What exactly is Día de los Muertos (aka Day of the Dead)? Here's a hint: It isn't Mexico's version of Halloween. This is a common misconception because the holiday is celebrated immediately after Halloween (Oct. 31). It’s a two-day celebration that takes place every year, starting on Nov. 1 and ending on Nov. 2—commonly known on the Catholic calendar as All Saints’ Day and All Souls Day. The days are focused on remembrance and celebration in honor of those relatives who have passed away. The idea and concepts behind the traditional celebration began more than 3,000 years ago with the rituals of the Aztec, Toltec, and Nahua people. The pre-columbian mesoamerican cultures believed that mourning the dead was disrespectful and that death was the natural next step in the cycle of life. While its origins date back thousands of years, modern celebrations encompass the changes that occurred as Christian traditions began to evolve and as the Roman Catholic Church expanded in Mexico.

Día de los Muertos is marked by several key features including the following:

• Altar de Muerto: Altar that includes a display of photos and special momentos honoring the dead.
• Ofrenda: This is an offering which typically includes the items placed on the table for sharing with loved ones that have passed (this can include momentos, food items or drinks that were typically favorites of those being honored).
• Pan de muerto: Sweet and anise-scented bread commonly baked in the weeks leading up to Day of the Dead and eaten during its celebrations.
• Calaveras: Thought to symbolize departed souls, these are sugar skulls.
• Papel Picado: Traditional Mexican craft in which intricate designs and patterns are cut from colorful tissue paper and can be found decorating altars during these festivities.
• Cempasuchil: Mexican marigold flowers that have a distinct scent that is thought to help attract spirits as they make their way back home to loved ones.

Modern day Americans have become more familiar with this traditional Mexican holiday given the release of recent animated films including ‘The Book of Life’ in 2014 and ‘Coco’ in 2017. These movies have allowed for a beautiful and joyous family tradition to be shared with many throughout the world. The Day of the Dead is a beautiful and vibrant celebration intended to honor our deceased loved ones. It's celebrated with colorful, thoughtful traditions meant to keep treasured memories alive. This premise is especially important because we know many in our community have experienced loss recently. Making personal adaptations to such traditions can help in the process of grief and may lead to personal traditions to carry on memories of those whom we loved.

In The Media

At 2 p.m. CST on Tuesday, Jan. 8, 2019, Jamye Coffman, M.D., will be a featured expert on Munchausen Syndrome by Proxy on 'The Dr. Oz Show.' The episode will explore the case of Gypsy Rose Blanchard, whose mother (Dee Dee Blanchard) claimed she was terminally ill and wheelchair-bound since childhood. Blanchard pleaded guilty to second-degree murder in the death of Dee Dee and is serving a 10-year prison sentence.

Anyone who has ever heard of Munchausen syndrome by proxy has probably asked themselves the same questions:

Why in the world would a mother want to hurt her own child?

And how does a child end up receiving unnecessary medical procedures? Don’t doctors know when a patient is really sick?

The answers are complicated. But each year, experts in Tarrant County get a little better at understanding how to spot these abusers and bring them to justice.

What is medical child abuse?

You may have heard about the HBO documentary ‘Mommy Dead and Dearest’ about the 2015 murder of Dee Dee Blancharge. Her daughter, Gypsy Rose, pleaded guilty to second-degree murder and is serving a 10-year sentence for her death. The trial uncovered a number of unknowns about the relationship between Dee Dee and Gypsy.

To everyone who knew Gypsy, she was believed to have been wheelchair bound and have a myriad of medical problems. It turns out those issues were largely fictitious and now, at 25 years old, Gypsy is arguably one of the most notorious victims of medical child abuse.

Medical child abuse is the diagnosis given to a child whose parent or guardian is suspected of lying about their medical history, leading to unnecessary treatments and procedures. This condition was formerly known as Munchausen syndrome by proxy. The abuser has what’s known as factitious disorder imposed on another.

“Anyone who has worked in pediatrics for very long has run across these kids. The question is whether or not you recognize it because it is so difficult to diagnose,” said Jamye Coffman, M.D., medical director of the Child Advocacy Resources and Evaluation (CARE) team at Cook Children’s. “We call it medical child abuse because in all of the other names, abuse is nowhere in it. But it’s abuse. And it’s medical, because we are the weapon.”

Few people may realize just how experienced experts in Tarrant County have become with this disturbing crime.

Since January 2009, the Tarrant County District Attorney’s office has investigated 19 reports of medical child abuse. Of the eight prosecutable cases, five were reported to Child Protective Services (CPS) by attending physicians at Cook Children’s. In each case, the abuser was the child’s mother.

“Tarrant County is pretty good at identifying and handling these cases,” said Michael Weber, a Tarrant County investigator who specializes in medical child abuse. “We have a system in place that is better than most counties in America.”

That system heavily relies on information provided by the medical community.

They’re using us to harm their child

In the medical field, the Hippocratic Oath is sacred. At the beginning of a physician’s career, they make a promise to ‘do no harm.’ But when a parent gives a doctor false information, they may unintentionally end up breaking the oath by providing procedures the child did not really need.

“The most common unnecessary surgery is placement of a feeding tube, or G-tube,” said Dr. Coffman. “That’s because there are very few tests that tell us if a child needs a G-tube. We are dependent on a history showing a failure to gain weight.”

The inability to gain weight is one of the top symptoms in medical child abuse cases. The abuser may withhold food and water from the child to make it seem as though there is a medical issue preventing weight gain. Besides inducing symptoms, abusers may also exaggerate and even fabricate symptoms.

“The parent may say their child threw up seven times in 12 hours, but they really threw up once. Or, if they are fabricating symptoms, they may say a child threw up seven times but there was never any vomiting at all,” said Dr. Coffman.

The severity of these cases can vary, and some symptom fabrications that seem mild may actually end up being life threatening.

For instance, a parent may tell a physician their child has been diagnosed with sleep apnea. Due to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), physicians cannot access another hospital’s records unless they have written permission from a parent or guardian. Without approval to access information protected by HIPAA, the physician has no way of knowing if the parent is being truthful about the apnea diagnosis. Once admitted to the hospital, the parent may actually suffocate their child in order to set off alarms, thus inducing symptoms.

“We’ve seen kids in wheelchairs who said they could not walk, even though there was no problem with their ability to walk. We’ve had parents tamper with lab tests and falsify records. Abusers have even gone as far as injecting feces into a feeding tube or IV line to make a patient septic,” said Dr. Coffman.

“In most cases, the abuse has been going on for many, many years. It’s psychological manipulation, physical manipulation and total control of the child by the parent,” said Weber.

It may seem baffling that children, who would be perfectly healthy otherwise, end up in these situations.

“You have to remember that ninety-nine point nine percent of our parents are good parents giving us accurate information,” said Dr. Coffman. “But if all an abuser has to do is say their child is vomiting and they’re secretly withholding food from them, how are we supposed to know that? We are depending on parents to tell the truth.”

Hiding in the spotlight

Identifying medical child abuse cases can be difficult for a number of reasons. The medical team is usually being lied to by the abuser, patients may be too young to speak for themselves or they may have been conditioned to lie as well.

Also challenging is the fact that the person harming the child is often the last person anyone would suspect.

“You may have a mother who seems like the best parent ever. The medical staff loves them, they are extremely concerned about their child, and they have a lot of medical savvy,” said Dr. Coffman. “We used to think these people had a medical background, but now with the internet, that’s not necessarily the case.”

According to Weber, Google and social media are key to the investigation.

“When we are building a case, we take all of the child’s medical records and dump it into a spreadsheet with social media posts and internet search history. When arranged by date, we can see the abuse pattern, and the lies,” said Weber.

He says in one case, a mother falsely told a doctor that she took her child to an emergency room the night before. Then later, she made posts on her Facebook page about her child being admitted to the hospital, though that never happened.

“She had numerous Facebook posts that were all lies,” said Weber. “Social media is a huge part of these cases.”

When the hero is the villain

One of the biggest mysteries surrounding medical child abuse cases is ‘why.’

For Dr. Coffman, that’s not something she spends time worrying about.

“We don’t have to know the reason why. Just like I don’t understand why a pedophile is sexually attracted to a child, I don’t have to understand why a parent is doing this.”

Instead, she says she needs to know if a parent is exaggerating, fabricating or lying about a child’s symptoms. Then, a report can be made to CPS.

“I do believe it’s a compulsive behavior that creates some sort of internal gain for them. They like to be the hero,” Dr. Coffman said.

That doesn’t mean they can’t control their actions, she said.

“They know what they are doing, and they know it’s wrong. It’s premeditated.”

Both Dr. Coffman and Weber say anyone who suspects a child is being subjected to unnecessary medical care should report their concerns to CPS.

“If you suspect it, report it,” says Weber. “It’s no different from physical or sexual abuse.”