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Child Abuse (cont.)

Failure to Thrive and Munchausen Syndrome by Proxy

Failure to thrive is a condition in which children fail physically to develop to their normal full genetic potential. It is most commonly caused by medical conditions that can result in children not growing as expected. At times, though, it can also be caused by intentional or unintentional behavior on the part of the parent or caregiver.

  • The diagnosis is made when a doctor compares the growth of a child on standard growth charts and looks for changes in the rate of growth of a child. These measurements are usually taken during well-child visits to the family doctor.
  • Any significant decrease in the rate of growth of a child with respect to weight, height, or head size is suggestive of a child who is failing to thrive.
  • Medical conditions that affect growth are primarily considered; however, if no other explanation for the abnormal growth is present, neglect is strongly considered. Behaviors considered as neglectful include:
    • Denying a child food
    • Feeding a child the wrong foods
    • Emotionally neglecting a child
    • Allowing a child to remain ill (not seeking medical care)
  • Once failure to thrive is considered, parents must comply with their doctor's recommendations regarding testing and any other investigation into the child's failure to thrive. If not, the doctor's suspicion may increase that the parent is contributing to or causing the condition.
  • Although some children are destined to be small, they generally grow at a predictable rate. If a child is eating adequately and consuming an adequate number of calories and generally appears happy and healthy, regardless of size, there is little reason to worry.

Munchausen by proxy syndrome is a serious psychiatric disorder of parents or guardians of children. The parent or guardian referred to as the perpetrator intentionally or unintentionally manufactures signs and symptoms of a disease in the child under their care. They do this, not for the good of the child, but generally to satisfy their own abnormal need. By literally making the child sick, the caregiver gets attention by having excessive contact with doctors and hospitals. Children undergo unnecessary testing and treatment for diseases that they do not have.

  • This condition is difficult for doctors to identify. Often it is more obvious to other family members or friends who sense an excessive contact with medical providers for an apparently healthy child being orchestrated by the offending parent or guardian. If you suspect this is happening discuss the issue with your family physician or pediatrician. Your provider should be able to guide your response and help determine whether an intervention is needed.
  • Parents who might be at risk for Munchausen by proxy can ask themselves these questions with respect to seeking medical attention for their children:
    • Are you overly concerned about the health of your children?
    • Do you remain concerned about minor problems that you have been told not to worry about?
    • Do you find yourself obsessing over possible medical problems that might affect your children?
    • Have you ever intentionally made a child appear ill?
    • Do you have any motivation or will you derive any benefit if you make your child appear ill?
  • Parents who see this behavior in themselves should stop the medical attention-seeking behavior and seek psychiatric help as soon as possible.

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