Munchausen syndrome by proxy.

Munchausen syndrome by proxy is a form of child abuse in which a disorder of the child is fabricated by a parent. Although often considered rare, it may have been overlooked frequently in the past. The reported cases of children with Munchausen syndrome by proxy range in age from infancy to 8 years. Their "illnesses" consist of fabricated histories, inflicted physical findings, altered laboratory specimens, and induced disorders. The perpetrator usually is the child's mother, who may have Munchausen syndrome. Consequences of the syndrome may include painful tests, frequent hospitalizations, potentially harmful treatment, and death. The diagnosis can be made when medical and social histories are characteristic of the syndrome and clinical findings are absent, suggestive of induced illness, or resolve upon separation of the child and parent. Suspicion of the syndrome should be discussed with the family once the safety of the child is insured, and the case should be reported under the child abuse reporting law of the state. Social, family, and medical histories must be obtained and verified, and court intervention should be considered. Four patients who illustrate typical features of the syndrome are described.

Munchausen syndrome by proxy: social work's role.

Munchausen syndrome by proxy is the diagnosis used to describe a variation of child abuse whereby the parent or adult caregiver fabricates a medical history or induces symptoms in the child, or both, resulting in unnecessary examinations, treatments, hospitalizations, and even death. This article reviews the assessment procedures, provides case studies, and describes family dynamics of the syndrome. The authors make recommendations for team management of the child-family system and recommendations for social workers. They propose broadening the assessment of the family on the basis of knowledge of the widespread physical and economic oppression of women and children in our society.