title: Munchausen syndrome by proxy in Mexican children: medical, social, psychological and legal aspects.
abstract: BACKGROUND
  The Munchausen Syndrome by Proxy (MSP), is considered as an unusual less frequent variety of child abuse (CA). In this type of abuse the perpetrators purposely provide factitious information, tamper with specimens or actually induce an illness in a child. Nowadays, it is a clinical entity described in pediatrics as more frequently than before. Despite the fact of its presence worldwide, there are still problems in order to get an appropriate diagnostic. It is also difficult to handle both the clinical and legal aspects in various countries.
  
  
  OBJECTIVE
  Make our academic fellows aware of various pediatric, psychological, social and legal aspects of a series of cases attended at the Clínica de Atención Integral al Niño Maltratado from Instituto Nacional de Pediatría (CAINM-INP), Mexico [Integral Clinic of Attention for Abused Children, at National Institute of Pediatrics, Mexico].
  
  
  METHODS
  From a series of 25 cases, 18 minors of age were considered with this syndrome since we found that they shared medical, psychological, social and legal characteristics.
  
  
  RESULTS
  18 minors of age belonged to 14 families. 4 of those families had two affected children each one. These affected children were girls 13/18, predominant in children under six years in 10/18. Syndrome expression was distributed as follows: fever from a non determined origin, seizures, chronic diarrhea, hematuria, and probable sexual abuse. 14 children were hospitalized. In all cases, the aggressor was the mother. The psychological evaluation of six perpetrators revealed psychotic, histrionic, and compulsive-obsessive traits. The socio-economic condition was low in 50% of the cases. A legal demand was posed for seven patients in which all the children remained under the custody of the mother.
  
  
  CONCLUSIONS
  In Mexico, reports of CA have increased within the last years according to experience. Some complex forms as MSP require the participation of an interdisciplinary team for both diagnosis and integral attention.
authors: Clínica de Atención Integral al Niño Maltratado, Institute Nacional de Pediatría, Coyoacán, México, DF. jorgethz@yahoo.com.mx
authors: Jorge
authors: J
authors: Trejo-Hernández
authors: Arturo
authors: A
authors: Loredo-Abdalá
authors: José Manuel
authors: JM
authors: Orozco-Garibay
mesh_terms: D002648:Child; D002675:Child, Preschool; D008192:Deception; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D019359:Knowledge; D008297:Male; D019221:Mandatory Reporting; D001523:Mental Disorders / Q000175:diagnosis; D008800:Mexico / Q000453:epidemiology; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D016735:Munchausen Syndrome by Proxy / Q000175:diagnosis / Q000453:epidemiology* / Q000331:legislation & jurisprudence / Q000523:psychology; D010372:Pediatrics / Q000193:education; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016312:Treatment Refusal