A patient with Factitious Disorder Imposed on Another (FDIA, formerly Munchausen syndrome by proxy) is identified in a paediatric ward. The most critical immediate action is:

• A Confront the caregiver directly with evidence to obtain a confession
• B Notify child protective services / conduct a mandatory child safeguarding referral to protect the child from ongoing harm ✓
• C Transfer the child to psychiatric ward for assessment of the caregiver
• D Perform a covert urine drug screen on the caregiver to confirm poisoning

Explanation

Factitious Disorder Imposed on Another (FDIA) is fundamentally a child safeguarding emergency — the child victim is experiencing physical harm from medically induced illness, unnecessary procedures, or toxic substances administered by the caregiver. The most critical immediate step is a mandatory referral to child protective services (or the equivalent child safeguarding authority) to ensure the child's safety, which must take priority over medical or psychiatric management of the caregiver. Direct confrontation of the caregiver (option A) may cause the child to be removed from the hospital or harmed. Psychiatric assessment of the caregiver is important but secondary to the child's protection.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.