Munchausen by Proxy Sendromu; Ağır Bir Çocuk İstismarı Formu

Abstract

Munchausen sendromu by proxy çocuk istismarının çok ağır ve özel bir şeklidir. Bir erişkin, genellikle anne tarafından çocukta hastalık belirti ve bulgularının oluşturulması ile karakterize karmaşık ve potansiyel olarak ölümcül bir çocuk istismarı formudur. Sonuçta gereksiz tanısal işlemler, cerrahi girişimler ya da medikal tedavi nedeniyle çocukta ciddi tıbbi zararlar oluşur. Pek çok klinisyen fiziksel veya seksüel istismarı oldukça iyi bilirken Munchausen sendromu by proxy’yi tanımakta güçlük çeker. Neyse ki literatürde fazla sayıda olgu paylaşıldıkça pediatristlerin konu ile ilgili farkındalıkları artacaktır. Tanı konulmasında ve ayırıcı tanı yapılmasında halen zorluklar vardır. Genel görüş nadir, olağan olmayan bulgularla başvuran veya standart tedaviye cevap vermeyen her olguda Munchausen sendromu by proxy’den şüphelenilmesi gerektiğidir. Tanı her olguya şüpheci yaklaşım ve özgün tanısal işlemler ile koyulabilir. Olguların multidisipliner bir ekip (Çocuk Koruma Birimi) tarafından değerlendirilmesi şarttır. Bu derlemede Munchausen sendromu by proxy’nin epidemiyolojisi ve tanı basamakları tartışılacaktır.

Keywords

• Munchausen sendromu by proxy, Çocuk, Çocuk İstismarı

Munchausen Syndrome by Proxy; A Serious Child Abuse Form

Abstract

Munchausen syndrome by proxy is a very special and dangerous form of child abuse. It is characterized by a child with symptoms and signs of an illness that have been fabricated by an adult, usually the mother. Fabrication of those signs and symptoms leads to many unnecessary and painful investigations and treatments for the victim. Although many physicians are familiar with the sexual or physical abuse of children, they are unaware of this particular form of child abuse. Fortunately, awareness among pediatricians will increase as more cases are shared in the literature. Diffi culties remain in defi ning the condition, as well as in the detection and differentiation from other illness. Although it is a relatively rare form of child abuse, pediatricians need to have a high index of suspicion when faced with seemingly inexplicable fi ndings or treatment failures. Diagnostic strategies should be case-specifi c and a multidisciplinary approach such as from a “Child Protection Team” is crucial for proper management and effective treatment planning in these cases. This review will discuss the epidemiology and diagnosis of Munchausen syndrome by proxy, as well as the role of the physician in sorting out these cases

Keywords

• Child, Child abuse, Munchausen syndrome by proxy

References

1. Violence Prevention Committee. Child abuse. Ann Emerg Med 2000; 36:180.
2. Schreier H. Munchausen by Proxy. Curr Probl Pediatr Adolesc Health Care 2004;34:126-43.
3. Sharif I. Munchausen syndrome by proxy. Pediatr Rev 2004; 25:215-6.
4. Foto-Özdemir D, Yalçın SS, Zeki A, Yurdakök K, Özusta Ş, Köse A, et al. Munchausen syndrome by proxy presented as recurrent respiratory arrest and thigh abscess: A case study and overview. Turk J Pediatr 2013;55:437-43.
5. İnce T. Munchausen by Proxy Sendromu. Katkı Pediatri Dergisi 2010; 32:525-37.
6. Schreier HA. Error in Munchausen by proxy defi ned. Pediatrics 2002;110:985-8.
7. Galvin HK, Newton AW, Vandeven AM. Update on Munchausen syndrome by Proxy. Curr Opin Pediatr 2005;17:252-7.
8. American Academy of Pediatrics Committee on Child Abuse and Neglect. Distinguishing sudden infant death syndrome from child abuse fatalities. Pediatrics 2001;107:437-41.

9. Terry L. Fabricated or induced illness in children. Paediatr Nurs 2004;16:14-8.
10. McGovern MC, Smith MBH. Causes of apparent life threatening events in infants: A systematic review. Arch Dis Child 2004;89:1043- 8.
11. McClure RJ, Davis PM, Meadow SR, Sibert JR. Epidemiology of Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Arch Dis Child 1996; 75:57-61.
12. Senocak ME, Türken A, Büyükpamukçu N. Urinary obstruction caused by factitious urethral stones: An amazing manifestation of Munchausen syndrome by proxy. J Pediatr Surg 1995;30:1732-4.
13. Sahin F, Kuruoğlu A, Işik AF, Karacan E, Beyazova U. Munchausen syndrome by proxy: A case report. Turk J Pediatr 2002 44:334-8.