Ali-Panzarella Andrea Z, Bryant Tamika J, Marcovitch Hannah, Lewis Jeffery D
Emory University School of Medicine, Atlanta, USA.
GI Care for Kids, LLC, 993-D Johnson Ferry Rd, Suite 440, Atlanta, GA, 30342, USA.
Curr Gastroenterol Rep. 2017 Apr;19(4):14. doi: 10.1007/s11894-017-0553-1.
We highlight the need for a multidisciplinary approach to the diagnosis of medical child abuse, also known as factitious disorder imposed on another (FDIA) or Munchausen syndrome by proxy (MSP), and review our experience focusing on the variety of symptoms that often present to the pediatric gastroenterologist many months before the diagnosis is made.
Recent literature on medical child abuse, mostly case reports, is markedly limited, highlighting a need for increased research on this topic. Articles agree on the value of a multidisciplinary approach to these cases and the importance of involving professionals outside the hospital setting. Given the technology-dependent nature of our current society, the use of social media to aid in making the diagnosis has emerged. Review of the literature shows that there are almost no data on long-term outcomes of the victims or perpetrators of MSP. Making the diagnosis of MSP involves a complicated process of piecing together inconsistencies among the history, examination, and clinical presentation. The diagnosis remains difficult and is not often considered during early presentation of symptoms. Once MSP is suspected, it is important that a multidisciplinary process is used, incorporating input from various sources: the outpatient care structure, the hospital, non-hospital agencies such as school and child protective services, and non-traditional sources such as social media. In our experience, a multidisciplinary approach augmented by thoughtful inpatient surveillance provides the greatest opportunity for confirming or excluding MSP. Pediatric gastroenterology is one of the most common services consulted prior to diagnosis and presents an opportunity for early intervention.
我们强调对医疗性儿童虐待（也称为代理型人为性障碍或代理孟乔森综合征）的诊断需要采用多学科方法，并回顾我们的经验，重点关注在做出诊断前数月经常出现在儿科胃肠病学家面前的各种症状。
关于医疗性儿童虐待的最新文献大多为病例报告，明显有限，这凸显了对该主题进行更多研究的必要性。文章一致认为对这些病例采用多学科方法的价值以及让医院环境以外的专业人员参与的重要性。鉴于我们当前社会对技术的依赖性质，利用社交媒体辅助诊断已出现。文献综述表明，几乎没有关于代理孟乔森综合征受害者或施虐者长期结局的数据。做出代理孟乔森综合征的诊断涉及一个复杂的过程，即拼凑病史、检查和临床表现之间的不一致之处。诊断仍然困难，在症状早期出现时往往不会被考虑。一旦怀疑代理孟乔森综合征，重要的是采用多学科方法，纳入来自各种来源的信息：门诊护理机构、医院、学校和儿童保护服务等非医院机构，以及社交媒体等非传统来源。根据我们的经验，通过精心的住院监测增强的多学科方法为确认或排除代理孟乔森综合征提供了最大机会。儿科胃肠病学是诊断前最常咨询的服务之一，为早期干预提供了机会。
