Information and Instructions

• About medical child abuse
• Harm resulting from medical child abuse
• Indicators relating to medical child abuse
• Practice considerations
• High-risk infants
• Legislative mandate

About medical child abuse

​Medical Child Abuse (previously identified as Munchausen Syndrome by Proxy / Fabricated or Induced Illness by carers) is where caregivers exaggerate, invent, or induce symptoms in their children and seek unnecessary medical care for them. Alternative terms also include paediatric condition falsification, factitious disorder by proxy, caregiver-fabricated illness, and more.


In many of the cases symptoms are induced by the perpetrator e.g., with the administration of toxic substances or medication such as laxatives or salt leading to chronic diarrhoea, or insulin injections leading to hypoglycaemia.  


Please note that medical abuse is not specifically referred to as a discrete type of abuse in the Children and Community Services Act 2004. Rather it can be seen as a form of physical abuse.


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Harm resulting from medical child abuse

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Physical harm	Emotional harm	Psychological harm
Illness sustained from medication including lethargy, tachycardia (consistent high heart rate), and Central Nervous System depression (dizziness, disorientation, blurred vision, shortness of breath, constipation, cold skin, slow reflexes, blue lips/fingertips). Induced bleeding, diarrhoea, and/or vomiting. Prolonged fever Induced neurological damage including muscle weakness, paralysis, loss of sensation and/or seizures Rashes Prolonged illness and/or injury including organ failure or death.	Poor self-esteem. Chronic sadness and impaired ability to experience joy or happiness. Early experimentation and/or harmful use of alcohol and other drugs. Increased aggression and/or antisocial /criminal activities. Fear and hypervigilance, even where a child would usually feel safe. Difficulties with emotional regulation. Impaired ability to develop and maintain safe and healthy. relationships with peers and adults Self-harm and suicidal ideation or related behaviours. Disconnection with culture and significant others. Increased vulnerability to re-victimisation.	Diagnosed mental illness or displaying behaviours associated with poor mental health. Learning and/or developmental delay and/or regression. Difficulties with concentration, memory and the ability to integrate new knowledge and/or skills. Perception issues, such as hearing voices. Reduced capacity to engage in imagination-based play and activities. Trauma related distress including hypervigilance, stress intolerance, dissociation, intrusive thoughts and flashbacks. Distorted view of own health.




In addition to the above, there is also a potential for victims and survivors to experience re-traumatisation associated with major life stages, milestones, and events. The detrimental impacts of child abuse, particularly when it is not addressed, may emerge, or develop later in adulthood, often compounding the effects of other adverse life experiences and may result in poor life outcomes.


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Indicators relating to medical child abuse

​Indicators associated with medical child abuse may include where a child has repeated and unexplained illnesses, signs and symptoms which may only occur in the presence of a parent. Signs and symptoms may be unable to be explained by any other medical condition, with physical examinations and investigation results unable to explain illness reported by caregiver/s. A child's life may be adversely impacted due to the caregiver imposing restrictions upon normal daily activity in accordance with a perceived disorder e.g., non-school attendance or unnecessary special aids. Where medication or therapy has been prescribed, a caregiver may report that a child has a poor response, and signs and symptoms persist. 


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Practice considerations

​Communities has a statutory role under the Children and Community Services Act 2004 (the Act) to do the following:

• Investigate and determine - whether a child has experienced physical, emotional, or psychological harm that has a detrimental effect and is significant nature as identified in section 28 of the Act as a result of physical abuse in the form of medical child abuse. Where a referral for medical child abuse has been received from a paediatric specialist, Communities must progress to a CSI, unless a decision has been endorsed by the Team Leader and recorded on file.

• Assess and respond - to medical child abuse, including safety planning, which is best achieved through a multi-agency approach that promotes the coordination of investigative, medical and support responses.

The Policy on Physical Abuse and Casework Practice Guidance entry 2.2 – Physical Abuse and entry 2.2 – Conducting a Child Safety Investigation explain the processes in assessing and responding to child physical abuse. 


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High-risk infants

​'High-risk infant' refers to an unborn infant or a child under three years of age and at increased likelihood of significant harm or death due to the presence of risk factors (parental, environmental and/or infant). 

This includes infants that are totally dependent on adult care and either do not communicate through language or are very limited in their ability to do so. In addition, their restricted mobility does not provide any measure of self-protection. They are also at risk of being socially 'invisible' and may have limited contact with support services.


Communities must assess concerns that involve an unborn infant or child under three, due to their vulnerability and increased risk.


Please refer to entry 2.2 – High-Risk Infants for more information.


When assessing infant injuries, it is critical that workers consider:

• the severity of the injury

• the mobility of the infant as infants who are immobile are unlikely to injure themselves

• the location of any bruising or bleeding as even crawling or toddling infants are unlikely to sustain injuries or bruising to protected parts of their body (e.g., inner bicep, inner thigh etc.) or non-bony/fleshy parts of the body

• whether there are multiple injuries at different stages of healing

• any bruising, cuts or welts which are patterned and/or uniform

• timeframe for parents to seek treatment

• whether there are any health conditions which could explain the infant's presentation (e.g., easy bruising-related conditions).
  

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Legislative mandate

​The relevant Objects as set out under Section 6 of the Act are:

• to promote the wellbeing of children, other individuals, families and communities; and

• to acknowledge the primary role of parents, families and communities in safeguarding and promoting the wellbeing of children; and

• to encourage and support parents, families and communities in carrying out that role; and  

• to provide for the protection and care of children in circumstances where their parents have not given, or are unlikely or unable to give, that protection and care. 
  

Specific provisions relevant to child physical abuse appear in the following sections of the Act:

• Part 3 Division 3 – Cooperation and assistance

• Part 3, Division 6 – Information Sharing

• Section 23- CEO may disclose or request relevant information

• Section 28 – When child in need of protection

• Section 31 – CEO may cause inquires to be made about child

• Section 32 – CEO's duties if action needed to safeguard child's wellbeing

• Section 33 – Access to child for the purposes of investigation

• Section 35 – Warrant (provisional protection and care), application for and issue of 

• Section 37 – Taking child into provisional protection and care without a warrant in certain circumstances

• Section 101 – Failing to protect child from harm.
  

There are also offences under the Criminal Code Compilation Act 1913 (WA) relating to the physical assault of a child.


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