title: Procedures, placement, and risks of further abuse after Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation.
abstract: OBJECTIVE
  To investigate outcome, management, and prevention in Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation.
  
  
  METHODS
  Ascertainment through British Paediatric Surveillance Unit and questionnaires to responding paediatricians.
  
  
  METHODS
  The UK and Republic of Ireland, September 1992 to August 1994.
  
  
  METHODS
  Children under 14 years diagnosed with the above.
  
  
  METHODS
  Placement and child protection measures for victims and siblings; morbidity and reabuse rates for victims; abuse of siblings; prosecution of perpetrators.
  
  
  RESULTS
  Outcome data for 119 with median follow up of 24 months (range 12 to 44 months). No previously diagnosed factitious disease was found to have been caused by genuine disease. Forty six children were allowed home without conditions at follow up. Children who had suffered from suffocation, non-accidental poisoning, direct harm, and those under 5 years were less likely to go home. Twenty seven (24%) children still had symptoms or signs as a result of the abuse at follow up; 108/120 were originally on a child protection register and 35/111 at follow up. Twenty nine per cent (34/118) of the perpetrators had been prosecuted and most convicted; 17% of the milder cases of Munchausen syndrome by proxy allowed home were reabused. Evidence in siblings suggests that in 50% of families with a suffocated child and 40% with non-accidental poisoning there would be further abuse, some fatal.
  
  
  CONCLUSIONS
  This type of abuse is severe with high mortality, morbidity, family disruption, reabuse, and harm to siblings. A very cautious approach for child protection with reintroduction to home only if circumstances are especially favourable is advised. Paediatric follow up by an expert in child protection should also occur.
authors.affiliation: Department of Child Health, University of Wales College of Medicine, Llandough Hospital, Penarth, Vale of Glamorgan.
authors.forename: P
authors.initials: P
authors.lastname: Davis
authors.forename: R J
authors.initials: RJ
authors.lastname: McClure
authors.forename: K
authors.initials: K
authors.lastname: Rolfe
authors.forename: N
authors.initials: N
authors.lastname: Chessman
authors.forename: S
authors.initials: S
authors.lastname: Pearson
authors.forename: J R
authors.initials: JR
authors.lastname: Sibert
authors.forename: R
authors.initials: R
authors.lastname: Meadow
mesh_terms: D000293:Adolescent; D001237:Asphyxia / Q000209:etiology*; D002648:Child; D002655:Child Custody / Q000331:legislation & jurisprudence; D002675:Child, Preschool; D005192:Family Health; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016735:Munchausen Syndrome by Proxy / Q000175:diagnosis / Q000517:prevention & control*; D011041:Poisoning / Q000209:etiology*; D012008:Recurrence; D012307:Risk Factors