title: Medical Child Abuse (Munchausen Syndrome by Proxy): Multidisciplinary Approach from a Pediatric Gastroenterology Perspective.
abstract: OBJECTIVE
  We highlight the need for a multidisciplinary approach to the diagnosis of medical child abuse, also known as factitious disorder imposed on another (FDIA) or Munchausen syndrome by proxy (MSP), and review our experience focusing on the variety of symptoms that often present to the pediatric gastroenterologist many months before the diagnosis is made.
  
  
  RESULTS
  Recent literature on medical child abuse, mostly case reports, is markedly limited, highlighting a need for increased research on this topic. Articles agree on the value of a multidisciplinary approach to these cases and the importance of involving professionals outside the hospital setting. Given the technology-dependent nature of our current society, the use of social media to aid in making the diagnosis has emerged. Review of the literature shows that there are almost no data on long-term outcomes of the victims or perpetrators of MSP. Making the diagnosis of MSP involves a complicated process of piecing together inconsistencies among the history, examination, and clinical presentation. The diagnosis remains difficult and is not often considered during early presentation of symptoms. Once MSP is suspected, it is important that a multidisciplinary process is used, incorporating input from various sources: the outpatient care structure, the hospital, non-hospital agencies such as school and child protective services, and non-traditional sources such as social media. In our experience, a multidisciplinary approach augmented by thoughtful inpatient surveillance provides the greatest opportunity for confirming or excluding MSP. Pediatric gastroenterology is one of the most common services consulted prior to diagnosis and presents an opportunity for early intervention.
authors.affiliation: Emory University School of Medicine, Atlanta, USA.
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: Ali-Panzarella
authors.affiliation: Emory University School of Medicine, Atlanta, USA.
authors.forename: Tamika J
authors.initials: TJ
authors.lastname: Bryant
authors.affiliation: GI Care for Kids, LLC, 993-D Johnson Ferry Rd, Suite 440, Atlanta, GA, 30342, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Marcovitch
authors.affiliation: GI Care for Kids, LLC, 993-D Johnson Ferry Rd, Suite 440, Atlanta, GA, 30342, USA. pediatricgi@gmail.com.
authors.forename: Jeffery D
authors.initials: JD
authors.lastname: Lewis
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D005845:Georgia; D006801:Humans; D007223:Infant; D008297:Male; D016735:Munchausen Syndrome by Proxy / Q000175:diagnosis*; D010348:Patient Care Team / Q000458:organization & administration*; D012189:Retrospective Studies; D014741:Video Recording
keywords: Child maltreatment; Covert video surveillance; Factitious disorder by proxy; Factitious disorder imposed on another (FDIA); Medical child abuse; Munchausen syndrome by proxy (MSP); Pediatric condition falsification