PROCEDURES, PLACEMENT, AND RISKS OF FURTHER ABUSE AFTER MUNCHAUSEN-SYNDROME BY PROXY, NONACCIDENTAL POISONING, AND NONACCIDENTAL SUFFOCATION

Objectives-To investigate outcome, management, and prevention in Munch ausen syndrome by proxy, nonaccidental poisoning, and non-accidental s uffocation. Design-Ascertainment through British Paediatric Surveillan ce Unit and questionnaires to responding paediatricians. Setting-The U K and Republic of Ireland, September 1992 to August 1994. Subjects-Chi ldren under 14 years diagnosed with the above. Main outcome measures-P lacement and child protection measures for victims and siblings; morbi dity and reabuse rates for victims; abuse of siblings; prosecution of perpetrators. Results-Outcome data for 119 with median follow up of 24 months (range 12 to 44 months). No previously diagnosed factitious di sease was found to have been caused by genuine disease. Forty six chil dren were allowed home without conditions at follow up. Children who h ad suffered from suffocation, non-accidental poisoning, direct harm, a nd those under 5 years were less Likely to go home. Twenty seven (24%) children still had symptoms or signs as a result of the abuse at foll ow up; 108/120 were originally on a child protection register and 35/1 11 at follow up. Twenty nine per cent (34/118) of the perpetrators had been prosecuted and most convicted; 17% of the milder cases of Muncha usen syndrome by proxy allowed home were reabused. Evidence in sibling s suggests that in 50% of families with a suffocated child and 40% wit h non-accidental poisoning there would be further abuse, some fatal. C onclusions-This type of abuse is severe with high mortality, morbidity , family disruption, reabuse, and harm to siblings. A very cautious ap proach for child protection with reintroduction to home only if circum stances are especially favourable is advised. Paediatric follow up by an expert in child protection should also occur.