Munchausen syndrome by proxy is a mental illness and a form of child abuse. The caretaker of a child, usually a mother, either makes up fake symptoms or causes real symptoms to make it look like the child is sick.
Factitious disorder by proxy
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).
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 elderly 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 really 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 doctors and has been in the hospital a lot, too.
The child often has had many tests, surgeries, or other procedures.
The child has strange symptoms that don't quite fit any disease. The symptoms do not match the test results.
The child's symptoms are reported by the mother, but 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, doctors and nurses have to see the clues. They have to review the child’s medical record to see what has happened with the child over time. Unfortunately, Munchausen syndrome by proxy often goes undiagnosed.
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, medications, 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 usually 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 health care 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 next steps. All calls are anonymous and confidential. Call Childhelp National Child Abuse Hotline 1-800-4-A-CHILD (1-800-422-4453)
Recognition of Munchausen syndrome by proxy in the child-parent relationship can prevent continued abuse and unnecessary, expensive, and possibly dangerous medical testing.
Dubowitz, H, Lane WG. Factitious disorder by proxy (Munchausen syndrome by proxy). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 36.
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, Bethanne Black, and the A.D.A.M. Editorial team.