Munchausen syndrome by proxy

Definition

Munchausen syndrome by proxy is a mental illness and a form of child abuse. The caretaker of a child, most often a mother, either makes up fake symptoms or causes real symptoms to make it look like the child is sick.

Alternative Names

Factitious disorder by proxy; Child abuse - Munchausen

Causes

No one is sure what causes Munchausen syndrome by proxy. Sometimes, the person was abused as a child or has Munchausen syndrome (fake illness for themselves).

Symptoms

The caretaker can do extreme things to fake symptoms of illness in the child. For example, the caretaker may:

What are signs in a caretaker?

What are signs in a child?

Exams and Tests

To diagnose Munchausen syndrome by proxy, providers have to see the clues. They have to review the child's medical record to see what has happened with the child over time. Very often, Munchausen syndrome by proxy goes undiagnosed.

Treatment

The child needs to be protected. They may need to be removed from the direct care of the caretaker in question.

Children may require medical care to treat complications from injuries, infections, medicines, surgeries, or tests. They also need psychiatric care to deal with depression, anxiety, and post-traumatic stress disorder that can happen with child abuse.

Treatment most often involves individual and family therapy. Because this is a form of child abuse, the syndrome must be reported to the authorities.

When to Contact a Medical Professional

If you think a child is being abused, contact a provider, the police, or child protective services.

Call 911 or the local emergency number for any child in immediate danger because of abuse or neglect.

You can also call this national hotline. Crisis counselors are available 24/7. Interpreters are available to help in 170 languages. The counselor on the phone can help you figure out the next steps. All calls are anonymous and confidential. Call Childhelp National Child Abuse Hotline 1-800-4-A-CHILD (1-800-422-4453).

Prevention

Recognition of Munchausen syndrome by proxy in the child-parent relationship can prevent continued abuse and unnecessary, expensive, and possibly dangerous medical testing.

References

Byrne R, Kirschner K. Unusual behaviors. In: Kliegman RM, Lye PS, Bordini BJ, Toth H, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. Philadelphia, PA: Elsevier; 2018:chap 27.

Carrasco MM, Wolford JE. Child abuse and neglect. In: Zitelli BJ, McIntire SC, Nowalk AJ, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 6.

Dubowitz H, Lane WG. Abused and neglected children. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 16.

Lindberg D. Child abuse. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 177.


Review Date: 8/10/2021
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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