What is it about?

One of the most troubling forms of psychopathology encountered in pediatric settings involves medical child abuse (MCA) where a parent, most commonly the mother, intentionally either induces symptoms or presents a false history of symptoms in her child resulting in clinical misdirection and unnecessary medical treatments. Such abuse can ripple beyond the parent’s abusive acts by triggering unneeded intrusive tests or arduous treatments that cause distress to the child. The parent initiates the abuse, but physicians can become unintentional contributors to this distress.

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Why is it important?

Pediatricians, psychologists and other health care providers generally presume the accuracy of history and presentation offered by patients’ parents, and certainly do not initial suspect parents of creating the problem. Psychologists serving on care teams can often help in detection of MCA by considering a wider range of behavioral data than other health professionals as a function of information elicited during patient encounters. Examples might include noting the contrast between the content and affect shown during a particular narrative, developmentally inappropriate parent-child interactions, or signs of unusual secondary gain (i.e., praise-seeking behavior or other pragmatic benefits accruing to the parent as a result of the child’s condition).

Perspectives

Although MCA does qualify as a relatively rare event, it can prove fatal and presents almost exclusively in medical settings especially in its more severe forms. Therefore, pediatric psychologists and other behavioral health specialists working in such settings should become more aware of the phenomenon, its manifestations, and key considerations in diagnosing and intervening to reduce mortality and morbidity, as well as protect child patients. Ethical sensitivity is required, because the use of surreptitious recording and other ethically controversial, steps (i.e., not fully informing parents of suspicions in advance) are at time critical in documenting certain symptoms or parental behaviors. We hope this article provides the fundamental information and recommendations needed to improve the care of those affected by MCA.

Dr. Gerald P. Koocher
Harvard Medical School

Read the Original

This page is a summary of: Medical Child Abuse Hidden in Pediatric Settings: Detection and Intervention, Journal of Clinical Psychology in Medical Settings, October 2019, Springer Science + Business Media, DOI: 10.1007/s10880-019-09666-8.
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