Meet Baron von Munchausen, a teller of tall tales

1 THE BABY BEAT March 21, 2012 D. Gary Benfield, Meet Baron von munchausen , a teller of tall tales DEAR DR. BENFIELD: I recently read about a little boy whose mother had repeatedly brought him to the emergency room for episodes of vomiting. Each time her son was admitted, the only thing the doctors found wrong was the amount of sodium in his blood was very high. Finally, after something like five admissions, the doctors figured out his very attentive and seemingly concerned mother was poisoning him with salt. The article called her problem munchausen By Proxy Syndrome. Can you explain this to me? Is there really someone named munchausen ?

2 DEAR : Let's start with your second question. Baron Karl Friedrich von munchausen was an 18th Century German who told dramatic and somewhat far-fetched tales , based on his travels. In 1785, Raspe published a collection of fictitious tales about the adventures of Baron von munchausen , which sold very well. So the name of munchausen became associated with outlandish story telling. Next, let's explain munchausen 's Syndrome, and then we'll tackle your first question. In 1951, Dr. Richard Asher wrote an article for the Lancet, one of England's most prestigious medical journals, in which he described patients who told dramatic and plausible, but ultimately false, stories about their medical symptoms.

3 Their phony symptoms resulted in an astounding number THE BABY BEAT March 21, 2012 Meet Baron von munchausen , a teller of tall tales 2 of admissions to the hospital, where they often endured many unnecessary diagnostic procedures and surgical operations. What did those patients gain from their lies? Nothing, except the first hand experience of all those procedures, the good feelings that come from being cared for by others, and the pleasure of deceiving the experts. Dr. Asher coined the term munchausen Syndrome to describe this previously unrecognized mental disorder. Since then, the disorder has had many names including hospital addiction, polysurgical addiction, and factitious disorder.

4 These patients are also called "Hospital Hoboes." Now, let's turn to your question about munchausen By Proxy Syndrome. In 1997, Dr. Roy Meadow, a British pediatrician, described Kay and Charles, two children who presented with puzzling symptoms somewhat like the child you described The case of six-year-old Kay. Her medical story included the following: A history of foul-smelling, bloody urine almost since birth; twelve hospitalizations at three medical centers; six major x-ray procedures; six exams under anesthesia; numerous courses of antibiotics; numerous urinary catheterizations; more than 150 urine cultures; and 16 consultants involved in her care.

5 Kay's mother always stayed with her in the hospital, loving and concerned. But she did not appear as worried as Kay's doctors. THE BABY BEAT March 21, 2012 Meet Baron von munchausen , a teller of tall tales 3 Since Kay's story didn't add up, Dr. Meadow decided to assume that everything about her story was false. So when he compared 57 of her urine specimens, he discovered that the 45 specimens collected by the nurses were normal while the 12 specimens collected by her mother were all abnormal. After Kay's mom was placed under a psychiatrist's care, Kay's health remained normal, with no further urinary problems.

6 The case of 14 month-old Charles. From the age of six weeks, this toddler had a history of repeated attacks of vomiting and drowsiness associated with an elevated level of sodium in his blood. He had been evaluated at three medical centers, each one not knowing about the other. Between attacks, he seemed healthy and was developing normally. When mom was not allowed to visit her son during a prolonged hospital stay, Charles was fine. But his attacks returned when she was allowed to visit over a weekend. His doctors concluded that his mom must have been giving Charles extra salt. While arrangements were underway to remove Charles from the home, he collapsed from salt poisoning and died in the hospital.

7 Dr. Meadow noted a similarity between the cases of Kay and Charles. Instead of a person presenting to the emergency room with false or induced symptoms, as occurs in munchausen Syndrome, a parent presents her child to the emergency room with symptoms, a "by proxy" form of the disorder. Seventeen years later, in a curious twist, Dr. Meadow learned Charles's THE BABY BEAT March 21, 2012 Meet Baron von munchausen , a teller of tall tales 4 mother had admitted to a psychiatrist that she had poisoned her son with salt, causing his death, nearly 20 years earlier. munchausen By Proxy Syndrome, then, is a form of child abuse, in which a caregiver fabricates or induces illness in a child.

8 The child's mother is the perpetrator in 95 percent of these cases. Here are a few of the reported ways symptoms have been induced: Under or over-medicating; suffocation; chronic poisoning; injection of oral, fecal, or vaginal substances into intravenous lines; contaminating urine or stool specimens with blood; and giving large doses of laxatives to the child. The perpetrator is motivated by a desire to maintain a relationship with medical personnel, which seems to meet a disturbed psychological need. Finally, the diagnosis is often overlooked because doctors may be unfamiliar with this bizarre level of manipulation and deception.

9 When the diagnosis is considered, the primary goal is to protect the child. After all, a child's life may be in danger. On the other hand, false accusations can devastate a family. So it's important for doctors to confirm their suspicions and make sure their diagnosis of munchausen By Proxy Syndrome is correct. 2012 Gary Benfield