Public Release: 

Faith in child protection system must be restored

Munchausen syndrome by proxy and sudden infant death BMJ Volume 328, pp 1309-12


Recent court cases into unexplained infant deaths have led to widespread confusion and have made many paediatricians reluctant to take part in child protection cases, warn experts in this week's BMJ.

They call for an urgent review of procedures to restore faith in the child protection systems.

The term Munchausen syndrome by proxy received publicity when in 1977 Meadow reported a case with deliberate fabrication of symptoms. Many manifestations of the syndrome are now recognised.

Yet recent events have raised questions about the diagnosis of the syndrome and have prompted some soul searching about the ways professionals respond to the unexpected death of an infant.

A non-adversarial approach needs to be introduced to deal with sudden infant deaths, say the authors. The emphasis must be first on assessing and minimising the risk to any other children cared for by the parents and secondly on management of the parents' needs. Professionals who offer expert evidence must also not promote ideas that are unsupported by research.

"We must restore the faith of the public and the professions in the child protection systems that are vital for a civilised society," say the authors. "Munchausen syndrome by proxy has captured the public imagination, but there is still much that we do not know about other aspects of child abuse.

"We urgently need to review procedures and to fund more research into the causes, mechanisms, and diagnosis of child abuse. And we call on journalists, lawyers, and the judiciary to ensure that they are well informed about the mass of evidence and data gathered over the past 40 years in child protection."


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