Medical Child Abuse and Medical Neglect

Carole Jenny; James B. Metz

doi:10.1542/pir.2017-0302

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Carole Jenny, MD, MBA*
James B. Metz, MD, MPH^†

^*Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
^†Department of Pediatrics, University of Vermont Children's Hospital, Burlington, VT

AUTHOR DISCLOSURE
Drs Jenny and Metz have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

AAP:: American Academy of Pediatrics
CAM:: complementary and alternative medicine
CPS:: Child Protective Services
MCA:: medical child abuse
MSBP:: Munchausen syndrome by proxy

Practice Gap

Medical child abuse and medical neglect are part of a spectrum of conditions that can lead to significant morbidity and mortality in children. Recognition of these forms of child maltreatment is crucial to preventing harm. Medical personnel should have a familiarity with and a framework for diagnosing and treating these 2 entities.

Objectives

After completing this article, readers should be able to:

Recognize medical child abuse and medical neglect in primary care practice.
Know the options available to managing medical child abuse and medical neglect in primary care practice.
Understand the parent factors, child factors, and physician factors contributing to medical neglect.
Know when to report cases of medical abuse and medical neglect to Child Protective Services agencies.
Know what other community resources can be helpful when dealing with medical abuse and medical neglect.

Introduction

In 1992, D. M. Eminson and R. J. Postlethwaite published an important paper discussing the range of parental behaviors when interacting with the medical care system. (1) On one end of the spectrum is medical child abuse (MCA) (previously referred to as Munchausen syndrome by proxy [MSBP]), wherein parents exaggerate, invent, or induce symptoms in their children and seek unnecessary medical care for them. On the other end of the spectrum is medical neglect, wherein parents either do not seek necessary care for their children or do not follow necessary instructions and medications that practitioners give them to treat illness. This behavior can put their children’s health at risk as well. In the middle of the spectrum are parents who respond appropriately to their children’s symptoms and seek medical care in a timely manner. Eminson and Postlethwaite …