Munchausen syndrome by proxy cases frighten, baffle

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By ERICA BLAKE
Thursday, June 14, 2007
For months, the reasons Carrie Weaver's young son remained sick were baffling.

Doctors probed and prodded the boy. Family members visited him in the hospital. His mother spent countless hours with him in and out of doctors' offices, in and out of hospitals.

He was examined by a slew of specialists and treated for a plethora of possible illnesses. Weaver's son would not get better.

That is until, Lucas County, Ohio prosecutors said, he was taken away from his mother.

In a crowded Lucas County Common Pleas Courtroom last week, Weaver was sentenced to serve three years in prison for slowly poisoning her son. She was convicted by a jury May 4 on one count of child endangering after prosecutors proved that she had been giving her son chronic doses of Ipecac, an over-the-counter drug that induces vomiting.

Although prosecutors presented evidence of Ipecac in the boy's tissues and witnesses who said Weaver had Ipecac in her home, the biggest hurdle in the state's week-long trial was explaining why a mother would harm her child.

"The first thing we needed to do is have the jury understand that mothers hurt their children," said assistant county prosecutor Lori Olender, who tried the case against Weaver. "That's why we really say that this was Munchausen (syndrome) by proxy. Otherwise you have nothing. You have no motive."

Named after the Baron Von Munchausen, an 18th-century soldier and politician known for his skill as a storyteller, the disorder was first used to describe adult patients who were thought to be addicted to hospitals and would induce illness in an effort to be admitted.

The term Munchausen syndrome by proxy was first used in 1977 by a British pediatrician who applied it to a form of child abuse.

The symptoms are often difficult to diagnose. Doctors, although familiar with the syndrome, do not tend to mistrust the information given to them by their patients' parents. And even if the syndrome is suspected, most doctors will want to be sure before making accusations.

"To the medical caregivers, these are the most wonderful people on the planet," said Dr. Michael Ruhlen, vice president for medical affairs for Toledo Children's Hospital. "They are super-engaged in their child's care, they never miss an appointment. ... And no physician wants to believe that the (parent-child) trust has been breached."

In Munchausen by proxy cases, the perpetrator is almost always the mother. She usually has experience in a medical-related line of work and sometimes exaggerates her qualifications.

When a child shows symptoms of illness, the perpetrator is the only person present. And when the child is brought in for treatment, the offender reacts calmly to the situation, even when doctors have difficulty determining the cause of the illness and the child fails to respond to treatment.

Often, the syndrome goes undetected for some time.

Experts agree that those diagnosed with Munchausen syndrome by proxy are not incompetent or insane. Instead, it is often compared to an addiction -- an addiction to attention.

Often incidents of the syndrome begin with fabrications of conditions, such as stories that the child is suffering seizures. Then, the perpetrator will take the abuse to the next level by doing something that makes the child sick.

And like other addictions, Munchausen syndrome by proxy is only treatable if the addict admits he or she needs help, doctors said.

"Perpetrators of Munchausen syndrome by proxy are well-known to be serial offenders," Dr. Ruhlen wrote in a letter to prosecutors before Weaver's sentence. "The first step in successful treatment of such a parent is the acknowledgment of guilt. Without such an admission, Ms. Weaver is highly likely to become a repeat offender."

Cases of Munchausen syndrome by proxy are sometimes resolved when the perpetrator is caught making the child ill.

Researchers in a hospital in Atlanta installed cameras in 41 rooms after being confronted with several baffling illnesses and discovered that, during four years in the late 1990s, more than 20 mothers apparently had the syndrome. The mothers were caught on tape injecting their children with urine, switching their medication, and, in some cases, even suffocating them to keep them sick.

Groups like Mothers Against Munchausen Syndrome by Proxy Allegations, or M.A.M.A., said more often than not, caring mothers are facing false accusations. The group has gone so far as to call for the review of all cases worldwide in which Munchausen syndrome by proxy has been diagnosed.

"Every parent who is seriously advocating for their child is in imminent danger of this cruel and ridiculous allegation," said information on the group's Web site. Instead, the group alleges that the syndrome is more often used as a tool for doctors to evade medical malpractice lawsuits or by an opposing parent in child custody suits.

Dr. Ruhlen said the syndrome is very real and not nearly as uncommon as believed. He warned that even if caught in time before the child is critically injured or killed, Munchausen syndrome by proxy will have lasting psychological effects on the child.

Lucas County Judge James Jensen, who presided over the case, said the "worst part" of the testimony brought forth in Weaver's case was the fact that she was watching her son endure months of illness and pain.

WHAT IS MUNCHAUSEN SYNDROME BY PROXY

- Munchausen syndrome by proxy is a form of child abuse in which a parent induces real or apparent symptoms of a disease in a child.

- It almost always involves a mother abusing her child by creating an illness and then seeking medical attention for him or her.

- Sir Richard Alan Asher, a British doctor, named Munchausen's disease after an 18th-century baron known for tall tales. In 1977, British pediatrician Roy Meadow noticed odd behaviors in mothers of two of his patients and recorded it in the medical journal The Lancet.

- This syndrome is rare and poorly understood.

- The cause is unknown.

- Children who are subject to the syndrome are typically preschool age.

Diagnosis is difficult but could include some of the following:

- A child with multiple medical problems who doesn't respond to treatment.

- Highly unusual physical or laboratory findings.

- Short-term symptoms that tend to stop when the perpetrator isn't around.

- A parent or caregiver who isn't reassured by "good news" when test results find no medical problems.

SOURCE: Medline Plus Medical Encyclopedia and KidsHealth.org

Contact Erica Blake at blake(at)theblade.com