagnosis of " syndrome of Münchausen" is reserved for the most serious forms, or the simulation of the disease is the central activity in the life of the patient.

In 1977, the English pediatrist Roy Meadow described a form of maltreatment with child in whom mothers induce or describe wrongfully diseases in their children. He named this Syndrome behavior of Münchausen per procuration.

Legal affairs

Subject of novels

JONQUET, Thierry. Moloch
Patricia Cornwell
GREGORY, Julie. My mother my torturer . Paris: the Archipelago, 2006,275 p.
KATOU; JAPP, Andrea H. the Syndrome of Munchaüsen . Paris: EP Éditions, 2003,70 p. (Small murders)
FLYNN, Gillian. On my skin . Paris: Calmann-Levy, 2007. (Calmann-Levy suspense)

Random links: