Editorial, by Chiara Dieguez and Manon Juillerat, MIDE students, 8 February 2019

2019 02 08 ED MIDE munchhausen C Diegez M JuilleratAccording to the latest figures obtained by the Swiss Society of Paediatrics, the number of children treated in clinics following proven or suspected ill-treatment totalled 1,730 cases in 2017. Among other forms of ill-treatment; physical and mental abuse, sexual abuse or negligence, Munchausen's syndrome by proxy (MSbP) appears as a small subgroup, accounting for just 0.3% of cases. The latter, although difficult to detect, is still diagnosed in seven children per year on average.

Munchausen's syndrome by proxy is a form of abuse whereby a parent, usually the mother, invents, falsifies or causes symptoms of illness in their child in order to submit them to numerous medical procedures. It is important to note that the focus of the abusive parent's interest is solely the medical attention; their actions are not motivated by other reasons, such as the desire to obtain exclusive parental authority during an acrimonious divorce.

Abuse by the parent is not just limited to emotional and possibly physical suffering. Repetitive auscultations (stethoscope examinations), medical treatments or unnecessary surgical operations also damage the physical and mental health of the victim. Although confronted with paradoxical or incoherent signals, a doctor remains faithful to the Hippocratic Oath, thinking they are acting in the best interests of the child. Thus, unknowing, becoming their executioner.

In order to reduce the influence of the parent and to detect Munchausen's syndrome by proxy as quickly as possible, the doctor's practice should include more attentive listening to the child's opinion. This is advocated by both the International Convention on the Rights of the Child (Article 12) and the Swiss Civil Code (Article 377 (3)). In addition, a methodical and multidisciplinary childcare, including social services, psychologists, paediatricians and other professionals, would help minimise the doctor's exposure to the parent's pathological need for attention.

However, once the syndrome is detected, that is just the beginning.

Contrary to popular belief, completely excluding the abusive parent from a child's life is not a miracle solution that will allow them to begin a fulfilling life. In order to overcome the negative consequences of abuse and to ensure the proper development of the child, it is necessary that a regular relationship be maintained, even if the parent has been sentenced to a custodial sentence or otherwise detained. However, these meetings must always take place in a supervised and safe setting.

Ultimately, Munchausen's syndrome by proxy is a form of ill-treatment that is complex to grasp thoroughly. Not overly common in Switzerland, it cannot be ignored as, in extreme cases, it can result in the death of a child.

Read the pdffull article and bibliography (in French).

Picture: Département des Yvelines, flickr/cc

NB: The editorial does not necessarily reflect the opinion of IDE board and team.

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