NCJ Number
227389
Journal
Child Abuse & Neglect Volume: 33 Issue: 5 Dated: May 2009 Pages: 293-295
Date Published
May 2009
Length
3 pages
Annotation
This article reports a case involving a 9-month-old infant suffering from caustic esophagitis following administration by the child's mother of an antilimescale agent in her food.
Abstract
The infant was brought by her parents to the pediatric emergency department of a local hospital following the sudden onset of inflammatory oral and pharyngeal lesions associated with vomiting 20 minutes after a meal. According to the child's parents, her last meal consisted of a jar of baby food. During hospitalization, biological results and skeletal radiography were normal. An esophagoscopy performed 9 days after admission revealed signs of superficial cicatrical mucosal injury associated with telangiectasia; the endoscopist's suggested diagnosis was caustic esophagitis. Treatment included complete fasting, parenteral hydration, broad spectrum antibiotics to reduce secondary infection, analgesics, inhaled steroids aimed at decreasing stricture formation, and topical treatment by antifungal agents. Outcome was favorable and the infant gradually recovered toward a normal diet. A second identical episode occurred 10 days following endoscopy, despite the child's still being in the hospital under her mother's close surveillance. Pediatricians consequently suspected Munchausen syndrome by proxy, a from of child abuse potentially involving a variety of symptoms that can be either induced, alleged, or simulated. The child was transferred to the Regional University Hospital. During hospitalization, a toy containing a suspicious powder was found close to the child's bed following a visit from her mother. Endoscopy revealed characteristic signs of severe Stage III ulceronecrotic caustic esophagitis progressing toward stenosis, which required the use of feeding gastrostomy. A police investigation was requested, along with a medicolegal investigation of the child's case and a psychiatric assessment of her mother. The examiner concluded that the child was suffering from caustic esophagitis, which was highly suspicious of third-party involvement. 9 references