Munchausen's syndrome

There was another recent story in the local newspaper that made me sad and a bit confused. A mother was found guilty of injury to a child for convincing doctors to perform unnecessary surgeries on one of her kids. The article online prompted many comments that also accused the physicians and said it would be impossible for the mother to fool a "competent" physician.

I know it seems difficult to believe, but I certainly know it can be done. The two surgeries the mother had done were the placement of a nerve stimulator for a seizure disorder, and a feeding button to treat poor feeding and nutrition. I believe that the child did have a documented seizure disorder. He was on medication, and the mother reported that he continued having seizures. There is essentially no way that a physician can prove that the child wasn't having seizures. The child also was underweight and not gaining. If the mother reported loss of appetite, vomiting or diarrhea and the child's weight corroborated it--no reason to doubt her.

So much of diagnosis has to do with history. With a child as a patient, unable to provide his own history, a mother who is seriously disturbed could misrepresent symptoms. It wouldn't be the physician's first or second thought that the mother was exaggerating or lying about failing to feed a child, or reporting seizures that did not really happen. This is a real disease, but it is not a common one. My understanding is that suspicions arose when the mother herself became ill and the child had a miraculous improvement when not in her care.

Having a truly ill child is a terrible thing, however, for an unstable parent, there can be secondary gains. I see the level of support and caring that mothers develop in a few short hours in the waiting room. Imagine being one of many mothers on a hospital unit for an extended time period. For a woman with few friends, this can have a huge impact. This woman had gathered contributions of $150,000 over a five year period. Mothers of sick kids are seen as unselfish, loving, great mothers. The hospital is perceived as a better place to be than with a miserable spouse or a wretched job.

This falls into the same category as anorexia for me. I understand the concept, but I just can't really conceive of what it feels like to be inside of it.

I took care of a child in Atlanta whose mother had this disease. Even with close supervision in the hospital she managed to do things to make her child ill. She would switch out formula bottles and give him medicine he did not need. When he was in the hospital he had no witnessed seizures, and he got better. Every time he went home he became sicker. We finally sent them to a hospital with a hidden camera, but that is the only such hospital room I have ever heard of. Even with that, it was difficult to find firm evidence that she was harming her child. I don't think that woman was ever prosecuted.

Perhaps I am prattling on about things that nobody else will find interesting, but I had all these ideas about what I had read, and where better to put it than in my blog?