{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T11:56:45Z","timestamp":1777463805914,"version":"3.51.4"},"reference-count":27,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T00:00:00Z","timestamp":1645660800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100006260","name":"Rheumatology Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006260","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Snider family"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["British Journal of Pain"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:p>Medical child abuse (MCA), previously referred to as Munchausen by proxy, can present as chronic pain. We report the presentation of five children seeking treatment for chronic pain who we identified as victims of MCA. The index case had essentially not eaten for the 6\u00a0years of her life due to alleged allergies to all foods, developed severe pain, used a wheelchair for ambulation beyond a few blocks, and was alleged to have dysautonomia requiring oxygen monitoring at night. Other cases posed as arthritis that resulted in foot amputation and total body pain, fibromyalgia with alleged mutation negative Stickler syndrome who had symptoms only in her mother\u2019s presence, severe incapacitating intermittent pains along with abdominal pain that resulted in appendectomy, cholecystectomy, and pancreatectomy, and alleged disabling hypermobile Ehlers-Danlos in a non-hypermobile child for which the mother sought a power wheelchair. The unusual pattern to the pain, the presence of multiple additional, atypical symptoms and diagnoses, and a generally well appearing child are characteristic. The perpetrator is typically over-invested in the symptoms, derives tangible and intangible secondary gain from the child\u2019s alleged illnesses, and is able to present the child in such a fashion to enlist the physician to aid in perpetuating the abuse. These children are highly over-medicalized and suffer significant morbidity. Multiple barriers exist to identifying and reporting these children to Child Protective Services, which need to be recognized and overcome in order to protect these vulnerable children.<\/jats:p>","DOI":"10.1177\/20494637221075186","type":"journal-article","created":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T04:25:45Z","timestamp":1643257545000},"page":"433-438","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Recognizing medical child abuse in children presenting with chronic pain"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8223-1715","authenticated-orcid":false,"given":"David D","family":"Sherry","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Rheumatology, Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"},{"name":"University of Pennsylvania Perelman School of Medicine and Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabrina","family":"Gmuca","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Rheumatology, Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"},{"name":"University of Pennsylvania Perelman School of Medicine and Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"},{"name":"Center for Pediatric Clinical Effectiveness, Children\u2019s Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, USA"},{"name":"Policy Lab, Children\u2019s Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7999-1366","authenticated-orcid":false,"given":"Cindy W","family":"Christian","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine and Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"},{"name":"Division of General Pediatrics, The Children\u2019s Hospital of Philadelphia, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,2,24]]},"reference":[{"key":"bibr1-20494637221075186","volume-title":"Beyond Munchausen Syndrome by Proxy","author":"Roesler 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