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Munchausen syndrome by proxy in the pediatric intensive care unit: An unusual mechanism

Kamerling, Lisa B. MD; Black, Xaviera A. RN; Fiser, Richard T. MD

Pediatric Critical Care Medicine: July 2002 - Volume 3 - Issue 3 - p 305-307
Case Reports

Objective To present a case of Munchausen syndrome by proxy (MSbP) by a previously unreported mechanism, discussing the occurrence of MSbP in patients in the pediatric intensive care unit (PICU) and the use of covert video surveillance in the diagnosis of MSbP.

Design Report of one case of a child who was proven to be the victim of MSbP while hospitalized in a PICU.

Setting A six-bed PICU in a military teaching hospital.

Patients One patient hospitalized for evaluation of confusing symptoms, later shown to be the victim of MSbP while on mechanical ventilation in the PICU. The mechanism of MSbP was intentional tracheal extubation by the patient’s mother.

Interventions Covert video surveillance.

Measurements and Main Results After initiation of covert video surveillance in the PICU, the diagnosis of MSbP was confirmed. The patient recovered with some physical sequelae.

Conclusions Children can be victims of MSbP even in a closely monitored PICU. Covert video surveillance was crucial to confirming the diagnosis.

From the Department of Pediatrics, Wilford Hall Medical Center, Lackland Air Force Base, TX.

Address requests for reprints to: Richard T. Fiser, MD, Division of Critical Care, St. Jude Children’s Research Hospital, 332 North Lauderdale Street, Memphis, TN. E-mail:

©2002The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies