The Deconstruction of a Complex Case of Medical Child Abuse

Medical child abuse (MCA) is a serious and potentially fatal form of child abuse. The condition of medical child abuse has historically been regarded as a “rare” entity. However, the lack of a standardized definition of medical child abuse may have limited our understanding of the true scope of the problem. Cases may straddle the elements of physical abuse, medical neglect, and psychological abuse. Many cases may have been overlooked as medical child abuse or categorized under another form of child maltreatment, when identified as abuse or neglect. There is no one typical presentation. Medical investigations into suspected cases must be carefully and conservatively conducted.

An illustrative case is described involving three young chronically-ill siblings with various degrees of medical dependencies, medical and surgical interventions, and multiple subspecialists and is deconstructed with the final outcome of three physically healthy children and a criminal conviction of the perpetrating caregiver.

Cases of child medical abuse can be complex and challenging. Potential complications and sequelae of unidentified cases are vast, including: pain and suffering from multiple, unnecessary procedures, diminished quality of life and life potential, and ultimately risk of death. Challenges to medical and social investigations can hinder early identification and protection of the children at risk.