Guidance
Medical child abuse
Medical child abuse can have serious, even life threatening, consequences for tamariki and rangatahi. It's not a common diagnosis but we need to understand this disorder so we can recognise when tamariki and rangatahi are impacted.Supporting practice
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What is medical child abuse
Medical child abuse is also known as Factitious Disorder Imposed on Another (FDIA), caregiver fabricated illness in a child or young person, and induced illness in a child or young person by a caretaker. It was previously known as Munchausen syndrome by proxy.
It is a medical diagnosis.
Medical child abuse involves an adult purposefully falsifying or inducing physical, psychological or developmental disorders in a tamaiti or rangatahi to fulfil their own psychological needs associated with caring for an unwell tamaiti or rangatahi.
In the vast majority of cases, mothers are the primary person responsible for harm to te tamaiti or rangatahi. Fathers or male caregivers are rarely the sole person involved, although cases involving harm caused by fathers tend to be more severe and have higher death rates of te tamaiti or rangatahi.
Most cases involve children under the age of 5. Boys and girls appear to be affected equally.
Direct harm caused by medical child abuse includes death in a small number of cases, or long-term medical conditions and physical illness in a larger number of cases, as well as emotional harm where te tamaiti or rangatahi becomes distressed about their health. Indirect harm includes te tamaiti or rangatahi being unnecessarily subjected to medical tests or interventions, being absent from school, and missing out on other social and developmental opportunities.
Many cases include similar abuse of other siblings.
When we suspect medical child abuse
When we suspect medical child abuse, we focus on the effects of the behaviour on the oranga of te tamaiti or rangatahi in the context of their whānau or family, rather than on obtaining a diagnosis. A diagnosis is not required to determine that abuse or neglect has occurred. We should also be aware of the possibility of misdiagnosis in cases of medically anxious parents or caregivers.
We work closely with medical professionals and others working with the whānau or family. Health services have a process to manage these complex cases. This includes multiple Multi-Disciplinary Teams that share information and plan and coordinate interventions.
Consider if this meets the criteria for the Child Protection Protocol and consult with Police if necessary.
Safety considerations when working with whānau or family affected by medical child abuse
We consider the ongoing safety of te tamaiti or rangatahi after a case of medical child abuse has been identified. For example, the people responsible need to be closely monitored in case they try to:
- intensify their abuse in order to 'prove' that their tamaiti or rangatahi is sick
- sabotage treatment while te tamaiti or rangatahi is in hospital – we discuss this with the multi-disciplinary team
- re-abuse or abuse other siblings, particularly where the people responsible deny their behaviours – we need to carefully consider safe levels of contact.
Some parents or caregivers (particularly those who engaged in severe forms of abuse like suffocation or poisoning) may never be able to safely care for their tamariki or rangatahi.
Social work assessment
We undertake a comprehensive social work assessment to build and deepen our understanding of the oranga and safety needs of all the tamariki and rangatahi in the whānau or family. We use our practice tools and resources.
We seek supervision and discuss with our Health and Disability Advisor and Specialist Services.
We focus on the experience of te tamaiti or rangatahi rather than the personality of the alleged perpetrator.
We consult and involve appropriate cultural expertise when needed.
We include the medical information available and reflect the medical interventions – but our focus is on oranga and safety.
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Organising my practice
Tiaki Oranga
Child/young person and family consult
Supervision triggers
Safety organised practice tools | Partnering for Safety
Practice triggers – vulnerable infants