Medical Child Abuse: A Case Presenting as Anogenital Bleeding of Unknown Origin in an Older Child

J Pediatr Adolesc Gynecol. 2018 Dec;31(6):637-639. doi: 10.1016/j.jpag.2018.06.011. Epub 2018 Jul 7.

Abstract

Background: Medical child abuse is a challenging diagnosis to make, particularly in older children with unusual presenting symptoms.

Case: A 7-year-old child with complex medical history presented with anogenital bleeding of unknown origin. Extensive laboratory testing, imaging studies, and diagnostic procedures were negative for any etiology. Forensic testing confirmed the blood in her underwear was a genetic match to the patient. Trial separation from the mother was diagnostic and therapeutic in this case.

Summary and conclusion: Older children who are victims of medical child abuse might present in a variety of ways, and might even collaborate with the perpetrator in falsifying symptoms. It is important to keep medical child abuse on the differential when the patient's symptoms and work-up do not match.

Keywords: Genital bleeding; Medical child abuse; Munchausen by proxy; Pediatric; Vaginal bleeding.

Publication types

  • Case Reports

MeSH terms

  • Anus Diseases / etiology*
  • Child
  • Child Abuse*
  • Female
  • Gastrointestinal Hemorrhage / etiology*
  • Humans
  • Mothers
  • Munchausen Syndrome by Proxy / complications*
  • Uterine Hemorrhage / etiology*