MUNCHAUSEN-BY-PROXY AND MEADOW’S SYNDROME

Posted by admin on April 20, 2009 under Allergies | Be the First to Comment

Baron von Munchausen was an eighteenth-century Hanoverian soldier who greatly exaggerated his prowess in war – and his battle-scars. ‘Munchausen’s syndrome’ is the name given to attention-seeking patients who feign illness or deliberately fabricate symptoms. There are instances, fortunately very rare, of mothers simulating illness in their children in order to get medical attention -this is known as ‘Munchausen-by-proxy’ or ‘Meadow’s syndrome’ after Professor Roy Meadows, who first described two cases in 1977. Doctors are far more aware of this possibility in children than they once were, and any parent attempting to fabricate symptoms is likely to be found out very quickly.

The question of Meadow’s syndrome in relation to food sensitivity is a difficult issue. Various doctors have described cases of children whose parents believe them to have food sensitivity, but where no consistent reaction to a food can be shown. If those parents seem over-anxious or over-protective, and have obvious emotional problems of their own, then they have often been labelled as ‘Meadow’s syndrome’.

Eleven such cases were reported in 1984, in an influential article that has coloured the outlook of many doctors, and led to the belief that Meadow’s syndrome is quite common in relation to food sensitivity. However, there were several important differences between the cases described in this article and Meadow’s syndrome proper. For one thing, the children involved all had genuine symptoms, and there was no suggestion that the parents had attempted to fabricate any symptoms. Unlike Meadow’s syndrome mothers, these women did not seem to relish their child’s hospital stay, nor were they willing to subject them to any investigation, however painful and unpleasant. Such differences are important and must raise serious doubts about the conclusions reached – was the label ‘Meadow’s syndrome’ really justified? These parents may have been disturbed or overwrought, but this does not necessarily mean that they were mistaken about their child’s illness. The elusive nature of the reactions seen in food intolerance makes it difficult to rule out this diagnosis without very thorough testing, and there seems to have been undue reliance on skin-prick tests in this study, despite the fact that these are unreliable indicators in most cases of food sensitivity. Despite the doubts over this study, the idea of ‘Meadow’s syndrome’ has become a popular one, especially among those doctors who are sceptical of food intolerance generally. This is unfortunate for parents, especially when such a diagnosis is made without proper testing for food sensitivity, and without any firm evidence of fabrication. There undoubtedly are cases of parents who exaggerate their child’s ills, and who are determined to blame them on some physical cause, when family tensions and emotional problems are actually the true source of the symptoms. But unless there is gross exaggeration or fabrication of symptoms, these should not be described as Meadow’s syndrome.

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