Child abuse term is 'too confusing'

Twenty years after first proposing the term Munchausen Syndrome by Proxy (MSBP) as a label for a form of child abuse, Roy Meadow, professor of paediatrics and child health at St James's University Hospital, Leeds, appears set officially to recommend abandoning the term, admitting failure to achieve a medical consensus.

The chair of the Standing Committee on Child Protection of the British Paediatric Association has written to one paediatrician saying: "Professor Meadow agree(s) that the term 'Munchausen Syndrome by Proxy' is probably used inappropriately." The letter goes onto say that the term is "used differently and a consensus would be difficult to achieve", and that Professor Meadow is re-writing his chapter in the new edition of ABC Child Abuse where "use of the term will not be advocated".

The term was first used by Professor Meadow in 1977 to describe forms of child abuse where a carer repeatedly poisoned, suffocated or otherwise harmed children in order to gain attention from doctors.

In 1994, a group of women claiming to have been mistakenly diagnosed as MSBP abusers confronted Professor Meadow at a British Paediatric Association press conference in London, inviting him to investigate their cases. The offer was not taken up.

It was applied to Beverly Allitt in 1991, but in the report of his inquiry into the events Sir Cecil Clothier said: "Frequent reports that [she] suffered from [MSBP] betray ignorance of the meaning of the term as defined by Professor Meadow and demonstrate the confusion which has been introduced." He commented on the "remarkable degree of confusion in the medical literature as to its precise meaning and as to whether it is the victim or the perpetrator that suffers from the syndrome".

For the past five years British medical journals have increasingly reported conflicting medical views. In March 1996, a set of papers in Archives of Disease in Childhood, the paediatricians' house journal, appeared to bring matters to a head, with the Cambridge senior lecturer Colin Morley advocating the "abandonment of the term in favour of giving an exact description of what has happened to the child". A Lancet editorial has also recommended abandoning the term.

The British Medical Journal, who publish the ABC of Child Abuse say a new edition will not appear before next May or June, and one mother demanding an inquiry into false allegations says this is too long to wait.

Professor Meadow was unavailable for comment.