Munchausen by Proxy: so I saw this kiddo today...

[GeneGoddess]

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Background: kiddo is 6 years old and is 5%ile for height/weight (predicted based on parents would be maybe 50%ile). Mom brought him in because she thought we (Endocrine) would be able to find out what was wrong with kiddo. Mom and Dad were quite vocal in complaining about the wait (30min) and were, of course, less than thrilled to see a med student first. Mom tells me that she has so far seen ***33*** specialists to try and figure out kiddo's "problem". She will be seeing Genetics next month. Only "official" diagnosis (they didn't bring any records) so far has been congential hypotonia at age 2 and a grand mal seizure (witnessed by parents, normal EEG). Anyway, on PE, kiddo seems basically ok ('cept for being small for age). Slight speech problems, but nothing really striking. Kiddo at one point begins to be a pain (running around, being loud) and mom looks at me and says, "Looks like he'll have ADHD, too." He seems to have normal strength as well. Anyway, I just kept getting a weird vibe off of mom. And so did my attending. He was actually the one who brought up MBP. I've seen one true case before, but this one isn't so clear cut. In pedi, you always have at least two patients: the kiddo and the "family". And I know that there are unusual zebras out there that go undiagnosed for years, but this sitch just seemed weird. Any thoughts?

 

[kas23]

That's strange, I don't know quite what to say in regards to it being MBP or not, but I agree, something was up. That also interesting that you have seen MBP before. Why don't you tell us about that case too?

That ADHD comment was strange. I wonder if she was saying it as a joke. Have you guys worked up GH-deficiency. I remember reading about these very strange GH-deficient conditions, even down to one being due to purely extreme neglect. But, it doesn't sound like they are neglecting this child, maybe the opposite.

And never underestimate the weirdness of people and of parents. People are weird! And the parents of chronically ill children are weird too. You just have to be able to separate cause and effect.

 

[GeneGoddess]

Kiddo has been worked up to the gills so far, but we have no results (like I said, they've seen 33 specialists, but didn't bring any lab results?). We ordered IGF1, IGFBP3, thyroid panels, bone age, etc. Kinda CYA, kinda not. Kiddo IS small, but there is something hinky going on.

The honest-to-goodness MBP was scary. Essentially, mom was a divorced mother and had a daughter (I saw them when daughter was 16). Daughter had some GI surgery as an infant (minor), but somehow mom got "hooked". So, for 16 years, daughter ended up having some form of GI surg or work-up for a variety of complaints every few months for years. By the time I saw her, daughter was having legitimate complaints (mainly from all of the adhesions), but mom was still insisting that daughter had all these problems. And, if the doctor didn't comply, she would sue. My attending wouldn't let students write notes because he didn't want us named in lawsuits. Mom luuuuuuuuved my attending because he "paid attention to daughter's problems". Daughter was completely psychologically dependent on her mom and looked to her for answers to every question (even "how are you feeling today?"). I know that she would have been fine (physically/mentally/psycologically) with another family. I don't know if mom ever DID anything to daughter to cause injury, but she basically convinced everyone that her poor kid was ill and needed surgery yearly for 16 years. That poor kid...

 

[vivamaria]

It does sound like Munchausen by proxy. Call CPS.

 

[mvenus929]

If you have any suspicion, call CPS. You could get in trouble otherwise...

 

[oldbearprofessor]

Yes, call CPS but call less than 14 months after the event which is when this thread was posted.😉

 

[IlDestriero]

Yes, call CPS but call less than 14 months after the event which is when this thread was posted.😉

Actually it was 11 years ago...

 

[oldbearprofessor]

Whoops - you're right.

 

[Cytarabine]

I can tolerate like 1-2 'kiddos', but get up to 20 'kiddos' in a short period of time and I'm thinking about sticking a pencil in my eye