Walters Ilana C, MacIntosh Rachel, Blake Kim D
Dalhousie University, Faculty of Medicine, IWK Health Centre, Halifax, Nova Scotia.
Paediatr Child Health. 2019 Jun 17;25(6):345-348. doi: 10.1093/pch/pxz053. eCollection 2020 Oct.
Factitious disorder imposed on another (FDIA) and malingering by proxy (MAL-BP) are two forms of underreported child maltreatment that should remain on physicians' differential. This case of a 2-year-old boy, which spans 6 years, reveals the complexity in and difficulties with diagnosis. Key features include the patient's mother using advanced medical jargon to report multiple disconnected concerns and visits to numerous providers. As a result, the patient underwent many investigations which often revealed normal findings. FDIA was suspected by the paediatrician, especially following corroboration with the child's day care and past primary health care provider. This case demonstrates the possible overlap in diagnoses, which are characterized by a lack of consistent presentation and deceitful caregivers, often complicated by true underlying illness. The authors use clinical experience and limited existing literature to empower paediatricians to confidently diagnose and report FDIA and MAL-BP to limit future harm to children.
对他人施加的做作性障碍（FDIA）和代理诈病（MAL-BP）是两种报告不足的儿童虐待形式，应始终保留在医生的鉴别诊断范围内。这个涉及一名2岁男孩、跨度为6年的病例揭示了诊断的复杂性和困难。关键特征包括患者的母亲使用高级医学术语报告多个不相关的问题，并就诊于众多医疗机构。结果，患者接受了许多检查，这些检查往往显示正常结果。儿科医生怀疑存在FDIA，尤其是在与孩子的日托机构和过去的初级医疗保健提供者核实之后。该病例表明了诊断中可能存在的重叠，其特点是表现不一致且照顾者存在欺骗行为，常常因真正的潜在疾病而变得复杂。作者利用临床经验和有限的现有文献，使儿科医生有信心诊断并报告FDIA和MAL-BP，以限制未来对儿童的伤害。
