PS019: IS THIS MUNCHHAUSEN BY PROXY IN CYSTIC FIBROSIS?
Maddison J, Rolles CJ (Department of Paediatrics, Southampton
University Hospitals NHS Trust UK),
Since first described by Meadows in 1977, Munchhausen's syndrome by proxy has been well documented in otherwise healthy children. Attention has been paid to the condition in the handicapped child but very little to the child with a chronic illness such as cystic fibrosis.
In our study we identified six children who clearly stood out from the rest of our 85 full care patients. These children were felt to be receiving a level of treatment that was not consistent with their clinical needs. Some had symptoms that were persistent and difficult to explain. They had a high level of attendance, either at the hospital or a variety of alternative therapists. They were frequently being admitted to hospital and usually settled quickly with their symptoms disappearing when their parents were not present. In all cases it was difficult for the nursing and medical staff to establish a good working relationship and in many cases there was open hostilities from the family. These families were also highly demanding and very time consuming.
In only one of our families did we resort to a "child abuse" case conference. In others informal advice was sought from social workers but in view of the unusual nature of the children's problems combined with their undoubted cystic fibrosis, recourse to legal action was not taken.
Parents of cystic fibrosis children become very experienced and become part of the professional team in their own right. Their ability to interpret their children's health needs is vital and professionals have to trust the families judgement in many situations. We cannot ignore the possibility that on occasions there may be secondary gain to family members for the child to maintain an inappropriate sickness mode with the resulting over treatment or inappropriate treatment. Details of our six patients will be presented.