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Munchausen Syndrome By Proxy


meridian
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anyone know much about Munchausen syndrome by proxy? Can a parent 'make up' incidents relating to behaviour in the home, or does it just relate to taking child to the doctor for all sorts of illnesses to gain attention? I have a child in the setting whose behaviour doesn't cause any concern when he is in the setting. I feel his development is normal for his age and stage of development. He is making positive relationship with not just his key person, but with other members of the staff. He gives eye contact and responds to instructions, will follow a 3-word instruction (as in the Elklan speech and language). He plays mostly alongside other children but will involve other children sometimes (only just aged 3:2).

At home mum really struggles with his behaviour. She says he is violent - breaks things, hits her, takes food off her plate...the list goes on..including head butting and breaking her nose! I have been on a home visit and have observed some negative behaviour, but the most significant thing (to me as a parent too!) is the negativity towards this child. His mum seems to not see anything positive..even when we invited her in to observe her child from a distance to see how he positively interacts with his key person and other children in the setting she said 'he would kick off with me' when asked to follow an instruction.

Now the parent has took the child off to the doctors who saw how the child pinched his mum and 'kicked off' in the room and referred him to a paediatrician who again observes similar behaviour (albeit the parent held the child on her knee and the appointment lasted for an hour! The report now lands on my desk and I am thinking 'what do I do with this?'..need to send back a report to say what child is like in the setting.

parent has also put in for disability living allowance and paed says we will need support in the setting with his behaviour!...

any advice welcome!

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It certainly sounds like there is something else happening here.

 

Is it that mum really struggles to cope and needs support with managing behaviour?

 

Is it that he has an undiagnosed additional need, which he is able to rein in at your setting but is secure enough to let go of at home - Upsy Daisy was talking about this on a recent thread.

 

Is it that mum needs help with something and this is either a smokescreen or a cry for help about something else - Domestic abuse, mental health problems, etc?

 

Is it that she is exagerating the situation to claim DLA?

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You can only report on what you see and know.

 

Can you invite the paediatrician to the setting to observe?

 

It does seem odd that there is such a disparity of behaviour and it would more usually present withthe setting having problems and the parent denial, in my experience.

I have had a family some years ago where the mother was suspected of munchausen syndrome but I dont remember many details but she did make up many stories to explain her children's absence from school including illnesses. We lost count of how many times grandma died!

 

Good luck.

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all you can do is be honest in the report ..i write mine in line with the six areas of learning so that it is about the childs development and what levels he is at. Will your area senco come in and do an observation independently or can you ring the ed phsyc ( with mums permission) and pass on your observations? they may well come to the setting and do another ob (are you school or pre-school?). I have just had an sen meeting today about a child who is showing us some difficult behaviour but it is nothing in comparison to what he does with his parents....i guess he has learnt that bad behaviour gets him what he wants at home but doesnt work for us! so be careful ...it may be that this child is as bad as his mother says in the homeenvironment with her (for various reasons!!! :o )good luck

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t is always s hard to try to help or give ideas without really knowing the child and parent..

 

That said.. many children are great with others but at home so totally different.. my son was one.. awful at home and always the no/ kick off with me.. with others did as asked and not a sign of any issues we had at home... while causing distress at times we coped , had strategies, followed through.. all the usual things.. and all helped.

 

but some parents we had through our setting had issues with behaviour and needed teaching how to deal with it, and many ended up at parenting classes which they all said really helped.. but they had them locally while we had the children.. but I do know parents were lucky to have them.

 

writing reports I was always factual and just put what we found.. if the child was fine with us we said so.sometimes they asked for specific areas to be covered but if not we put in things like date the child started with us, session times and days per week, as well as a brief summary on areas of learning, in this case would concentrate on the PSE side.

 

They usual sent and Ed Psychologist to see child in the setting and reports will come in from so many sources to be put together.. Parents were not always happy, but we felt it unfair on the child to be anything other than truthful. reports will be asked from many , so your will just be one side of the picture..

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First impression that went through my head was a CAF. Obvioulsy we dont know all the ins and outs and clearly something isnt quite right, but it sounds like mum needs some support.

 

If mum agrees, it would be good to get the ed psych into observe him in your setting. Another possibility would be for you to film him during play to show the ed psych or paediatrician.

 

Your report can only indicate what you observe not what mum has said. It isnt uncommon for a child to be very difficult to manage at home but a completely different child at nursery.

 

Do you have access to family services via your Children's centre, and wuld mum agree to you talking to someone?

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In my experience, Munchausen syndrome by proxy is more where the parent is attention seeking by making the child actually ill. It's abuse. The mother in question was giving the child huge amounts of salt which caused his kidneys to almost fail. She was apparently a very loving and protective mother, but the child was always poorly and she was forever at the doctor - an eye infection (she's rubbed faeces in his eye) a perforated eardrum (goodness knows) a nasty rash down his back etc etc.

 

I'm not sure whether your 'Mum' fits this category quite, as it seems almost the opposite - she doesn't appear a loving, protective person.

 

I think you can only report it as you see it - do you have an area INCO/SENCO who could come in and observe - ostensibly to help you write your report?

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It is entirely possible that the child is behaving how his mother describes at home and it is possible that it is caused by a developmental disorder. She may be getting the brunt of frustrations which are held in within your setting and let out when he gets home. I have seen dozens and dozens of posts on a forum for parents of children with ASD which could be written by the parent you're describing. It's possible that his behaviour is influence both by a developmental disorder and less than competent parenting. There are no rules which say that unskilled parents always have healthy children.

 

But as Susan says you can only report what you see.

 

If you want to do the right thing by this little boy you'll put aside questions of what the underlying cause may be and concentrate on the information you are qualified to provide. Don't try to gloss over anything you don't think is relevant or highlight anything in particular. Perform detailed observations of his interactions with other children to see if he is really playing cooperatively or alongside, to identify persistent interests and anything he appears to find unsettling. Try to provide a comprehensive picture of his development and allow the professionals to use that information in their own assessments.

 

In terms of the DLA just write honestly about how he is in your setting and try not to make judgements about what he may be like at home.

Edited by Upsy Daisy
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Had a similar case in my setting just last year ( agree with comments made about it not being Munchausens by Proxy - it's a toltally different thing from causing the child to suffer physical symptoms in order to gain attention from the medical profession)

 

Back to the main point - the child you describe sounds just like the one we have, parents insisting something was seriuosly wrong with behaviour, tantrums, attitude etc at home and pushing for all sorts of reports and assessments. Mum especially very negative , asked at end of childs first session whether he had 'hurt' anybody, and seemed surprised when we said he had been fine!

I had the request for a DLA assessment , and wrote a factual report based on what we saw at setting, also shared this with parents as made it clear we can only report what we see.

 

Six months down the line had Dad come to me and thank us for all the positive work we have put in and the positive impact it has had on the childs behaviour at home and thier relationships in general. He actually stated that what both he and Mum needed was somebody to set the boundaries and then guide them in how to keep them,and to be more positive when parenting,

and in this case it seems to have worked without interventions like parenting classes.

 

Sounds as if your parents might just need a bit of extra support but the CAF idea and getting other professionals to see what you see is a good idea. Just going through the CAF assessment paperwork with parents can be a real eye opener onto a child's life. :o

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I wish i could respond more fully but my experience has shown that munchausens by proxy whilst normally relating to making the child ill can also be mum stating 'symptoms' and seeking medical advice again, again and being so convincing in detail the child is subjected to a battery of tests .

 

Like you we have a child whose behaviour outside the setting it totally poles apart from what we see day in and day out, neither do we see any of the many, many medical symptoms that the child displays at home.

 

However the family in question are receiving alot of support from a range of agencies and this included one of them coming in to observe the child in our setting on several occasions and her observations totally supported what we stated we see.

 

You can only be honest in any report.

 

I agree with someone who has said something about children displaying very different behaviour at home/preschool, I have a few of those and occasionally see atrocious behaviour in the car park or when I am out and about but the child i mention is a different scenario entirely. The behaviour and symptoms are only ever witnessed by mum, not when the child is with relatives or when any of the agencies make a home visit, never at a medical appointment, I can't explain it any better other than it is very different to the usual differences in behaviour that we all see from time to time

Sorry not sure I have been much help but good luck

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I also agree that you can only report what you have actually observed, without interpreting the findings.

 

However, my personal thoughts are that the child is 'behaving better' within the settings environment as (I'm making the assumption) he receives positive re-enforcement there, and does not receive attention for minor negative behaviour.

The 'Self-Fulfilling' phrophecy (sp?) theory, in that he is 'living up' to expectations made of him, in what sounds like two very different environments.

 

Aside from the report that you need to make, would it be at all possible/feasible to organise a parents function where you, or an early years advisor, gives a talk on supporting positive behaviour. It may be that this parent would not attend anyway, but maybe she could be provided with a handout of the talk after (along with other parents who don't attend of course). As others have mentioned, following this, she may be interested in parenting classes, but it sounds unlikely. Could you then put in your report that this has been part of your plan for supporting this child.

 

However, it may well be that the child is a 'ticket' to some form of financial support (as others suggest) and until she gets that support, she may not 'buy into' anything else.

 

I suppose as long as he is developing well, as far as you can see within the setting, ensuring that he remains in the setting and not allienating (sp?) mum in case she moves him, is very important for the child.

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thank you all for your input. :o

Yes, I have put in a CAF to support this family (although worryingly the mum does not want her ex-partner involved..although he does have contact with the child on a regular basis). would be good to get his feedback on how the child is with him!

I also have involved a family worker from Sure Start so hopefully she will be able to support the parent with positive behaviour strategies.

I will also be sending back the strengths and weaknesses feedback sheet to the paed. Interestingly, the paed has suggested that we could receive additional funding to support the child in the setting. I can't imagine the paed will come to visit the child in the setting!...think he will be much too busy for that!...i am finding at the moment that parents have having to wait about 9 months for a second appt (even though on the last report is says the child will be seen in another 3 months. This seriously holds everything up especially if I am waiting for a report to include with an MDA...so frustrating xD

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Interestingly, the paed has suggested that we could receive additional funding to support the child in the setting.

 

Hi

Have you had a word with your area SENCO? We have a child with severe behavioural issues. We have received fantastic support from our area senco and early years behaviour specialist. We requested funding for one to one support for this child - we wrote an 'application' to our local SEN department - really just a document outlining the difficulties the child has, how we as a setting are supporting thr child, the progress they are/ are not making and how with one toone support we believe the child couldachieve further positive progress. We got funding for ten hours a week on a term by term basis. Just a thought.

Edited by Gezabel
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If you take off the 'by proxy' bit you have what you describe - the 'by proxy' means doing it via someone else, i.e. the child. The syndrome itself can also be in the first person, i.e. someone makes themselves ill or claims injury to gain attention.

 

Just a thought.

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I teach at an SEN school and the situation you describe is very common with our children. We have lots and lots of children who are angelic in school but behave terribly at home. One boy who was in my class a couple of years ago was an absolute sweetheart in school, an absolute little gentleman, charming, polite, respectful, but at home it was a totally different story. Anything that his mum asked him to do he did the opposite and the look of contempt that he gave his lovely mum whenever she spoke to him was heartbreaking. Another example is a boy who was again absolutely lovely in school, one of the most popular amongst staff. He got really upset if he ever thought he'd accidentally done something wrong but at home he'd throw full cups of hot coffee at his mum's head amongst other things. Again this was the loveliest mum you could wish for who did everything she could think of to help the situation. of course we've got plenty of other parents like the one you describe who are really negative about their child's behaviours, which I suppose turns into a vicious circle because the more negative the parent's attitude gets the worse the behaviour gets.

 

I can think of lots of possible explanations, e.g. mum and child didn't bond after birth for some reason, but the most common reason seems to be that school is much more structured and consistent than home. At school they know exactly what to expect and where their boundaries lie. We have improved the situation with lots of parents with referral to a basic parenting class where they learn to be more consistent when dealing with behaviour and often a visual timetable at home can help, especially if you use one in school, so they know what is coming next and have time to prepare mentally for it so getting rid of some of the stress they might feel which could be the cause of bad behaviour.

 

I hope this makes you feel a little better and like everyone else has said, just be completely honest in your report. If the behaviour really is so different at home they can start to unpick what you do at school compared to what happens at home and then give real practical advice.

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Following on from missblinx's comments i too work in a special school and have also seen these behaviours with children. Perfectly behaved in school and unbelievable outside of school. With one little boy I would never have believed mum if i hadn't of witnessed it with my own eyes out of school. However I had picked up from this mum that she was under a lot of pressure from her in-laws to make him 'normal' rather than accept that he had a learning disability and couldn't do and would probably never achieve waht his sister was. I think she transferred this stress on to the little boy and he in turn reacted. It is quite likely that your little boy does misbehave for his mum but there will be a reason for it, behaviour is a form of communication and there is always a reason for it.

 

When it comes to report writing you can only write what you see.

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