Patty,
 
There are a  whole lot of refs in MEDLINE; enclosed are some
from 1990-95.
 
                                                  DOCUMENT: 1 of 36
 
UI: 94253633
AU: Baldwin MA
TI: Munchausen syndrome by proxy: neurological manifestations.
AD: Department  of  Pediatrics,  Arizona  Health  Sciences  Center, Tucson
    85724.
AB: Munchausen  syndrome  by  proxy  (MSP) is a recently described form of
    child  abuse  in which a caregiver fabricates or induces symptoms in a
    child   in   order   to   attract medical attention. The epidemiology,
    clinical  features,  diagnosis  and  the spectrum of MSP are reviewed.
    Central  nervous  system  symptoms  are  a  common presentation of MSP
    because  they  can  be  reported without confirmation. Three cases are
    reported  to  illustrate  the most common neurological manifestations.
    It  is important for neuroscience nurses to have an awareness that MSP
    can  present  as  a neurologic problem, because appropriate management
    depends on early identification and treatment.
RF: 23
SO: J Neurosci Nurs 1994 Feb;26 (1):18-23
                                                  DOCUMENT: 2 of 36
 
UI: 94051498
AU: Mitchell I; Brummitt J  ; DeForest J  ; Fisher G
TI: Apnea and factitious illness (Munchausen syndrome) by proxy.
AD: Department of Paediatrics, University of Calgary, Alberta, Canada.
AB: OBJECTIVE.  Munchausen  syndrome  by  proxy (MSP) is recognized in the
    differential  diagnosis  of  apparent life-threatening events, but the
    early  signs  and  the full spectrum of this presentation are not well
    recognized.   We   aim   to   describe   MSP  presenting with apnea to
    illustrate  this  spectrum  and the evolution in our management over a
    period  of  10  years.  PATIENTS  AND RESULTS. Eleven children in five
    families  seen  in  one  institution  and  assessed  by  one  team are
    described  in detail. The children had apnea and/or pallor, but with a
    wider  age  range  than  usually  seen  with apparent life-threatening
    events,   sometimes   associated   with   other  injuries, and a large
    percentage  of  parents  were  health  care  providers. In no case was
    apnea  witnessed  by health care professionals other than the parents.
    There  were frequent disagreements in management between professionals
    and,  consequently,  delays  in  considering  the  diagnosis at first.
    There  were  two  deaths.  A team developed, allowing the diagnosis of
    MSP  to  be considered sooner and the cases to be assessed and managed
    consistently.  CONCLUSION. MSP is part of child abuse, and it needs to
    be  recognized  by  all  physicians. Family assessment is required and
    the  development  of  a  team interested in MSP facilitates assessment
    and management.
 
SO: Pediatrics 1993 Dec;92 (6):810-4
                                                  DOCUMENT: 3 of 36
 
UI: 94238213
AU: Magnay AR; Debelle G  ; Proops DW  ; Booth IW
TI: Munchausen syndrome by proxy unmasked by nasal signs.
AD: Institute of Child Health, University of Birmingham, UK.
AB: The   protean   manifestations   of   child   abuse  continue to cause
    diagnostic  difficulty.  Recent  observations of the high mortality in
    victims   of   Munchausen   syndrome   by   proxy, and their siblings,
    reinforce  the  need for early diagnosis and appropriate intervention.
    We  report the nasal manifestations which unmasked Munchausen syndrome
    by  proxy in an infant who presented with intestinal and peri-orifical
    signs  masquerading  as Crohn's disease. The possibility of Munchausen
    syndrome  by  proxy  should be considered in an infant with persistent
    nasal excoriation presenting as part of an undiagnosed illness.
 
SO: J Laryngol Otol 1994 Apr;108 (4):336-8
                                                  DOCUMENT: 4 of 36
 
UI: 93277144
AU: Meadow R
TI: False  allegations  of  abuse  and  Munchausen  syndrome by proxy [see
    comments]
AD: Department  of  Paediatrics  and  Child  Health, St James's University
    Hospital, Leeds.
AB: Fourteen  children  from  seven  families  are reported for whom false
    allegations  of  abuse  were  made by the mother. Twelve children were
    alleged  to  have  incurred sexual abuse, one both sexual and physical
    abuse,  and  one  physical  abuse  alone. Thirteen of the children had
    incurred,  or  were  currently  victims  of,  factitious illness abuse
    invented  by  the  mother. The one child with no history of factitious
    illness  abuse  had  a  sibling  who  had incurred definite factitious
    illness  abuse.  The  false  allegations of abuse did not occur in the
    context   of   parental   separation,   divorce,   or custody disputes
    concerning  the  children.  They occurred in the context of Munchausen
    syndrome  by  proxy  abuse. The age of the children, 3 to 9 years, was
    older  than  the usual age for Munchausen syndrome by proxy abuse. The
    mother  was the source of the false allegations and was the person who
    encouraged  or  taught six of the children to substantiate allegations
    of sexual abuse.
CM: Comment in:Arch Dis Child1993 Nov;69(5):61
SO: Arch Dis Child 1993 Apr;68 (4):444-7
                                                  DOCUMENT: 5 of 36
 
UI: 93309764
AU: Macdonald HA
TI: Munchausen syndrome by proxy [letter]
 
SO: N Z Med J 1993 Jul 14;106 (959):292
                                                  DOCUMENT: 6 of 36
 
UI: 93086561
AU: Goss PW; McDougall PN
TI: Munchausen syndrome by proxy--a cause of preterm delivery.
AD: Department   of   Neonatology,   Royal Children's Hospital, Parkville,
    Victoria.
AB: OBJECTIVE:  To  present the first case of Munchausen syndrome by proxy
    involving   self-induced   preterm   delivery.   CLINICAL  FEATURES: A
    27-year-old   Caucasian   woman   induced   antepartum haemorrhage and
    rupture  of  membranes  with a knitting needle at 26 weeks' gestation,
    leading  to delivery of the infant. This "prenatal child abuse" led to
    a  prolonged  intensive  care stay, extensive treatment and subsequent
    bronchopulmonary  dysplasia.  As  the child recovered from the effects
    of  extreme  prematurity, he became a victim of fabricated illness and
    recurrent  smothering  episodes.  INTERVENTION  AND OUTCOME: After the
    diagnosis  of  Munchausen  syndrome  by  proxy was made, the child was
    removed  from  the  mother  and  he  has  since  enjoyed  good health.
    CONCLUSION:  Self-induction  of  antepartum  haemorrhage  can  lead to
    preterm   delivery   and   may   be   recognisable by certain clinical
    parameters.  The  victim of self-induced preterm delivery, if survival
    ensues, may be subject to further abuse.
 
SO: Med J Aust 1992 Dec 7-21;157 (11-12):814-7
                                                  DOCUMENT: 7 of 36
 
UI: 93166315
AU: Mercer SO; Perdue JD
TI: Munchausen syndrome by proxy: social work's role.
AD: School of Social Work, University of Arkansas, Little Rock 72204.
AB: Munchausen  syndrome  by  proxy  is  the  diagnosis used to describe a
    variation  of  child  abuse  whereby  the  parent  or  adult caregiver
    fabricates  a  medical  history  or  induces symptoms in the child, or
    both,     resulting     in     unnecessary   examinations, treatments,
    hospitalizations,  and even death. This article reviews the assessment
    procedures,  provides  case  studies, and describes family dynamics of
    the  syndrome. The authors make recommendations for team management of
    the  child-family  system and recommendations for social workers. They
    propose  broadening  the  assessment  of  the  family  on the basis of
    knowledge  of the widespread physical and economic oppression of women
    and children in our society.
RF: 19
SO: Soc Work 1993 Jan;38 (1):74-81
                                                  DOCUMENT: 8 of 36
 
UI: 93191309
AU: Mehta P; Bussing R
TI: Factitious   coagulopathy   due   to   Munchausen   syndrome  by proxy
    [editorial]
 
SO: Am J Pediatr Hematol Oncol 1993 Feb;15 (1):124-5
                                                  DOCUMENT: 9 of 36
 
UI: 93191310
AU: Babcock J; Hartman K  ; Pedersen A  ; Murphy M  ; Alving B
TI: Rodenticide-induced   coagulopathy   in   a   young   child. A case of
    Munchausen syndrome by proxy.
AD: Department of Pediatrics, Walter Reed Army Medical Center, Washington,
    D.C. 20307-5100.
AB: PURPOSE:  To  present  the  diagnosis  and management of superwarfarin
    ingestion,  a  cause  of  serious and prolonged coagulopathy. METHODS:
    Specific    identification    of    the    anticoagulant   was made by
    high-pressure  liquid  chromatography.  RESULTS:  A 24 month-old child
    developed  bruises and a prolonged prothrombin time (PT) and activated
    partial  thromboplastin  time (aPTT) after receiving multiple doses of
    brodifacoum,   a   superwarfarin   rodenticide.   The coagulopathy was
    treated  successfully  with large doses of parenteral and oral vitamin
    K1;  fresh  frozen  plasma was administered as a precautionary measure
    on   two   occasions.   After   the   first   10   days of the child's
    hospitalization,   the   mother   was   identified   as  the source of
    brodifacoum,   exemplifying   the   behavior   described as Munchausen
    syndrome  by  proxy. Oral vitamin K1 was initiated and continued in an
    outpatient  setting with tapering doses over nine months, using the PT
    as  a  guide  for  therapy.  CONCLUSIONS:  This  report emphasizes the
    necessity  of  recognizing rodenticide poisoning and investigating its
    source.   Frequent   monitoring   of   the  PT is essential to prevent
    hemorrhagic  complications  due to repeat exposure, inadequate vitamin
    K1 therapy, or noncompliance.
 
SO: Am J Pediatr Hematol Oncol 1993 Feb;15 (1):126-30
                                                  DOCUMENT: 10 of 36
 
UI: 92152965
AU: Bools CN; Neale BA  ; Meadow SR
TI: Co-morbidity  associated  with fabricated illness (Munchausen syndrome
    by proxy).
AD: Department  of  Paediatrics  and  Child  Health, St James's University
    Hospital, Leeds.
AB: Fifty  six  children  who had been victims of fabricated illnesses and
    82  of  their  103  siblings  were  studied.  In addition to the index
    fabrication,  64% of index children had had other illnesses fabricated
    by  their  mothers.  Twenty  nine per cent of the index children had a
    history  of  failure  to  thrive  and  29% a history of non-accidental
    injury,  inappropriate  medication, or neglect. Seventy three per cent
    of  the  index  children  had  been  affected by at least one of these
    additional  problems.  Eleven  per  cent  of  the siblings had died in
    early  childhood, the cause of death not being identified. Thirty nine
    per  cent of siblings themselves had had illnesses fabricated by their
    mothers,  and  17%  had  been  affected  by  either failure to thrive,
    non-accidental injury, inappropriate medication, or neglect.
 
SO: Arch Dis Child 1992 Jan;67 (1):77-9
                                                  DOCUMENT: 11 of 36
 
UI: 92327171
AU: Crouse KA
TI: Munchausen syndrome by proxy: recognizing the victim.
AB: Munchausen  syndrome by proxy is a serious and potentially lethal form
    of  child  abuse  in  which  a  parent deliberately induces or reports
    physical  symptoms  in  a  child.  The  child  not  only  suffers from
    parent's  action,  but  he or she is subjected to an extensive battery
    of  invasive medical and radiological testing that are unnecessary and
    painful.  All  health  care professionals must work together to ensure
    that  the  syndrome  is discovered in time and the child is protected.
    The child's psychological and physiological welfare are in danger.
 
SO: Pediatr Nurs 1992 May-Jun;18 (3):249-52
                                                  DOCUMENT: 12 of 36
 
UI: 95114842
AU: Hochhauser KG; Richardson RA
TI: Munchausen  syndrome  by  proxy:  an  exploratory  study  of pediatric
    nurses' knowledge and involvement.
AD: School of Family and Consumer Studies, Kent State University, OH.
AB: The  awareness  and  involvement  of  pediatric  nurses in the type of
    child  abuse known as Munchausen syndrome by proxy (MSBP) was explored
    in  this  study.  A questionnaire assessing knowledge about and extent
    of  involvement  in  the  identification of MSBP cases and demographic
    information  was  completed by 320 registered nurses (RNS) employed at
    a   children's   hospital.   Fewer   than   half of the subjects (47%)
    responded  that  they  had  heard of MSBP. Those who had heard of MSBP
    demonstrated  only  a  moderate  level  of  knowledge of the signs and
    signals  of  the syndrome. Thirty-four percent of those nurses who had
    heard  of  MSBP  had been involved in the detection of cases. Findings
    suggest  that it might be important for pediatric hospitals to include
    information  about  MSBP  in  their  own  required classes or in-house
    seminars.
 
SO: J Pediatr Nurs 1994 Oct;9 (5):313-20
                                                  DOCUMENT: 13 of 36
 
UI: 95094030
AU: Bools C; Neale B  ; Meadow R
TI: Munchausen   syndrome   by   proxy:   a  study of psychopathology [see
    comments]
AD: Department  of  Pediatrics  and  Child  Health, St. James's University
    Hospital, Leeds, UK.
AB: Munchausen  Syndrome  by Proxy (the fabrication of illness by a mother
    in  her  child)  is  often a serious form of child abuse that has been
    recognized  increasingly  over recent years. Approximately one-half of
    the  mothers  in  this  study  had  either smothered or poisoned their
    child  as  part  of their fabrications. Lifetime psychiatric histories
    are  reported  for  47  of the mothers. Thirty-four had a history of a
    Factitious  or  Somatoform disorder, 26 a history of self harm, and 10
    of  alcohol  or  drug  misuse.  Nine  mothers  had  a forensic history
    independent  of  convictions related to child abuse. Nineteen of these
    mothers   were   interviewed   from   1-15   years  after the original
    fabrications.  The  most notable psychopathology was the presence of a
    personality  disorder  in  17 of the mothers, which were predominantly
    Histrionic  and  Borderline  types.  Most  subjects,  however, met the
    criteria for more than one category of personality disorder.
CM: Comment in:Child Abuse Negl1994 Sep;18(9):769-7
SO: Child Abuse Negl 1994 Sep;18 (9):773-88
                                                  DOCUMENT: 14 of 36
 
UI: 95094031
AU: Porter GE; Heitsch GM  ; Miller MD
TI: Munchausen  syndrome  by  proxy: unusual manifestations and disturbing
    sequelae [see comments]
AD: Department   of   Pediatrics,   Marshfield  Clinic, Marshfield Medical
    Research Foundation, WI 54449.
AB: Since  the  initial description of Munchausen Syndrome by Proxy (MSBP)
    (Meadow,  1977) , numerous  cases  have  been reported varying from as
    simple   as   the   complaint   of   a nonexistent symptom to those as
    complicated   as   altered   laboratory   tests   leading to the false
    diagnosis  of cystic fibrosis (Orenstein & Wasserman, 1986; Rosenberg,
    1987) .  We  report  three  findings previously unreported: esophageal
    perforation,  retrograde  intussusception, and tooth loss. Bradycardia
    has  been  previously  reported  associated  with suffocation (Meadow,
    1984) , but  in  our  case  may  have  been  caused  by carotid artery
    massage.   We   also   suggest   possible   induction by the mother of
    premature  rupture  of  fetal membrane leading to delivery of infected
    infants.
CM: Comment in:Child Abuse Negl1994 Sep;18(9):769-71
SO: Child Abuse Negl 1994 Sep;18 (9):789-94
                                                  DOCUMENT: 15 of 36
 
UI: 95271457
AU: Klebes C; Fay S
TI: Munchausen  syndrome  by  proxy:  a  review,  case  study, and nursing
    implications.
AD: School of Nursing, Indiana University, Indianapolis, USA.
AB: Munchausen  syndrome  by proxy (MSBP) is a serious form of child abuse
    that  often  remains  undetected  for  years. Victims (and often their
    siblings)  suffer  serious  physiological and psychological damage and
    sometimes  even  death.  Nurses  educated about this syndrome can have
    significant  impact  on  its  earlier diagnosis and intervention. This
    article  presents  a  literature  review  and case study and concludes
    with  a  discussion  of  nursing  implications including the effect of
    MSBP on nursing staff.
RF: 14
SO: J Pediatr Nurs 1995 Apr;10 (2):93-8
                                                  DOCUMENT: 16 of 36
 
UI: 95049089
AU: Feldman MD
TI: Denial  in Munchausen syndrome by proxy: the consulting psychiatrist's
    dilemma.
AD: University of Alabama Medical Center, Birmingham.
AB: OBJECTIVE:  The purpose of this review, which also includes the report
    of  a  new  case, is to discuss the pervasive denial of responsibility
    among  individuals  who  have  engaged in Munchausen syndrome by proxy
    (MSBP)  behavior.  In  MSBP,  a  caretaker  (almost always the mother)
    fabricates  or  induces  illness  in  her child; she then presents the
    child  for medical treatment, disclaiming knowledge of the etiology of
    the   illness.   METHOD:   Literature   searches   of several computer
    databases  were performed, and ninety-two citations dealing with MSBP,
    culled  from  medical,  legal, and lay publications, were examined for
    descriptions  of  caretakers'  responses  to being confronted with the
    allegation of MSBP. Thirty-four citations contained relevant material,
    which  was  combined  with observations from cases in which the author
    has  served  as  a  consultant.  RESULTS:  Caretakers engaging in MSBP
    consistently  deny any role in the dissimulation, even when confronted
    with  compelling  evidence. This denial complicates management, though
    intervention   must   focus   on   ensuring   the  safety of the child
    regardless   of   the   caregiver's  response. CONCLUSIONS: Techniques
    sometimes  advocated  in factitious disorders in general may be useful
    in  stopping  the abusive behavior; however, no consistently effective
    strategy for overcoming denial in MSBP has yet been described.
 
SO: Int J Psychiatry Med 1994;24 (2):121-8
                                                  DOCUMENT: 17 of 36
 
UI: 95235081
AU: Barker LH; Howell RJ
TI: Munchausen  syndrome  by  proxy  in  false allegations of child sexual
    abuse: legal implications.
AD: Brigham Young University, Provo, UT 84602, USA.
AB: A  review  of the literature regarding Munchausen syndrome by proxy in
    relation  to  allegations of child sexual abuse is presented. Problems
    in  the  diagnosis  of Munchausen syndrome by proxy in these cases can
    be  the  result  of  a failure to consider that the allegations may be
    false,  legal  issues  surrounding  the  child's  testimony, and other
    biases  in  professional  and  legal  attitudes towards allegations of
    sexual  abuse.  A  proposal  for  a more stringent standard of care is
    made.  Treatment  of  Munchausen syndrome by proxy is best effected by
    case  management,  with the person who made the diagnosis managing the
    case  throughout  the  treatment. This person should act as liaison to
    relay information between all the parties involved.
RF: 36
SO: Bull Am Acad Psychiatry Law 1994;22 (4):499-510
                                                  DOCUMENT: 18 of 36
 
UI: 95191720
AU: Krupinski M; Tutsch-Bauer E  ; Frank R  ; Brodherr-Heberlein S  ; Soyka M
TI: [Munchausen syndrome by proxy]
AD: Psychiatrische Klinik und Poliklinik, Universit at M unchen.
AB: The  term  "Munchausen  by proxy" denotes a special form of factitious
    disorder  and  a  rare  kind  of child abuse. We present the case of a
    12-year-old   boy,   whose   mother's  manipulations culminated in his
    immobilization  in  a  wheelchair and the implantation of a pacemaker.
    Problems  of  diagnosis and clinical management of Munchausen by proxy
    are discussed.
 
SO: Nervenarzt 1995 Jan;66 (1):36-40
                                                  DOCUMENT: 19 of 36
 
UI: 95199165
AU: Hertz S; Skau K  ; Uldall P
TI: [Munchausen syndrome by proxy]
AD: Barne- og Ungdomspsykiatrisk afd M, Hiller d Sygehus.
AB: Munchausen  Syndrome  by  Proxy  (MSbP) in children is a form of child
    abuse  in  which  a  parent  (usually  the mother) or other care-taker
    feigns  or  fabricates  disease  symptoms  in  the child, often to the
    extent  of  causing serious physical harm, sometimes even resulting in
    death.  Even  if the child does not suffer actual physical harm, there
    is  great  danger that his or her social and mental development may be
    jeopardized.  Health  care  personnel risk becoming party to the abuse
    through  exposing  the child to unnecessary medical procedures. A case
    of  MSbP  involving two siblings is presented in the article, together
    with  a  brief  summary  of  current  knowledge  of  the  syndrome and
    measures  for  its  management,  emphasising  the  necessity  of close
    cooperation  between  paediatrician, child psychiatrist and the social
    services.
 
SO: Nord Med 1995;110 (3):102-4
                                                  DOCUMENT: 20 of 36
 
UI: 90205078
AU: Kahan BB; Yorker BC
TI: Munchausen syndrome by proxy.
AD: Medical/ Psychiatric  Unit,  Henrietta Egleston Hospital for Children,
    Atlanta, GA.
 
SO: J Sch Health 1990 Mar;60 (3):108-10
                                                  DOCUMENT: 21 of 36
 
UI: 91016694
AU: Alexander R; Smith W  ; Stevenson R
TI: Serial Munchausen syndrome by proxy.
AD: Department  of  Pediatrics,  University of Iowa Hospitals and Clinics,
    Iowa City.
AB: Five  cases  of  Munchausen  syndrome by proxy (MSBP) are presented in
    which  more  than  one child in the family was victimized. There was a
    high    incidence    of    maternal    psychiatric  histories, marital
    difficulties,  and  M  unchhausen  syndrome in the mothers themselves.
    Seventy-one  percent  of the children in the families were known to be
    victims  of  MSBP;  four  of these children (31%) died. Multiple-child
    MSBP  may reflect more significant maternal psychopathology than found
    in   other   cases   of   MSBP,   or it may indicate the deteriorating
    consequences  to  the  mother and other children in the family if this
    syndrome   is   not   identified   with  the first child and effective
    interventions made.
 
SO: Pediatrics 1990 Oct;86 (4):581-5
                                                  DOCUMENT: 22 of 36
 
UI: 91045383
AU: Ksia zyk J; Socha J  ; Rujner J  ; Ry zko J
TI: ["Munchausen syndrome by proxyo as an example of diagnostic error]
AD: Oddzialu Gastroenterologicznego Centrum Zdrowia Dziecka w Warszawie.
AB: A   case   of   the   girl  who underwent multiple hospitalizations is
    presented.   Gastrointestinal   disorders   were   seen in the infancy
    together  with  skin  rash of allergic type, hypoglycaemia without any
    clear   reason   in   the   fourth   year   of  age, and polyuria with
    hyponatremia  and  hypokalemia  since  the sixth year of age. Mother's
    lack  of  concern  was  unexplainable  in  view  of  the deteriorating
    child's  health.  Samples  of  the  urine  and  faeces supplied by the
    mother  have  shown  the laboratory findings suggesting that potassium
    chloride  was  added  to the faeces and natrium hydrocarbonate--to the
    urine.  Urine  collected during polyuria contained large quantities of
    furosemide.  Long-term  follow-up, numerous examinations and performed
    tests  have  led  to  the  diagnosis  of  the  particular  form of the
    ill-treated   child   syndrome,   so-called   "Munchausenn   by proxyo
    syndrome.
 
SO: Pol Tyg Lek 1990 Mar 10-26;45 (12-13):255-6
                                                  DOCUMENT: 23 of 36
 
UI: 91070877
AU: Kravitz RM; Wilmott RW
TI: Munchausen syndrome by proxy presenting as factitious apnea.
AD: Division  of  Pulmonary  Medicine, Children's Hospital Medical Center,
    Cincinnati, OH 45229-2899.
 
SO: Clin Pediatr (Phila) 1990 Oct;29 (10):587-92
                                                  DOCUMENT: 24 of 36
 
UI: 91079246
AU: Stevenson RD; Alexander R
TI: Munchausen   syndrome   by   proxy   presenting   as   a developmental
    disability.
AD: Department of Pediatrics, University of Virginia, Charlottesville.
AB: Munchausen  syndrome by proxy (MSBP) is a form of child abuse in which
    a  parent  falsifies  illness  in  a child by fabricating or producing
    symptoms  and  presenting the child for medical care while disclaiming
    knowledge  as  to  the  cause of the problem. This report presents the
    case  history  of  a  child  diagnosed  with MSBP who was portrayed as
    having   multiple   developmental   disabilities  by her mother. Three
    elements  of  the  case  are noteworthy. The emphasis by the mother on
    multiple   developmental   disabilities   has   not been reported. The
    complexity  of  this case is unusual and may reflect the complexity of
    the  mother's  psychopathology.  The interdisciplinary team evaluation
    was instrumental in making the diagnosis.
 
SO: J Dev Behav Pediatr 1990 Oct;11 (5):262-4
                                                  DOCUMENT: 25 of 36
 
UI: 92027876
AU: Godding V; Kruth M
TI: Compliance with treatment in asthma and Munchausen syndrome by proxy.
AD: UCL University Hospital of Mont-Godinne, Yvoir, Belgium.
AB: Among  1648  asthmatic  patients,  17 families (1%) were identified as
    having  Munchausen syndrome by proxy. Ten families did not treat their
    children's,  attacks  or  refused  medical care, and seven exaggerated
    the   severity   of   symptoms   to obtain invasive investigations and
    treatment.  All  the  families had disturbed psychosocial backgrounds.
    The  abuse  consisted  mainly  of neglect, in that necessary treatment
    was not given. In some cases a more direct form of abuse was observed,
    when  useless  and sometimes harmful investigations and treatment were
    given.  We  conclude  that  medical  control of the compliance of both
    parents  and  children  is  necessary  in  the management of childhood
    asthma.
 
SO: Arch Dis Child 1991 Aug;66 (8):956-60
                                                  DOCUMENT: 26 of 36
 
UI: 91092880
AU: Roth D
TI: How "mildo is mild Munchausen syndrome by proxy?
AD: Department  of  Psychiatry,  Hadassah  University Hospital, Jerusalem,
    Israel.
AB: This paper describes four cases of Munchausen Syndrome by Proxy (MSbP)
    ,in  each  of  whom  the  disorder  could  be considered mild from the
    physical   viewpoint.   However,   in   all   cases a severe emotional
    disturbance  was evident in the mother-child relationship, and certain
    significant  features were common to each case, including the dynamics
    of  the development of the disorder. In all, maternal anxiety resulted
    in  the mother perceiving the child as sick, leading to her insistence
    that  he/she receive medical attention. A follow-up over several years
    showed  severe  disturbances  in  the emotional development of all the
    children.  It  is  thus  suggested  that  mild  cases  of  MSbP may be
    indicators  of  severely disturbed mother-child relationships, raising
    important questions about their proper management.
 
SO: Isr J Psychiatry Relat Sci 1990;27 (3):160-7
                                                  DOCUMENT: 27 of 36
 
UI: 91145794
AU: Mehl AL; Coble L  ; Johnson S
TI: Munchausen syndrome by proxy: a family affair.
AD: Colorado Permanente Medical Group, Boulder.
AB: Munchausen  syndrome  by  proxy  is  an unusual form of child abuse: a
    child  presents with an illness that has been factitiously produced by
    a  parent,  typically  the  mother.  A case of chronic illicit insulin
    administration  to a one-year-old girl is described. Despite temporary
    separation  of  the  child  from  the mother and long-term psychiatric
    intervention,   factitious   illnesses   continued,   including  urine
    specimen  contamination,  laxative-induced diarrhea, suspected bladder
    catheterization,  and suspected poisoning. Retrospective review of the
    medical   records   of   the   mother   and  two siblings demonstrated
    previously  unrecognized evidence of factitious illnesses. The medical
    records  contained  evidence  of  30 separate episodes of suspected or
    documented  factitious  illness  in  these  four  members  of the same
    family.  This  unique  family illustrates the significant morbidity of
    Munchausen  syndrome  by  proxy  and  a  poor  response to psychiatric
    treatment.
 
SO: Child Abuse Negl 1990;14 (4):577-85
                                                  DOCUMENT: 28 of 36
 
UI: 90254448
 
TI: Munchausen syndrome by proxy [letter; comment]
CM: Comment on:Child Abuse Negl1987;11(4):547-63
SO: Child Abuse Negl 1990;14 (2):289-90
                                                  DOCUMENT: 29 of 36
 
UI: 92129238
AU: Turk LJ; Hanrahan KM  ; Weber ER
TI: Munchausen Syndrome by Proxy: a nursing overview.
AB: Munchausen  Syndrome by Proxy is a common but often undetected form of
    child  abuse  in  which a parent fabricates or falsifies an illness in
    the   child   and   then   presents   the child for medical treatment,
    disclaiming  knowledge  as  to the etiology of the illness. Nurses are
    instrumental  in  the early identification and detection of Munchausen
    Syndrome  by Proxy. A case study emphasizes the role of nurses as part
    of   the   multidisciplinary   approach.   Use  of the nursing process
    demonstrates comprehensive care in management.
RF: 14
SO: Issues Compr Pediatr Nurs 1990 Oct-Dec;13 (4):279-88
                                                  DOCUMENT: 30 of 36
 
UI: 91127443
AU: Yomtovian R; Swanger R
TI: Munchausen syndrome by proxy documented by discrepant blood typing.
AD: Institute  of  Pathology,  Case  Western  Reserve University School of
    Medicine, Cleveland, Ohio.
AB: The  authors  describe  a case of Munchausen syndrome by proxy, a form
    of  child  abuse,  documented  by  use of routine blood bank serologic
    procedures.  While  immunohematologic  testing  has  been  used in the
    legal   arena   to   resolve   issues   of   disputed paternity and to
    investigate  instances  of  criminal acts, the authors believe this to
    be the first documented application to this clinical disorder.
 
SO: Am J Clin Pathol 1991 Feb;95 (2):232-3
                                                  DOCUMENT: 31 of 36
 
UI: 91176677
AU: Sullivan CA; Francis GL  ; Bain MW  ; Hartz J
TI: Munchausen syndrome by proxy: 1990. A portent for problems?
AD: Department of Pediatrics, Walter Reed Army Medical Center, Washington,
    D.C. 20307-5001.
 
SO: Clin Pediatr (Phila) 1991 Feb;30 (2):112-6
                                                  DOCUMENT: 32 of 36
 
UI: 91224394
AU: Meadow R
TI: Neurological  and  developmental  variants  of  Munchausen syndrome by
    proxy.
AD: Department  of  Paediatrics  and  Child Health, St. James's University
    Hospital, Leeds.
 
SO: Dev Med Child Neurol 1991 Mar;33 (3):270-2
                                                  DOCUMENT: 33 of 36
 
UI: 91273796
AU: Loredo-Abdal a A; Sierra-G. de Quevedo JJ  ; Oldak-Skvirsky D  ;
    Carbajal-Rodr iguez L
TI: [Munchausen syndrome in children: report of 2 cases]
AD: Departamento  de  Medicina  Interna, Instituto Nacional de Pediatr ia,
    Mexico, D.F.
AB: We  report  the existence of two cases of an infrequently know form of
    child  abuse, Munchausen syndrome "by proxyo treated in the Department
    of  Internal Medicine of the National Institute of Pediatrics. We have
    considered  it  necessary to emphasize the way this clinical entity is
    presented,  pointing out the exact clinical data and how the relatives
    referred  to  them  when faced with the treating physician, the number
    of  people involved in treating the children as well as the exagerated
    number  of  laboratory and X-ray studies performed. The discrepancy in
    terminology  to  point to this disease, allows for the use of the term
    "Munchausen  syndrome  in childreno to differentiate it from that used
    in  psychiatry.  The  need  to  alert the medical community who treats
    these  children  on  this  rarely  seen  disease,  will  allow for its
    recognition  and  early  treatment  which avoid a reinforcement of the
    perpetrators attitudes.
 
SO: Bol Med Hosp Infant Mex 1991 Feb;48 (2):121-5
                                                  DOCUMENT: 34 of 36
 
UI: 92065658
AU: Kahn G; Goldman E
TI: Munchausen  syndrome  by  proxy:  mother  fabricates  infant's hearing
    impairment.
AD: Dept. of Pediatrics, University of Iowa, Iowa City 52242.
AB: Munchausen  syndrome  by  proxy  is  a  form of child abuse in which a
    mother  causes  or  simulates  her  child's  symptoms and presents the
    child  for diagnosis and treatment. All previously reported cases have
    involved  acute illnesses. This case study describes the ways in which
    a  mother  obtained  a diagnosis of sensorineural hearing loss as well
    as amplification for her normally hearing infant.
 
SO: J Speech Hear Res 1991 Aug;34 (4):957-9
                                                  DOCUMENT: 35 of 36
 
UI: 92074045
AU: Sofinowski RE; Butler PM
TI: Munchausen syndrome by proxy: a review.
AD: Department  of  Psychiatry,  Baylor  College  of Medicine, Houston, TX
    77030.
AB: Munchausen  syndrome  by  proxy  is  a  form of child abuse in which a
    parent  or  caretaker  simulates  or produces illness in a child. Case
    reports  of Munchausen syndrome by proxy document a wide and confusing
    spectrum  of  symptoms.  The  children  who  are  the  victims of this
    syndrome  suffer  morbidity  linked  to  numerous unnecessary hospital
    admissions  and diagnostic procedures, severe psychological morbidity,
    and   a   significant   risk   of  mortality. Because of these extreme
    consequences,  all health-care professionals must be able to recognize
    its warning signals.
RF: 38
SO: Tex Med 1991 Oct;87 (10):66-9
                                                  DOCUMENT: 36 of 36
 
UI: 92149053
AU: Lim LC; Yap HK  ; Lim JW
TI: Munchausen syndrome by proxy.
AD: Department  of  Pyschological  Medicine, National University Hospital,
    Singapore.
AB: Munchausen  syndrome  by  proxy  is  the  falsification of symptoms by
    parents   which   results   in   their children having unnecessary and
    sometimes   harmful   hospital   procedures.   We   describe a case of
    Munchausen syndrome by proxy in a 15 month-old toddler. The diagnosis,
    management and outcome of this syndrome is also discussed.
 
SO: J Singapore Paediatr Soc 1991;33 (1-2):59-62
 
 
Naina Pandita
Indian MEDLARS Centre,
New Delhi, India