In his short life, 2-year-old Michael Herzog of Hugo, Minn., had been hospitalized more than 20 times for pneumonia, mysterious infections and sudden fevers. His mother, Peggy, 24, took his temperature–rectally–every hour and used a stethoscope to check his breathing. But despite this apparent maternal concern, doctors were already suspicious when Michael was admitted to Children’s Hospital of St.Paul on Feb.9 with infected puncture marks on his thigh. His mother said the marks were from pins in a quilt. Questioned by a family friend, Michael told another story: “Mommy gave me shots.”
When police searched the Herzog home they found syringes and plastic tubes containing sodium chloride solution. Based on that evidence and Michael’s medical records, Peggy Herzog was charged with third-degree assault–a felony. She won’t comment, but her lawyer says she’ll plead not guilty on court next week. Her son, now in a foster home, has been healthy since he left her care. As bizarre as the case seems, it’s not unique. Doctors claim that Peggy Herzog’s alleged actions are an example of Munchausen syndrome by proxy (MSBP), a mental illness in which parents hurt their children in order to gain sympathy or attention. It is a variation on Munchausen syndrome, which causes people to harm themselves for the same reasons. Both were named after Baron Karl F.H. von Munchausen, the 18th-century cavalry officer who returned home from war against the Turks and told embellished tales of his adventures.
The baron’s stories were harmless; MSBP, first described in the medical literature in 1977, can be tragic. Pediatrician Donna Rosenbuerg of Colorado’s C.Henry Kempe National Center for the Prevention and Treatment of Child Abuse and Neglect studied 117 cases for a 1987 medical-journal article. She found that children suffered from bleeding, seizures, diarrhea, vomiting, fever and rashes; 9 percent died. Faced with such a variety of symptoms, physicians often think they’re seeing a rare disease, Rosenburg says, and may not recognize the problem until it’s too late.
Even people used to dealing with child abuse cases say the parents’ behavior in MSBP cases can be shocking. Rosenburg found that some mothers contaminated a child’s urine specimen with their menstrual blood or injected feces into the child’s intravenous line in the hospital. Unlike standard child abusers, who may strike out spontaneously at their children from anger or frustration, these parents plan their attack, says psychiatrist David Gibson Folks of the University of Alabama School of Medicine. The typical MSBP parent is a mother between 25 and 40, often with a health-care background. The victims are mostly infants and toddlers–too young to talk. Researchers suspect that the parents were probably abused in some way themselves as children.
Fortunately, experts estimate that MSBP accounts for fewer than 1,000 of the more than 2.5 million cases of child abuse reported each year. But each case carries a high toll. Dr. Richard Krugman, director of the Kempe Center, says he has seen children with as many as 300 clinic visits and 14 hospitalizations in the first 18 months of life. The only cure, says Krugman, is for people to keep their eyes open–and reach out to a child in trouble.
