Munchausen Syndrome by Proxy (Child Abuse in the Medical Setting)

Munchausen Syndrome by Proxy (Child Abuse in the Medical Setting) is a topic covered in the Select 5-Minute Pediatrics Topics.

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  • Symptoms of illness in a child that are exaggerated, fabricated, or induced by a caretaker. There is usually no underlying health disorder in the child.
  • Results in harm to the child victim through repeated interactions with the medical care system, including unnecessary tests, medications, and surgeries
  • Known by many names, including the following:
    • “Pediatric condition falsification”
    • “Caregiver-fabricated illness”
    • “Medical child abuse”
    • “Factitious disorder by proxy”
  • All refer to harm that befalls children through the actions of a caregiver in a medical setting.
  • Symptoms decrease when the child is separated from the perpetrator.


  • Rare, with no typical presentation. The most commonly described symptoms include apnea, seizures, factitious fevers, feeding and GI problems, failure to thrive, behavioral problems, bleeding, and sepsis.
  • Presenting symptoms may present along a spectrum of severity from mild to fatal.
  • Most victims are <4 years of age, but victims may often be older children.
  • Males and females are equally represented.
  • Symptoms may be present for years before factitious illness is considered and diagnosed.
  • Morbidity is significant; cases may be fatal, especially those involving surreptitious administration of medications, poisoning, or inducing apnea.


  • The parent, most commonly the mother, exaggerates, fabricates, or induces the illnesses.
  • The term Munchausen syndrome by proxy refers to specific instances where the caregiver is motivated by a desire for self-aggrandizement. As such, it only defines a subset of factitious illnesses.
  • Medical providers are advised to concentrate on the specific harm done and the patient’s safety rather than on the caregiver’s motives.

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