The American Academy of Pediatrics (AAP) has released a report warning healthcare professionals about the dangers of “caregiver-fabricated illness” in children, giving a new name to the condition and emphasizing the harm it can do to kids. As a result of the rarity of the condition, it is often overlooked, and the AAP is urging physicians to be vigilant in potential cases of the condition. Finding out more about the issue itself, how common it is and the harm it can cause helps to understand the importance of recognizing caregiver-fabricated illness as soon as possible.
What Is Caregiver-Fabricated Illness?
The name of the condition pretty accurately describes what it is, but the condition’s previous eponym, Munchausen’s-by-proxy, helps to clarify its characteristics. Munchausen syndrome is a condition in which the sufferer pretends to be ill or even induces symptoms of illness in themselves purposefully in order to fulfill the role of the “patient,” and this can happen with either psychological or physical symptoms. There is nothing to gain by claiming to have the condition (the feigned illness isn’t used to claim sick pay at work or for other benefit), other than to receive care and attention from others. Caregiver-fabricated illness is this same process except a child is the target, so caregivers take him or her to a doctor unnecessarily and lie about, exaggerate or even induce symptoms in order to convince physicians or psychologists that there is a problem. The name for the condition is still in something of a state of flux (with other names such as pediatric condition falsification being suggested), but the AAP has made its suggestion and hopes to establish a consensus within the field. Additionally, the report calls for the establishment of a consensus on symptoms and diagnostic criteria to help identify those at risk.
A Form of Child Abuse
The AAP’s report is also focused on the severity of the condition, calling it a form of child maltreatment. This may seem like an exaggeration, but the condition—when undetected—results in unnecessary medication being taken by the child. This wouldn’t be such an issue, but medications all carry some risk of side effects, so any unnecessary treatment is effectively a mechanism through which harm can come to the child. The National Poison Data System recorded over 1,400 calls over an eight-year period (2000 to 2008) where children under the age of 7 had been “maliciously” exposed to medications. The report stresses that the condition can lead to serious morbidity and even death. Of course, the person with the psychological abnormality is the caregiver, and the otherwise healthy child is the one who risks coming to harm.
Rare, Often Unnoticed
One of the biggest problems regarding the condition—and in particular with determining common symptoms—is that it is extremely rare. According to the report, only between 0.5 and 2 out of every 100,000 children under the age of 16 is exposed to the condition, making the incidence around 0.002 percent of the population at most. This makes it very rare indeed, but physicians are likely to encounter at least one case throughout their career. However, this doesn’t provide much opportunity for the healthcare provider to become accustomed to the cluster of symptoms and is assumedly a reason that only about 30 percent of all cases are correctly reported. Effectively, this means that physicians need to conduct further research to correctly identify the condition where it is suspected, whether through reviewing medical literature or liaising with other providers.
Staying on the Lookout
Actually identifying the condition is very difficult, but the report suggests that physicians should feel suspicious if a child has a recurrent or otherwise persistent illness that doesn’t appear to stand up to medical scrutiny. As Munchausen’s patients will often travel around to different healthcare providers to avoid being caught, it’s reasonable to assume that children with caregiver-fabricated illness may be taken to different locations, so contacting physicians who’ve previously seen the child is important. The report also notes that the most commonly-reported symptoms are bleeding, diarrhea, apnea (temporarily stopping breathing), vomiting, rash and depression of the central nervous system. Conditions such as attention-deficit hyperactivity disorder are often reported, however, so it may be more difficult to determine whether the reported problem is genuine in such cases due to the lack of unambiguous physical symptoms.
The Importance of Raising Awareness
Pediatrician Maureen Claiborne pointed out to Medscape Medical News that there is little in the way of new information in the report (other than the name-change), but emphasized the importance of increasing awareness of the condition in ordinary physicians. Raising awareness appears to be the main purpose of the report, but this in itself could lead to a better understanding of the condition. The more cases that are identified, the bigger the potential dataset becomes, and this allows for a more accurate picture of the condition.