Materia Medica is a brief review of current literature in medicine relevant to criminal law designed to help prepare you for your next case.

Monsters in the Closet: Munchausen Syndrome by Proxy
Laura Criddle, RN PhD, ACNS-BC, CCRN, CCNS

This article discusses Munchausen’s Syndrome by Proxy (MSBP) and states that it is underrecognized and underreported. Some points in the article to be brought forward for defense attorneys are:

  • “…there is likewise no standardized definition of the disorder.”
    • This ambiguity allows the defense attorney to question the medical diagnosis.
  • “Although the condition is often characterized as “rare,” lack of a standardized definition and centralized reporting repository make it difficult to quantify the incidence of MSBP. Expert estimates range from 1 in a million children to 2.8 in 100,000 children”.
    • The only consensus is that it is a rare disease. There is little literature that defines its incidence. Rarity alone supports a defense case.
  • “…if this fabrication does not garner sufficient interest from medical providers, abusers are driven to increase the stakes.”
    • The disorder is considered an escalating disorder. It is beneficial to review past medical history of the child and determine if there were previous incidences of potentially mild symptom fabrication such as claims of apnea or ataxia.
  • “Mothers, and other women in a guardian role, are by far the most frequently reported perpetrators (93%), but Sheridan’s large scale review found that fathers were primarily responsible approximately 7% of the time.”
    • This is relevant for both male and female defendants. Defense may postulate that the male defendant is an unlikely suspect, or that the female is not the exclusive perpetrator in this condition.

Full text available online: http://www.aacn.org/WD/CETests/Media/C106.pdf

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