Monica Prieto, MD Children’s National Medical Center

Case: 3 year old healthy and thriving male presents with MGM in the setting of recurrent bloody emesis. Has presented to multiple ED’s with similar complaints with a “normal” workup and has never been witnessed by a medical professional. You are reassured that the patient appears well on your exam and potentially concerned about the mental health capacity of the grandmother.

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Discussion:

The major dilemma of this case is the crux of many physicians worst nightmare. What do you do when you flat out disagree with the parents? In fact, truly worried about the parents mental health thus, the child’s potential physical safety.

Dr. Gilchrist stated her road-map is usually first, ensuring there is no harm at this time to the child immediately. If there is not, then seeing if the child has any objective findings that one can use to back their suspicion. If so, then call CPS and open a case but admission may not be warranted.

Dr. Ward stated that there are millions of people with mental health problems with children and not very many are neglecting their children. So without hard evidence such as FTT, physical exam findings, or other objective data, one would be hard pressed to call Child Protective Services.

Dr. Lindgren stated the fact that this child has no reliable follow up and PMD is worrisome and thus should have a short admission/observation. This is often helpful in cases where Munchhausen by proxy is a concern and admission for video monitoring can help decipher what the true issues are. However, Dr. Chapman felt that this mother is most likely truly delusional and not Munchhausen by proxy as there does not seem to be any clear secondary gain.

Overall, the underlying theme was that open communication with providers and following your gut is the best option to take in these social dilemmas.

Denouement:

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