Medical Child Abuse: A Retrospective Analysis from a Tertiary Pediatric Hospital’s Childhood and Adolescent Abuse Group

TL;DR

This study examines 8 cases of medical child abuse at a pediatric hospital, highlighting the challenges in diagnosis and the importance of multidisciplinary collaboration.

Contribution

The paper presents a retrospective analysis of MCA cases using a multidisciplinary team approach and diagnostic criteria.

Findings

MCA accounted for 0.99% of 816 child maltreatment cases, with all perpetrators being biological mothers.

Children had a median of 23 emergency department visits, with common symptoms including fever and minor trauma.

Most cases were classified as 'possible diagnosis' using Rosenberg criteria, indicating diagnostic challenges.

Abstract

Background: Medical child abuse (MCA), previously known as Münchausen syndrome by proxy, involves the fabrication or induction of illness by caregivers—most commonly the mother—leading to unnecessary medical interventions and potential harm to the child. Methods: This retrospective study analyzed cases of suspected or confirmed MCA managed by the GAIA multidisciplinary team at Meyer Children’s Hospital, Florence, between 2010 and 2022. Cases were identified using Rosenberg diagnostic criteria and red flags outlined by the American Academy of Pediatrics (AAP) and the Royal College of Paediatrics and Child Health (RCPCH). Data were extracted from medical records and analyzed descriptively. Results: Among 816 cases of child maltreatment, 8 (0.99%) were identified as MCA. The median age of affected children was 5 years (range: 4–12 years), with a female predominance (6/8, 75%). All perpetrators were biological mothers (8/8, 100%). Children had a median of 23 emergency department visits (range: 4–44), with the most frequent presentations being fever (6/8, 75%), minor trauma (7/8, 87.5%), respiratory complaints (5/8, 62.5%), and gastrointestinal symptoms (4/8, 50%). According to Rosenberg criteria, 5 cases (62.5%) were classified as “possible diagnosis,” 1 (12.5%) as “definitive diagnosis,” 1 (12.5%) as “diagnosis by exclusion,” and 1 (12.5%) as “inconclusive.” Conclusions: Despite its low prevalence, MCA poses serious clinical and ethical challenges. Early detection requires thorough documentation, interdisciplinary collaboration, and improved access to shared medical records. The GAIA model offers a replicable framework for effective multidisciplinary management.