Munchausen syndrome by proxy in twins

Munchausen by Proxy in Twins

Overview

A family is described in which twin infants had repeated admissions for apparent haemoptysis. It was proved that the mother was simulating these episodes and she eventually injured one of the children with a pin. The mother has subsequently shown some evidence of a Munchausen tendency in herself.

Twins abused by Munchausen by a Munchausen Mum - Case Report

Twins, a boy and a girl, weighing 2.5 kg and 1.9 kg respectively were born at 36 weeks' gestation by spontaneous vertex delivery. There were no immediate problems at birth. The boy was allowed home with his mother after 5 days. The girl was kept in the special care nursery for 3 weeks during which time parental visiting, although encouraged, was infrequent. Both parents, previously married, were known to the Social Services Department because each had children who were suspected, but not proved, to have been non-accidentally injured. These children are now in the custody of the other remarried partners.

During the first 4 months, despite intensive support, there were 5 admissions for relatively minor illnesses. Then, on consecutive evenings, both twins were admitted with a history of having vomited blood. No cause was found for this and they were subsequently discharged. The same evening the girl was readmitted and the boy the next night, again having vomited blood. On this occasion, blood-stained bibs were produced. Aspiration of stomach contents showed no evidence of blood and again no cause was found for the bleeding. The next day, while the mother was feeding the boy in hospital, she reported that he was again bleeding. Blood was present on his clothing and on the mother's nursing gown. Thorough examination showed no bleeding points on the child. Mother and baby were known to have different blood groups so the clothing was sent for forensic analysis.

At this stage it was thought that the mother was probably simulating the bleeding by injuring herself, and this was confirmed at a much later date by the forensic tests. However, the twins were allowed home in the knowledge that the mother had 'an escape route' when under pressure. The next evening both twins were readmitted, again having vomited blood and no cause was found.

A few days later while the mother was momentarily alone with the twins, blood appeared on the girl's chin. A nurse heard the baby crying, immediately examined her, and found a small bleeding point on her lower lip. He also saw a nappy pin that was almost hidden in the mother's hand. The twins were wearing self adhesive disposable nappies which did not require the use of pins. The mother subsequently admitted injuring her child with the pin, was charged with assault, and found guilty. She consistently denied falsifying any of the previous episodes. The children were then both placed in the care of the local authority.

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