What is Medical Child Abuse?
According to Dr. Thomas Roesler, MD, a child and adolescent psychiatry expert who specializes in Medical Child Abuse:
Medical child abuse (MCA) is defined as a child receiving unnecessary and harmful or potentially harmful medical care at the instigation of a caretaker. Previous names for this type of child maltreatment include Munchausen syndrome by proxy, factitious disorder by proxy, pediatric condition falsification, and fabricated or induced illness by a carer.
In this form of child abuse a caretaker, most commonly a mother, engages in a pattern of behavior that results in medical care providers giving care that the child does not need and which is or could be harmful. 
Medical Child Abuse often encompasses both physical abuse (from unnecessary treatments and procedures) and psychological abuse (from the children’s beliefs in the fictional diagnoses).
Educational Neglect may occur when a child misses school due to the false diagnoses and treatments. Additionally, children who are victims of Medical Child Abuse may not receive proper treatment for legitimate problems.
How does Medical Child Abuse relate to Chronic Lyme?
According to the American Academy of Pediatrics, “‘Chronic Lyme disease’ is not a medical diagnosis.”
The AAP notes that Lyme disease prognosis is excellent, but false positive diagnoses are frequent:
There are many websites that contain misinformation about Lyme disease that only enhance the already inflated and inaccurate fears about the consequences of Lyme disease of many parents and patients.
Many patients labeled as having chronic Lyme disease actually have medically unexplained symptoms. Such patients are best treated symptomatically rather than with prolonged courses of antimicrobial therapy, which have been associated with serious adverse effects and little or no benefit.
It is important to acknowledge that the patient has symptoms even if they are not due to Lyme disease.
A 2019 study from Italy of seven children with chronic Lyme diagnoses found none had Lyme infection. Instead, five had somatic symptom disorder, one had an anxiety disorder with somatic symptoms, and one had a viral infection.
Health Protection Agency of the UK warned, in discussing potential harms of guidelines issued by the pseudoscience group ILADS:
- Children misdiagnosed with “chronic Lyme disease” are a particularly vulnerable group, and one of the references cited by the ILADS guidelines authors  illustrated the dangers of misdiagnosis and gross and painful mistreatment.
- Experience from other clinicians has indicated that some children diagnosed as having “chronic Lyme disease” according to the ILADS criteria received oral and parenteral antibiotics for years, and had unnecessary interruption of schooling and social development, to the extent that there has been a loss of childhood.
- Serious physical harm to children from adverse events related to overuse of broad spectrum antibiotics for unsubstantiated Lyme disease has also been well-documented. 
Dr. Roesler, together with pediatrician Dr. Carole Jenny, MD, MBA wrote about two disturbing instances of apparent Medical Child Abuse involving chronic Lyme in their book Medical Child Abuse: Beyond Munchausen Syndrome by Proxy . Please read the excerpt.
Hallmarks of Medical Child Abuse
The following excerpts contain useful information from a Medscape slideshow on Medical Child Abuse prepared by Dr. Paige Culotta, MD and Dr. Marcella Donaruma-Kwoh, MD, FAAP:
No specific individual symptoms are associated with MCA; a broad range of presentations may be seen. However, certain patterns of caregiver behavior and disease development are common.
Frequently, the histories are inconsistent, remarkably complicated, and quite difficult to follow, with care scattered across multiple institutions. Additionally, some caregivers may fabricate, exaggerate, or falsify symptoms, whereas others may go on to induce symptoms in the victim.
This caregiver behavior, by both adversely affecting the child and misleading the physician team, may impede the development of a clear management plan and ultimately give rise to chronic treatment complications for the child.
Abusive caregivers manipulate all systems of which they become a part, including not only health care systems (usually several) but also school, community, and support group networks.
In MCA cases, it is common for caregivers to engage the social media community in discussing the medical condition of the victim as a form of attention seeking, and the discussion is often accompanied by purposeful distortion of the medical information. Over time, caregivers often relay an escalation in illness severity to their online community, regardless of whether any such escalation is actually taking place.
Caregivers may also contact online donation sources or “wish” organizations, unbeknownst to their medical teams. This use of internet attention lures the community into participation, propagation, and support of the child’s “illness.”
Abusive caregivers frequently have professional training in the medical field, which lends them some credibility as historians even when the histories are far-fetched. Offending caregivers also seek out attention and empathy from hospital staff and other patient families, behavior that can easily mimic the actions of devoted parents embracing a community and advocating for a truly ill child.
The secondary gain of praise and admiration is thought to be a motivator for ongoing abuse. A key behavior that distinguishes these abusers from truly concerned parents is that they lavish attention on the child when others are present and essentially ignore the child in private.
Often, diseases that are difficult to diagnose or disprove definitively are latched onto with great enthusiasm. Upon closer observation, healthcare providers find that the reported symptoms are not witnessed during the hospitalization. They also find that the history does not follow an expected clinical pattern and that the presumed illness does not respond to conventionally effective treatments.
When presented with medical test results that are within normal ranges and invasive procedures that yield unremarkable findings, abusive caregivers typically persist with the original history and may even embellish it further. They insist that the testing is inaccurate or that a procedure needs to be repeated, and they perpetuate the abusive pattern of “doctor shopping” for additional medical opinions to obtain increased medical intervention.
Caregivers who perpetrate MCA commonly misrepresent medical information; thus, it is vital to compare the information provided by treating physicians in the medical records (eg, test results, medication prescriptions, and medical impressions) with the history presented by the caregiver.
Because medical providers in pediatrics are trained to trust that caregivers know their child better than anyone, they rarely question the histories that caregivers provide. To add to the clinical difficulty of assessing patients who have been subjected to MCA, 30% of MCA victims have a true underlying medical illness in addition to their numerous false diagnoses, a circumstance that further muddies the clinical presentation in this subpopulation.
Siblings are commonly victims of MCA as well. Children who have sustained MCA may develop chronic invalidism because they accept the “illness” and believe themselves to be disabled and unable to attend school, work, or even walk. Older children may participate in the deception because doing so is a behavior that was learned from and expected by their caregiver, whom they love. 
Medical Child Abuse: Rampant in “Chronic Lyme” advocacy groups
Signs of Medical Child Abuse can be seen in many chronic Lyme stories where one or more children in a family are diagnosed and treated inappropriately.
LymeScience has compiled a list of Red Flags of Chronic Lyme Quackery that may be helpful in determining if a child is a victim of Medical Child Abuse.
In addition to a false Lyme diagnosis, children may receive false diagnoses of “coinfections“, including:
- toxic mold illness (aka CIRS or biotoxin illness)
- chronic tick-borne Bartonella (including false claims that harmless stretch marks mean Bartonella)
- candida overgrowth
- electromagnetic hypersensitivity
- unsubstantiated parasites
- chronic atypical babesia.
Chronic Lyme groups frequently scare mothers into believing they passed a chronic Lyme infection to their children. The children are then diagnosed with “congenital chronic Lyme”, which does not exist.
Chronic Lyme groups also scare families into thinking that harmless stretch marks—which often appear during teenage growth spurts—are evidence of a Bartonella infection. But Bartonella:
- has nothing to do with stretch marks,
- is not transmitted by ticks,
- is not a coinfection of Lyme disease, and
- in cat-scratch disease caused by Bartonella henselae, typically goes away on its own with no treatment.
In response to the proposal of the now-passed Massachusetts law that requires insurance companies to pay for unnecessary antibiotics for presumed Lyme disease, pediatric infectious disease specialist and Assistant Professor of Pediatrics Dr. Christina Hermos, MD wrote:
Those of us in pediatrics have the extra burden of witnessing children subjected to unnecessary long-term antibiotics. These children often have other medical or psychological conditions that are left untreated due to an unnecessary focus on Lyme disease.
When they do not recover on antibiotics for Lyme, typically an alternative antibiotic is prescribed rather than an alternative diagnosis explored. When I care for these children as part of my practice, I see parents have significant difficulty accepting that their children’s symptoms are not from Lyme, because they have so much hope that treating this infection will cure their persistent symptoms.
I find this situation especially difficult because there are many resources and other treatment options that I can recommend for these children that would likely help them. 
- ILADS doctor says a boy is harmed by Wi-Fi, so the parents sued the school.
- Lyme quack abused her daughters and endangered patients
- Steven Harris- Disciplined for intravenous garlic
- Julia Bruzzese and the need for media responsibility
- I was misdiagnosed with “chronic Lyme” by a quack doctor… but I am chronically ill
6. The Scientific Parent: When Seeking Treatment For A Child Crosses the Line: How to Recognize Medical Child Abuse (Part One)
7. The Scientific Parent: When Seeking Treatment For A Child Crosses the Line: Medical Child Abuse Vs. Rare Diseases (Part Two)
8. Teenage Boy With Multiple Pain Disorders: A case of mild factitious disorder by proxy
9. Child Welfare Information Gateway: Perpetrators of Munchausen by Proxy
11. Isaacs D. Lyme disease or a lemon? J Paediatr Child Health. 2016;52(12):1051-1052.
12. Peri F, et al. Somatic symptom disorder should be suspected in children with alleged chronic Lyme disease. Eur J Pediatr. 2019.
13. Drs. Paige Culotta and Marcella Donaruma-Kwoh: Slideshow: Medical Child Abuse to Child Neglect: A Spectrum of Maltreatment
14. Dr. Carole Jenny: Pediatric Grand Rounds on Medical Child Abuse and Medical Neglect
17. Dr. Jamye Coffman and Michael Weber: What’s in a name? Munchausen Syndrome by proxy vs Medical Child Abuse
19. Dr. Rachel Berger: Medical Child Abuse in the Age of Facebook, Go Fund Me, and Press-Ganey
20. FBI Law Enforcement Bulletin: Investigating Medical Child Abuse
21. Center for Innovation and Resources: Munchausen by Proxy: Guidelines for Identification and Intervention
- E. J. v. Texas Department of Family and Protective Services, 03-18-00473-CV (Tex. App. 2018)
- In the matter of L.K.
- In the matter of M.
- W.W.H. v. M. K.
- Denunzio v Denunzio
- Courthouse News Service: ‘Bugs in the Biofilm’
- The Oregonian: ‘Extreme Makeover’ family in Oregon finds mother under ‘medical child abuse’ scrutiny
- Ferrara J, Jankovic J. Psychogenic movement disorders in children. Mov Disord. 2008;23(13):1875-81.