Munchausen syndrome by proxy

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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

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 mother can do extreme things to fake symptoms of illness in her child. For example, she may:

  • Add blood to the child's urine or stool
  • Withhold food so the child looks like they can't gain weight
  • Heat up thermometers so it looks like the child has a fever
  • Make up lab results
  • Give the child drugs to make the child throw up or have diarrhea
  • Infect an intravenous line (IV) to make the child sick

What are signs in a mother?

  • Most people with this problem are mothers with small children. Some are adult children taking care of an older parent.
  • The mother often works in health care and knows a lot about medical care. She can describe the child's symptoms in great medical detail. She likes to be very involved with the health care team and is liked by the staff for the care she gives her child.
  • These mothers are very involved with their children. They seem devoted to the child. This makes it hard for health professionals to see a diagnosis of Munchausen syndrome by proxy.

What are signs in a child?

  • The child sees a lot of health care providers and has been in the hospital a lot.
  • The child often has had many tests, surgeries, or other procedures.
  • The child has strange symptoms that don't fit with any disease. The symptoms do not match the test results.
  • The child's symptoms are reported by the mother. They are never seen by health care professionals. The symptoms are gone in the hospital, but start again when the child goes home.
  • Blood samples do not match the child's blood type.
  • Drugs or chemicals are found in the child's urine, blood, or stool.

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 parent.

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 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

Dubowitz H, Lane WG. Abused and neglected children. In: Kliegman RM, Stanton BF, St Geme JW III, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 40.

Shapiro R, Farst K, Chervenak CL. Child abuse. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 24.

Version Info

  • Last reviewed on 7/10/2015
  • Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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