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Fabricated or induced illness in children

BMJ 2002; 324 doi: (Published 12 January 2002) Cite this as: BMJ 2002;324:114

Open mind is needed regarding origins of childhood symptoms and illnesses

  1. Charles Pragnell, social care management consultant
  1. Social Care Consultants, Redcar and Cleveland TS10 2JN
  2. Kingston NHS Trust, Kingston KT2 7AZ

    EDITOR—I do not agree with Wilson that guidance issued by the Department of Health for consultation is excellent.1 Wilson admits that the origins of Munchausen syndrome by proxy were based in the personal experience of Roy Meadows.

    Is this how paediatric diagnoses are made, simply on the basis of an individual's subjective experience? Especially when such a “diagnosis” has had such a devastating and damaging effect on many hundreds of children and families in the United Kingdom and around the world. Emotional damage is caused to children, their parents, and siblings from being separated and placed into state care; or where stigmatised parents, avoid contact with doctors because they would be dismissed as child abusers if they presented their children for medical treatment. Consequently some very ill children have not received the medical attention they so desperately needed.

    So, Munchausen by proxy is not based on painstaking research under scientific conditions? There is no system of verification nor validation by an accredited national medical body? No field testing has been done over a reasonable period of time? Does the Royal College of Paediatrics and Child Health not have a duty and responsibility to all children and parents to ensure that paediatric diagnoses are not merely based on the subjective personal experience of one paediatrician?.

    Wilson also says that a child's doctor is not required to clarify whether inappropriate parental care is the result of mental illness, and yet there are doctors without a psychiatric qualification who have stated in evidence to courts in cases of Munchausen by proxy that the parent has a serious personality disorder.

    The claim by Wilson that rates of fabricated or induced illness in children are underestimates is not based in fact. If it were, then there must be many thousands of extremely gullible doctors in the United Kingdom who can so easily be deceived, and their ability to diagnose childhood illnesses is seriously impaired.

    I agree with Wilson that we need to have an open mind regarding the complex origins of childhood symptoms and illnesses, but unfortunately the Department of Health's guidance and Wilson's letter do not show such open mindedness.


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    Author's reply

    1. Richard Wilson, consultant paediatrician
    1. Social Care Consultants, Redcar and Cleveland TS10 2JN
    2. Kingston NHS Trust, Kingston KT2 7AZ

      EDITOR—Pragnell and his work are motivated by his sense of injustice done to some parents. His remarks have no clear target, and he seems to wish to support individuals by claiming that fabricated or induced illness does not exist. He wishes to protect parents; I wish to protect children first. He seems to have a punitive retrospective aim. Professionals and the Department of Health, as well as the overwhelming majority of the public, want preventive and protective action to improve the present and the future. The Royal College of Paediatrics and Child Health and Department of Health have used the views of children and families in drawing up their current procedures.

      I know that Pragnell wants progress too. Rather than be attracted by the flames of conflict we should highlight the issues on which we agree. This may be easier when the full draft of the royal college's document is issued.

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