An 8-month-old boy is admitted repeatedly with episodes of apnea and cyanosis that occur only at home and never while he is under observation in hospital. Extensive metabolic, cardiac and infective workup is normal. An older sibling died suddenly in similar circumstances. The mother appears deeply devoted and anxious. The MOST likely diagnosis is:

• A Congenital long QT syndrome
• B Munchausen syndrome by proxy (fabricated or induced illness) ✓
• C Obstructive sleep apnea due to adenotonsillar hypertrophy
• D Infant botulism

Explanation

Munchausen syndrome by proxy is a form of childhood abuse in which a caregiver, usually the mother, fabricates or induces illness in the child to gain attention. Typical clues are symptoms occurring only in the caregiver's presence, normal investigations, a previous unexplained sibling death, and an apparently caring parent. Long QT syndrome would produce events regardless of location and a family history of sudden death, adenotonsillar apnea causes snoring and daytime sleepiness, and botulism produces progressive weakness and constipation rather than episodic witnessed-only apnea.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.