Munchausen Syndrome by Proxy

Symptoms

The following warning signs may alert health professionals that a parent (typically the mother) or caregiver has Munchausen syndrome by proxy (MSBP):

• A child has a recurring or unusual illness for which no adequate explanation can be found. The parent has the child go through many different tests and evaluations, and the child continually fails to respond to or tolerate medical treatments that in most cases are effective.
• Symptoms occur or begin only when the caregiver is with or has recently been with the child. Symptoms improve or do not occur when the caregiver is absent.
• The other parent (usually the father) is noticeably absent. He is uninvolved even though a child's condition may be or appear to be serious.
• Evidence proves that the parent has given false information to health professionals or others.
• Normal test results do not reassure the parent. She is inappropriately calm or euphoric when her child's condition is most severe.
• The caregiver makes an exceptional effort to become friendly and close to medical staff. She may seek medical care for the child from a series of doctors if current relationships become strained.
• The caregiver is seen or videotaped directly harming the child or causing symptoms.

The discovery that the caregiver has been diagnosed with a similar condition, Munchausen syndrome, in which a person causes or reports symptoms in herself, is also a symptom.

Symptoms in the child who is a victim of Munchausen syndrome by proxy vary, depending on the actions of the abuser. The caregiver may report false symptoms (such as periods of not breathing during sleep, known as apnea), manipulate laboratory samples (such as by adding blood or feces to them), or physically harm the child to produce symptoms. In some cases, the caregiver smothers the child or otherwise causes him or her to stop breathing. The caregiver may also feed or inject the child with substances such as medicines or poisons to cause illness.

Less commonly, the offending caregiver will report symptoms of a behavioral problem or mental (psychiatric) condition such as attention deficit hyperactivity disorder (ADHD) rather than a physical illness.¹

Sometimes MSBP starts with a child receiving medical attention for a true illness. In order to continue receiving attention from medical personnel, the caregiver may exaggerate, prolong, or produce additional symptoms.

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Author:	Jeannette Curtis	Last Updated: July 27, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Michael J. Sexton, MD - Pediatrics
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