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Clinical Medicine: Pediatrics

Synopsis: An open access, peer reviewed electronic journal that covers diagnosis, management and prevention of conditions specific to childhood and adolescents.


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Clinical Medicine: Pediatrics is an international, open access, peer reviewed journal which considers manuscripts on all aspects of the diagnosis, management and prevention of disorders specific to children and adolescents, in addition to related genetic, pathophysiological and epidemiological topics.

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ISSN: 1178-220X


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Misdiagnosis of Child Abuse Related to Delay in Diagnosing a Paediatric Brain Tumour

Authors: Lynne Wrennall
Publication Date: 20 May 2008
Clinical Medicine: Pediatrics 2008:1 1-12

Dr. Lynne Wrennall

Public Health Research Group, Criminology Programme, School of Social Science, Liverpool John Moores University, Clarence Street, Liverpool, United Kingdom, L3 5UG.

Abstract

Conflicting opinion regarding the relative weight that should be allocated to the investigation of organic causes of child illness, compared to the pursuit of suspicions of child abuse, has generated considerable public debate. The discourse of Munchausen Syndrome by Proxy/Fabricated and Induced Illness is at the centre of contention. In particular, concern has arisen that children’s medical needs are being neglected when their conditions are misdiagnosed as child abuse. This paper documents a case study in which the use of Child Protection procedures was linked to the belief that the child’s illness had “no organic cause.” The case study is contextualised in a review of literature relevant to the diagnostic process. The deployment of the Child Protection perspective resulted in significant delay in the diagnosis of the child’s brain tumour. The child was ultimately found to be suffering from an optic chasm mass lesion involving the hypothalamus and the medial temporal regions, resulting in Diencephalic Syndrome. The evidence in this case is that erring on the side of suspecting Munchausen Syndrome by Proxy/Fabricated and Induced Illness, was not “erring on the side of the child.” Several lessons need to be learned from the case. The importance of ensuring that the Child Protection perspective does not displace adequate assessment of alternative explanations for the child’s condition is emphasised, as is the need for good communication in medical relationships. Strategies involving empathy, mediation, negotiation and conflict resolution may provide a more appropriate and therapeutic alternative to the use of Child Protection procedures in cases where the diagnosis is contentious. The need to re-write relevant policy, protocols and guidance is imperative.

Categories: Pediatrics , Health services


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Posted by
Catherine Mills
21:09,June 21, 2008

There are so many mothers being labelled with this MSBP- yet it is only an opinion and not hard facts. A bit like the old witch trials in fact. I would definitely have been done for this in 1995, but the fact was my son reacted to the 3 in 1 vaccine and this was later proven. Social services are removing children into care too quickly- causing far more real abuse through TRAUMA. But, then that is the idea- even though social workers are not aware of whom they are serving- like Anna Freud Centre and Tavistock etc. " It is unimaginable given our resources and psychological knowledge that it wasn't a top priority to keep children and their parents together. We have known since World War II, from the work of Anna Freud and Dorothy Burlingham in wartime nurseries, that separating children from their families is much, much more traumatic for them than being directly exposed to bombing." http://www.medscape.com/viewarticle/513888

Posted by
Michelle
20:00,June 15, 2008

This garbage is often used if child has any kind of disorder not yet understood well, the old unknown to us, we cannot even count the numbers of children torn from loving families for ASD. Mongolian spots, Rickets,Inborn errors of metabolism, chemical exposures, allergies, GERD, sleep apena, this is a long list. We now have Canada and the US saying they are seeing M.S as in multiple sclerosis in very young children. What once was thought as only occupational illness, we now see in children, given lead in toys, and water, and old levels of concern lowered. Asking a pead about environmental illness in a child, is a sure way of having that child suffer from change in environment to foster care, and all the harm we do know that may cause. Given medicine does NOT stand still in time, it is long past time we ended the witch hunts.

Posted by
Brendan Newport
16:59,June 03, 2008

A concern is that MSBP/FII false allegations can be routinely made if a parent (notably a woman) continually requests medical intervention or furnther diagnosistc tests on a child in their care. It seems too easy for a paediatrician who is either harrassed with too much work, or unsure with their skill set, or perhaps (because of racial or cultural reasons) finds the concept of a woman being critical of the work (or lack of) being carried out, an obcenity...to make a false MSBP/FII allegation, just to either get them out of the way or "teach them a good lesson". Seeing as such allegations are virtually impossible to counter - due in part to their use of "ducking stool" circular arguments (you are guilty if you did something and guilty if you didn't do it) through the use of numerous "profiles" it seems that medical staff and social workers have been given a tool to use that has its origins deep within the 16th Century. Of course those who are enthusiastic supporters of MSBP/FII allegations against women (such as Dr Lasher) might say that occasional errors are sure to occur, but the ultimate benefits of being able to lay allegations of MSBP/FII against (notably) women, outweigh the blunders. In the UK, thanks in part to the exposure of Dr Roy Meadow, those errors would appear to number many thousands (perhaps even 15,000) over a decade. It may simply be that many medical staff feel that changes in society are such that professionals like paediatricians absolutely have to have the facility to bring women "back into line" if the occasion (in their judgement) merits it. Decades ago no woman (let alone a male) would have dreamed of questioning a paediatricians judgement, or demanding further effort - now in the 21st century, such behaviour can be discouraged with the threat of an MSBP/FII allegation. FII does of course exist - we call it child abuse. The question isn't whether child abuse exists but rather why as society have we given professionals such an easy route to, if they fill inclined to do so, or are trained in such a way, to dish out such allegations with such ease.

Posted by
Barbara Jacobs
17:19,May 23, 2008

I agree with much of what is being said here. I am not a scientist, but a senior educationalist, currently completing a very late life PhD on autistic intelligence in inclusive education. This involves talking to parents and children and teachers about their understandings of the autistic spectrum. Over and over again I am shocked by failures of diagnosis of these conditions, and the tendency of professionals to 'blame' parenting for the behaviours of children with ASCs, a belief that has not been in currency in research fields since the 1960s, since Bruno Bettleheim was so strongly discredited. So why are so many of the mothers in my research still being referred on to parenting courses or family therapy while a diagnosis for their special needs child is withheld during the most vital years of the child's education? Why are some of the mothers in my study having to go through child protection proceedings? Why, when it's known to academics that ASCs 'cluster' within families, are some of the children in my study refused diagnosis because this could be 'learned behaviour' from an ASC sibling? Why are these children being sent for 'observation assessment' when those observing them don't have the breadth of knowledge to observe clear indications of Asperger's Syndrome? Why are so few Social Workers, teachers, and CAMHS personnel really aware of the complex and perhaps contradictory nature of hypo- and hyper-sensitivities and motor functionionality in these children? Why do CAFCASS ask these children, 'How do you feel?', when the ASC-friendly way of eliciting a response is to ask 'What do you think?' or 'Is this fair?' Why are these professionals so poorly educated that they believe that if a child can maintain adequate eye contact, then they're not on the autistic spectrum. Eye contact has become, for many, a principal diagnostic element, although it is merely a mentioned guideline among very many in one section of one element of the diagnostic criteria. Last week I interviewed a 7-year-old able autistic, who managed reasonable eye-contact with me throughout, even when he was flapping and squealing. I recently appeared in court as a pro bono witness for a mother. My very careful interpretation of the SALT reports, the Wechsler tests, and the child's developmental history reports (which could have formed an ASC template), all empirical, hard fact evidence, was dismissed in favour of an Expert Witness psychiatrist who diagnosed the child, in his 'opinion' with separation anxiety disorder and recommended that he be removed from his mother's care, therefore. Yes, I know it doesn't have any internal logic, let alone any diagnostic justification. I despair. Thank you, Lynne, for raising awareness of this issue. And Sarah, my heart bleeds for you. If it's any comfort, there are very very many mothers in exactly your position. I hope in my postdoctoral research to investigate the role of professionals in denying spectrum children their right to 'enjoy and achieve' within their loving family. These children NEED their mums. And their mums shouldn't have to fight for that human right to protect and safeguard their children. And we, as a society, should care enough about all children to know that if we fail them, then society collapses into mayhem.

Posted by
sarah collins
21:26,May 22, 2008

Conflicting opinion gives rise to delays especially if the courts are involved, delays and re-assessments ensure that certain people within the court process benefit from the repetitious nature of updating certain assessments. No professional admits they are wrong or alternatively they will do there utmost to protect the local authority doctors wether they have made mistakes or not. Unfortunately this is never in the interests of the child and in reality there really is no excuse for that. my child was let down by 3 camhs doctors in succession, they missed vital indicators. It doesnt matter that I know that now or indeed have all the relavent evidence because they will always protect the reputations of local authority doctors.Facts and a meticulous raking through of the childs medical history ought to be first and foremost before anyone starts to raise there self righteous fingers towards anyone. Please excuse me but I may come across a little frazzled around the edges as my experience of FII and the draconian courts are very fresh in my mind. I was accused of fabrication because I dared to have an opinion of what may have been wrong with my son. From that day on I can only describe our trial as a family as torturous.. I have evidence that is plentiful and undisputable, I sought guidance and backing from only the VERY BEST in this field, however as you may have guessed the courts scene was already pre-scripted, the judge (puppet) chose to ignore bits that didnt look too good for the LA and jumped up and down at the bits he felt made me look stupid. Anyway my evidence was ignored, the courts have ongoingly stopped me from persuing a diagnosis he hasnt had any education for 3 yrs now and he is to have a statutory assessment conducted by the local authority and depending upon the outcome of their assessment they will decide wether to re-open care proceedings (give you 3 guesses as to what the outcome will be)despite them already trying to remove him previously from me on two occasions. At the moment he is under no order from the courts, our lives have been in limbo trying to keep our heads above water and as a parent that is disabled herself I ongoingly am trying to cope with the practicalities and realities of looking after two sons that are both on the spectrum. My own health at present has taken a nosedive as my body physically reacts to any external stress, they know I must avoid it like the plague yet prolong this cruel game of theres...I may be a tad down at present but I will never give up as long as I draw breath....

Posted by
Philip Armstrong
20:16,May 22, 2008

My name is Philip, I am the father of the child called 'Mellisa' in this case study (Mellisa is not my dauhter's real name). The publishing of this paper about our daughter's case is a significant step in our family's fight for justice for our daughter and ourselves. The delay in diagnosis in our opinion has grossly negatively affected our daughter's chances of living a normal life, if indeed any life at all. Our daughter's life expectancy is still not promising despite over 7 years of appropriate medical care following diagnosis. The many severe side effects, cause daily life as our daughter and ourselves know it, to be significantly different from what could be called 'normal' family life. We as a family want those un-named medical practioners involved in the mis-diagnisis and accusation against us to be held accountable for their actions. The physcological damage that this false accusation has caused on our family, particularly Sandra, my wife, is significant and we only hope that when the day comes when we feel justice has been obtained that this may ease. Furthermore, we hope that by allowing the publication of the details our case and the learnings from it, both medical practioners and parents of sick children will reflect and act in the best interests of the child. For the medical practioners that means not entering into 'group think' and not being influenced by peers with agendas not matched to the specific childs immediate welfare. For the parents, that means questioning what is being done or not done if not satisfied with progress towards their childs well-being. This case study, for reason, does not specify detail of names, dates & places. Should these be required for achieving our ultimate objectives in allowing this publication to proceed, namely justice and learnings, then we welcome direct contact, details are obtainable through the author of this article. We as a family would like to sincerely thank Lynne Wrennall for her tenacity and kindness.

Posted by
Elizabeth Robillard
13:43,May 22, 2008

Thank you for this. The pernicious charachter of false allegations effectively destroys people in a multitude of ways. History will tell how people died and became lifetime disabled due to whispering campaigns, fabrications by accusers and the machinations of some of the professionals eg Childrens social workers, LEA's, CAFCASS, family lawyers and the 'closed shop' that is Public Family Law in England. It's not quite Guantanomo Bay, but almost, the suffering and emotional bullying by professionals is very real, I can attest to it, with evidence. This must stop *now* - don't say you were warned if it happens to you. There are no class barriers here. I hope the strong opposition of the secrecy of the family courts (Dominic Grieve, Theresa May, Eric Pickles etc) will break down those hideous bleak walls as promised, as the courts are Britians' 'Berlin Wall' we need to tear down ASAP.

Posted by
Charles Pragnell
09:09,May 21, 2008

Courts in England and Australia have made judicial findings that MSBP/Fabricated or Induced Illness in Children has no probative value and in fact is prejudicial to a fair hearing. MSBP/FII pre-judges the evidence or is used in the absence of factual evidence and pre-empts the decision-making powers of the Court.i.e. this is the crime (child abuse), this is the culprit (usually the mother), and this is the sanction (removal of the child). Such usurping of judicial authority by medical and social work agents should not be permitted in any country's legal system if that legal system is to make any pretence at being fair and just.

Posted by
Linda McDermott
21:56,May 20, 2008

I have asked the Children's Shadow Minister Tim Loghton to now make sure that a law is passed were pathology must be accepted in cases of children who are adopted or taken into care. The LA do not disclose the truth about any relevent medical history or genetic congenital diseases within the family. It should be made a criminal offence to stop such a handover of vital information to familiesor children in the future . The worst case scenario is when the child /adult will need to find information which is so badly needed to find a genetic key in cases of leukaemia. The cases will not be likely to be opened to search for a suitable donor. I am not convince the current set up to contact families through the NHS system is enough for a life or death situation, as some people have already fled the country leaving the stolen child behind in this country or it has been taken abroad during the processof adoption .These people ,the SW's Expert witness's get simple facts wrong time and again there is nothing random about this process, how can they then be expected to manage later on to find a real family for a child /adult searching for a blood relative for a stem cell donor . MAy I suggest to you that can only be 1 thing for the purposes of the law, so if you are a hyperchondriac,or have abnormal illness behavoiur you are more than likely to be a stem cell donor in the future .That is IF the EW is right in closed court ,the EW will go on to say for eg; says "you do not have incurable disease", even though you do have this incurable disease then legally why is there no opportunity given to you at this time or any other time for you to leave a sample for the future for the child? . The reason is this they have not got any understanding of medicine these so called EW's however they always have their opinions accepted in court! This is matter is not dealt with in the court process I can reassure you of this as a matter of fact. Simply because of the lighter label of MSBP I have lost my case my son is in remission from leukaemia should he come out of remission we have not been brought into the loop. From a solicitors point of law this oversight is barking madness the courts decided upon the EW in theory she is right so why have the doctors not asked the motherto leave a key or looked at her to be a suitable donor ? Simply because the disease can be passed on by blood . There needs to be scrutiny into the background of these so called doctors, judges need to brush up on their knowledge of medicine too. Maybe a health Watch Dog is needed to double check the pathology going on in courts before any more harm is done in the name of psychobabble.

Posted by
Catherine Mills.
19:55,May 20, 2008

I have a friend whose son had leukemia and she was labelled MSBP too. If a mother complains in any way, she seems to get labelled immediately and the child removed, thus causing enormous further trauma to the child and life long damage to the mother too. It is like that MSBP is what professionals are brainwashed to look out for- so of course, once the seed is planted in their minds, it grows and they see it everywhere. It was the same with SRA in Cleveland.

Posted by
dolores
17:39,May 20, 2008

I am a physician. I am aware of a similar story. ER called CAS. Family in meantime took the kid down the 401 to London Ontario where a brain tumour was diagnosed. I was accused of causing my 2 children's autism and the CAS called on me.

Posted by
Liz Armstrong
16:19,May 20, 2008

RN. Have a child , also told I was causing illness MSbP, he had a brain tumor, we had to take child out of city, not easy when one is being watched for child abuse, and have the CT done, is well today, it is so rare, we have an epidemic of so called MSbP, around the teaching hospitals, and children and parents are suffering. Canada.

Posted by
Jan E Leestma, MD
15:39,May 20, 2008

I have had a case of PNET that was missed in a 2 month old said to have died from SBS. At the most recent meeting of the Amer Acad Forensic Sciences, a forensic pathologist from Medical University of South Carolina reported a similar case of brain tumor in an infant misdiagnosed as abusive injury. These are uncommon but not rare and illustrate that there are many conditions that can present with ALTE, may be interpreted wrongly as SBS, and reflect medical tunnel vision. Jan E. Leestma, MD Chicago IL


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