Munchausen syndrome by proxy: the importance of behavioral artifacts

FBI Law Enforcement Bulletin,The,  August, 2003  by Deborah Chiczewski,  Michael Kelly

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Police and EMS personnel not only must remain aware of offenders' characteristics but also must be observant of MSBP signs at a child abuse or illness scene. MSBP often goes unrecognized because many law enforcement officers have never encountered, or are unfamiliar with, the disorder. Thus, when dealing with a suspected case of MSBP, law enforcement personnel must alert colleagues of the abuse to ensure correct management of the investigation. They also can employ certain guidelines to help in determining a case of MSBP, including--

* a described medical problem that does not respond to the normal course of treatment;

* multiple responses to the same location for the same patient with similar complaints or a variety of illnesses;

* a family history of similar incidents with siblings, including multiple SIDS within the family;

* signs and symptoms disappear upon the child's removal from the parent; and

* attempts by a caregiver to convince others of illness even in the absence of signs and symptoms.

These guidelines, along with understanding the behavioral artifacts that may exist, are critical to the recognition of MSBP. Artifacts can be both behavioral characteristics and linguistics exhibited by those who fall under MSBP. Because MSBP often leads to the victim's death, recognizing its existence often occurs only after the death of a child and a review of the case.

PROTECTION

MSBP makes child protection very difficult. An interview with a previous director of social services at a children's hospital in Chicago revealed that once hospital personnel became aware of MSBP in the late 1980s they began to take steps to protect children. High risk of injury or death exists while a child remains in the care of the perpetrator; therefore, incidents where the child already has been hospitalized contain less risk.

Based on the existing laws in Illinois, (3) video surveillance in a child's hospital room may be permissible for various reasons, such as security of the child, constant monitoring/assistance in diagnosis and treatment, or protection of the facility and employees from allegations of negligence. For years, discussions about videotaping suspected MSBP offenders finally led to placing a camera in a room at the aforementioned children's hospital in Chicago. In this particular case, a 14-month-old girl was hospitalized for apnea. While in her hospital room, the child periodically would stop breathing for no apparent reason. She remained hospitalized for 30 days, and medical personnel could not uncover anything medically wrong with her. However, hospital personnel did make a connection between the mother's presence and the child exhibiting symptoms of apnea. The hospital decided to videotape the child's room and place a heart monitor on the child. After another episode of apnea, a review of the videotape revealed that the child's mother had put a pillow over the child's face to induce the symptoms. The physician immediately took protective custody of the child. After being removed from her mother, the girl exhibited no more symptoms of apnea. Prosecutors eventually charged the mother with endangering the life and health of a child, a minor misdemeanor. The videotape became the proof beyond a reasonable doubt along with the fact that the child did not show any symptoms of apnea when removed from the mother's supervision.