تمارض های پروکسی: نیاز به حفاظت از کودکان و راهنمایی برای گزارش

The feigning of disabling illness for compensation at the direction or pressure by others, which is called malingering by proxy (MBP), has been the subject of several spirited articles. Chafetz and Prentkowski (2011) suggested that MBP has the potential for real harm to the child. In a poster at the AACN scientific session in 2011, Chafetz and Binder (2011) pursued a case of MBP that showed the child had clearly suffered and failed to progress in the 6 years that had passed since she was first evaluated as an 11 year old. In the present article, we identify three cases that compare and contrast effects of MBP, illustrating that child abuse and/or neglect can be a serious and reportable consequence of MBP behavior. To illustrate how MBP behavior can cause child abuse, we compare MBP behavior with Munchausen Syndrome by Proxy (MSBP), another condition of volitional noncredible behavior produced in a vulnerable person at the direction or pressure by others. Guidance criteria for reporting MBP as child abuse/neglect are introduced in this article.

Laws regarding child protection attempt to balance the constitutional and civil rights parents enjoy concerning their children with children's fundamental interest in being protected from abuse and neglect. The parens patriae (i.e., “parent of the country”) doctrine gives all states the right to intervene when a child has been harmed or is at-risk of being harmed (American Psychological Association Practice Organization, 2013). When a report is made to the state Child Protection Agency, interventions usually occur in conditional stages: (1) investigation; if the findings indicate sufficient risk for harm, then (2) the State can assume custody and care through the foster system, and help rehabilitate the parents; if this step fails, then (3) the state moves toward final disposition, which may include adoption and termination of parental rights (American Psychological Association, 2013). The primary purpose during the investigation phase is to determine if a child's health or welfare has been harmed.