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Diagnosing serious child abuse

BMJ 1999; 318 doi: (Published 13 February 1999) Cite this as: BMJ 1999;318:462

Death from Munchausen syndrome by proxy is overestimated

  1. Brian Morgan, Freelance journalist
  1. 4 Rawden Place, Riverside, Cardiff CF1 8LF
  2. Park Hospital for Children, Oxford OX3 7LQ
  3. Guy's Hospital, London SE1 9RT
  4. Combe Down Surgery, Combe Down, Bath BA2 5EG

    EDITOR—Jones and Lynch1 have made mistaken claims, purportedly drawn from the epidemiological study by McClure et al.2 They failed to notice that the study collected data on non-accidental poisoning and non-accidental suffocation as well as Munchausen syndrome by proxy. They say that McClure et al identified 128 cases of “factitious illness by proxy.” The actual figure was 97; 128 is the global figure. They also say that eight children died from Munchausen syndrome by proxy. Again this is a global figure, and closer reading of the study shows these cannot all have been from Munchausen syndrome by proxy, and in fact only one of them may have been.

    The study took the convening of a first case conference for suspected abuse as confirmation of a diagnosis of Munchausen syndrome by proxy. Case conferences are not called for a dead child. Therefore, for a death from Munchausen syndrome by proxy to have been recorded the child must have died after referral and registration at a case conference or have had a sibling thus registered for the first time, both of which are likely to be rare. I …

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