Caregiver-fabricated illness in a child prescribed long-term opioids and benzodiazepines

Deepa Kattail, MD, MHS, FAAP; Anne Niec, MD, FRCPC

doi:10.5055/jom.2020.0562

Authors

Deepa Kattail, MD, MHS, FAAP
Anne Niec, MD, FRCPC

DOI:

https://doi.org/10.5055/jom.2020.0562

Keywords:

analgesics, opioid, caregiver-fabricated illness in a child, Munchausen syndrome by proxy

Abstract

Caregiver-fabricated illness in a child (CFIC) can result in unnecessary, potentially harmful medical investigations and treatment. As pediatric pain has historically been undertreated, the movement for more compassionate treatment has led to an increase in analgesic prescribing in children and adolescents. Overall, this has been a positive change but this may also lead to unintentional harm, particularly if CFIC is not considered as a possibility in the presentation. We present a case in which CFIC was associated with long-term prescribing of opioids, benzodiazepines, and other central nervous system depressants.

Author Biographies

Deepa Kattail, MD, MHS, FAAP

Assistant Professor, Department of Anesthesiology, McMaster University, Hamilton, Ontario, Canada; McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada

Anne Niec, MD, FRCPC

Professor, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada

References

Flaherty EG, MacMillan HL, Committee on Child Abuse and Neglect: Caregiver-fabricated illness in a child: A manifestation of child maltreatment. Pediatrics. 2013; 132(3): 590-597. doi:10.1542/peds.2013-2045.

Petska HW, Gordon JB, Jablonski D, et al.: The intersection of medical child abuse and medical complexity. Pediatr Clin North Am. 2017; 64(1): 253-264. doi:10.1016/j.pcl.2016.08.016.

Bass C, Glaser D.: Early recognition and management of fabricated or induced illness in children. Lancet. 2014; 383(9926): 1412-1421.

Birnie KA, Chambers CT, Fernandez CV, et al.: Hospitalized children continue to report undertreated and preventable pain. Pain Res Manag. 2014; 19(4): 198-204. doi:10.1155/2014/614784.

King S, Chambers CT, Huguet A, et al.: The epidemiology of chronic pain in children and adolescents revisited: A systematic review. Pain. 2011; 152(12): 2729-2738. doi:10.1016/j.pain.2011.07.016.

Friedrichsdorf SJ, Sidman J, Krane EJ: Prevention and treatment of pain in children: toward a paradigm shift. Otolaryngol Head Neck Surg. 2016; 154(5): 804-805. doi:10.1177/0194599816636100.

Schechter NL: The undertreatment of pain in children: An overview. Pediatr Clin North Am. 1989; 36(4): 781-94.

Weisman SJ, Bernstein B, Schechter NL: Consequences of inadequate analgesia during painful procedures in children. Arch Pediatr Adolesc Med. 1998; 152(2): 147-149.