June 7, 2000 -- Researchers may have found an effective way to help diagnose a particularly insidious form of child abuse known as Munchausen syndrome by proxy. Using cameras and audio equipment hidden in children's rooms at an Atlanta hospital, officials were able to identify several parents who were abusing their children this way.
In a new report, published in the journal Pediatrics, researchers say that all specialized children's hospitals should have systems in place to conduct surveillance in suspected cases of Munchausen syndrome by proxy (MSBP). Hidden cameras were instrumental in identifying 23 out of 41 suspected cases at the Children's Healthcare of Atlanta at Scottish Rite, the report says. The surveillance also exonerated several parents who had been under suspicion.
The syndrome, which gets its name from a German baron renowned for his tall tales, is a form of abuse that is very difficult to diagnose because the child shows no visible signs of being battered. Instead, parents intentionally make the children sick, usually by feeding them unprescribed medicines and other toxic substances. These parents -- in the vast majority of cases, the perpetrator is the mother -- are often skilled at deceiving medical professionals.
There is no single conclusive test for diagnosing MSBP, so doctors tend to look for an accumulation of indicators, says one expert on the syndrome.
"It tends to be a diagnosis that we make based upon a thorough review of the case, comparing it to the known warning signs of Munchausen by proxy syndrome," says Marc Feldman, MD, medical director of the Center for Psychiatric Medicine at the University of Alabama at Birmingham. Feldman was not involved in the study.
"It could be the child having an inexplicable illness that improves when the child is away from the mother, other children in the family having similar unexplained illnesses or death ... [with] the mother being alone with the child each time an illness occurs. "
The decision to monitor parents suspected of this syndrome was carefully made by a team of doctors and social workers. Monitoring was considered when team members believed Munchausen syndrome by proxy was the only likely explanation for a child's illness. It was also done in a few cases in which the syndrome was unlikely but there was no other explanation for the child's symptoms.
"In 13 of those cases, we felt that we could not have made the diagnosis without the monitoring," says study author David Hall, MD, a pediatrician with Children's Healthcare in Atlanta who specializes in inpatient care. "So we think that this is an essential tool to have in the diagnosis of MSBP."
Some argue that covert surveillance is unethical because it interferes with the family's privacy. But Hall points out that everyone gives up privacy when they enter a hospital, and that it is the child who is the patient, not the family. There's also a big difference in monitoring an adult without permission and monitoring a child, he says.
"A child can't speak up for himself," he says. "And someone has to be an advocate for the child. No one can ask that child if its okay to videotape your parents making you sick."
Feldman agrees. "There's been a question as to whether parents have a reasonable right to anticipate privacy in a hospital room, and the answer -- both legally and ethically -- is no."
He also points out that people don't question monitoring devices in stores and other facilities. "You can go into a department store and the cameras are everywhere -- you are being surveyed continuously to make sure you don't engage in a criminal act," he says.
Because of the hidden cameras, four mothers who had been suspected of Munchausen syndrome by proxy were exonerated, as no suspicious or abusive behavior was noted. This shows that hidden surveillance can work both ways, Hall says.
"We believe strongly that [the surveillance] is ethical and the right thing to do in selected cases," Hall says. "Not only does it protect children, but it can also protect parents who are innocent."