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Volume 12
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10.3390/children12111575
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Medical Child Abuse: A Retrospective Analysis from a Tertiary Pediatric Hospital’s Childhood and Adolescent Abuse Group

by
Martina Focardi
1,
Marta Guerini
1,
Beatrice Defraia
1,*,
Laura Nanni
2,
Rossella Grifoni
1,
Giovanni Castellini
3,
Barbara Gualco
1,
Ilenia Bianchi
1,
Vilma Pinchi
1 and
Stefania Losi
2
1
Section of Forensic Medical Sciences, Department of Health Sciences, University of Florence, 50134 Florence, Italy
2
GAIA Service (Childhood and Adolescent Abuse Group), AOU Meyer IRCCS, 50139 Florence, Italy
3
Section of Psychiatry, Department of Health Sciences, University of Florence, 50100 Florence, Italy
*
Author to whom correspondence should be addressed.
Children 2025, 12(11), 1575; https://doi.org/10.3390/children12111575
Submission received: 14 October 2025 / Revised: 13 November 2025 / Accepted: 19 November 2025 / Published: 20 November 2025
(This article belongs to the Section Global Pediatric Health)
Versions Notes

Abstract

Background: Medical child abuse (MCA), previously known as Münchausen syndrome by proxy, involves the fabrication or induction of illness by caregivers—most commonly the mother—leading to unnecessary medical interventions and potential harm to the child. Methods: This retrospective study analyzed cases of suspected or confirmed MCA managed by the GAIA multidisciplinary team at Meyer Children’s Hospital, Florence, between 2010 and 2022. Cases were identified using Rosenberg diagnostic criteria and red flags outlined by the American Academy of Pediatrics (AAP) and the Royal College of Paediatrics and Child Health (RCPCH). Data were extracted from medical records and analyzed descriptively. Results: Among 816 cases of child maltreatment, 8 (0.99%) were identified as MCA. The median age of affected children was 5 years (range: 4–12 years), with a female predominance (6/8, 75%). All perpetrators were biological mothers (8/8, 100%). Children had a median of 23 emergency department visits (range: 4–44), with the most frequent presentations being fever (6/8, 75%), minor trauma (7/8, 87.5%), respiratory complaints (5/8, 62.5%), and gastrointestinal symptoms (4/8, 50%). According to Rosenberg criteria, 5 cases (62.5%) were classified as “possible diagnosis,” 1 (12.5%) as “definitive diagnosis,” 1 (12.5%) as “diagnosis by exclusion,” and 1 (12.5%) as “inconclusive.” Conclusions: Despite its low prevalence, MCA poses serious clinical and ethical challenges. Early detection requires thorough documentation, interdisciplinary collaboration, and improved access to shared medical records. The GAIA model offers a replicable framework for effective multidisciplinary management.
Keywords: medical child abuse; Münchausen syndrome by proxy; fabricated or induced illness; child maltreatment; forensic pediatrics; perplexing presentations; factitious disorder imposed on another medical child abuse; Münchausen syndrome by proxy; fabricated or induced illness; child maltreatment; forensic pediatrics; perplexing presentations; factitious disorder imposed on another

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MDPI and ACS Style

Focardi, M.; Guerini, M.; Defraia, B.; Nanni, L.; Grifoni, R.; Castellini, G.; Gualco, B.; Bianchi, I.; Pinchi, V.; Losi, S. Medical Child Abuse: A Retrospective Analysis from a Tertiary Pediatric Hospital’s Childhood and Adolescent Abuse Group. Children 2025, 12, 1575. https://doi.org/10.3390/children12111575

AMA Style

Focardi M, Guerini M, Defraia B, Nanni L, Grifoni R, Castellini G, Gualco B, Bianchi I, Pinchi V, Losi S. Medical Child Abuse: A Retrospective Analysis from a Tertiary Pediatric Hospital’s Childhood and Adolescent Abuse Group. Children. 2025; 12(11):1575. https://doi.org/10.3390/children12111575

Chicago/Turabian Style

Focardi, Martina, Marta Guerini, Beatrice Defraia, Laura Nanni, Rossella Grifoni, Giovanni Castellini, Barbara Gualco, Ilenia Bianchi, Vilma Pinchi, and Stefania Losi. 2025. "Medical Child Abuse: A Retrospective Analysis from a Tertiary Pediatric Hospital’s Childhood and Adolescent Abuse Group" Children 12, no. 11: 1575. https://doi.org/10.3390/children12111575

APA Style

Focardi, M., Guerini, M., Defraia, B., Nanni, L., Grifoni, R., Castellini, G., Gualco, B., Bianchi, I., Pinchi, V., & Losi, S. (2025). Medical Child Abuse: A Retrospective Analysis from a Tertiary Pediatric Hospital’s Childhood and Adolescent Abuse Group. Children, 12(11), 1575. https://doi.org/10.3390/children12111575

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