CHILD ABUSE IN A MEDICAL SETTING: CASE ILLUSTRATIONS OF TWO VARIANTS OF MUNCHAUSEN SINDROME BY PROXY.

Munchausen syndrome is a complex type of abuse, which is offen underdiagnosed or misdiagnosed in clinical practice, and has harmful consequences for children. Its relationship with child abuse, of which it is a vanety, must be recognized in clinical and forensic practice. The authors report herein two observed of different types of Munchausen syndrome by proxy (MSbP). The first, the most severe form of MSbP, with induced, true illness and related pathological symptoms into victim. The second case is moderate form, much more complex to detect, in which a perpetrator parent simulates and aggravates the child's illness. Adequate training of health professionals and investigators is essential in revealing cases of MSbP. Diagnosis must be based on the study of the different forms of "abuse" and the knowledge of clinical protocols used to validate any suspected behaviour which could be potentially harmful to the child. Moreover, a lack of training may lead to misleading interpretations of medical history interpretation and fallacious conclusions. Our study aims to review the features that are to be considered in a suspected of MSbP, in accordance with recently updated consensus statement by the Committee on Child Abuse and Neglect from the American Academy of Pediatrics.