Abstract
Background
Medical child abuse (MCA) is challenging to diagnose. Although young children are
often affected, adolescents can be victims through caregiver coercion. Presentation
is highly variable. Diagnosis is essential because of high associated morbidity and
mortality.
Case
We describe the case of a 12-year-old girl who presented to multiple subspecialty
clinics with reported menorrhagia. Despite reassuring clinical examinations, the family
described menorrhagia that failed to respond to standard treatment. After an urgent
evaluation for reported heavy bleeding revealed only scant blood, the diagnosis of
MCA was made.
Summary and Conclusion
Vaginal bleeding is a rare presentation of MCA, but must be considered whenever reported
symptomatology does not follow physiologic patterns, respond to standard medical treatment,
or correspond to clinical evaluation. Prompt identification is important to prevent
further harm.
Key Words
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References
- Munchausen’s syndrome.Lancet. 1951; 257: 339
- Munchausen syndrome by proxy: the Hinterland of child abuse.Lancet. 1977; 310: 343
- Diagnostic and Statistical Manual of Mental Disorders.5th ed. American Psychiatric Publishing, Arlington, VA2013: 324-325
- Munchausen by proxy: a case, chart series, and literature review of older victims.Child Abuse Negl. 2005; 29: 931
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- American Academy of Pediatrics Committee on Child Abuse and Neglect: Beyond Munchausen syndrome by proxy: identification and treatment of child abuse in a medical setting.Pediatrics. 2007; 119: 1026
Article info
Publication history
Published online: March 25, 2019
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
© 2019 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
