COVID-related stress as a driver of unusual medical presentations

Amid the COVID-19 (SARS-COV2) global pandemic, children and families faced a number of stresses. This practice insight case study describes a presentation of a child with a rash at the height of the pandemic shutdowns with the realization that the stress of closing school led to her presentation for medical care for a factitious disorder. This case shows that, while staff may initially suspect parents, children can also report factitious illness without the knowledge of their parents, and these reports were affected by the COVID-19 pandemic. While it is unclear whether actual child abuse and neglect increased during the pandemic, there is no question that the stresses placed on families resulted in a number of harms. This highlights the need for dedicated child protection teams and preexisting procedures to objectively and sensitively look beyond physical injury to best support children and families, especially during times of monumental community stress.