Munchausen Syndrome by Proxy was first described in 1951 by a British physician, but it was not until 1977 that the condition was labeled “Munchausen Syndrome by Proxy” by pediatrician Roy Meadow. The syndrome was defined as, “a condition in which a parent or other caretaker persistently fabricates symptoms on behalf of another, causing that person to be regarded as ill.” Dr. Meadow was the first to describe this behavior as abuse and is still considered a form of abuse by the American Professional Society on the Abuse of Children. Currently, in the United States the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM – 5), the syndrome is termed Factitious Disorder Imposed on Another or FDIA. 


According to the literature, boys and girls are equally victimized and 77% to 90% of the time the perpetrator is the child’s biological mother. In addition, 29% of perpetrators have symptoms of Munchausen Syndrome themselves. Because most cases of MSP are between a mother and a child, this article refers to that relationship; however, it is important to remember that MSP can involve any vulnerable person who has a caregiver.



What the Victim Might Look Like

  • Failure to thrive due to nutritional neglect 
  • A history of multiple hospitalizations 
  • Is usually less than age 5 at the time of symptom onset 
  • Has a deceased sibling or a sibling with a complicated medical history 
  • Testing completed does not match the clinical picture of the child 
  • Worsening of the symptoms reported by the caregiver, but not seen by the medical providers 
  • May exaggerate symptoms to obtain caregiver’s attention 
  • Symptoms worsen upon discharge 


What the Caregiver Might Do to Mimic Illness in the Child

  • Add chemicals to the child’s urine or stool 
  • Withhold food so the child looks like he/she is anorexic 
  • Make up lab results to be abnormal 
  • Give the child drugs to make the child throw up or have diarrhea and abdominal pain 
  • Infect an intravenous line (IV) by adding feces or saliva to the IV site 
  • Apply fecal matter to wounds or rub dirt and coffee grounds into orthopedic pin sites 
  • Inject urine into the child 

What the Offender Might Look Like

  • Usually is a parent; typically the mother of the child, but can be the father 
  • May also be a health care professional 
  • Is very friendly and cooperative with the health care providers 
  • Appears quite concerned about the child or designated patient 
  • Is even willing to have the child undergo painful or risky procedures and/or operations in order to get the sympathy and special attention given to people who are truly ill 
  • May utilize many different medical providers and facilities as a way to earn praise from others for their devotion to the child’s care 
  • Tends to be quite “fluent” in the medical jargon and able to explain medical details easily 
  • Will not usually leave the child alone with the medical provider 


This syndrome is considered a form of medical child abuse in terms of physical abuse and medical neglect. This type of abuse is considered to be premeditated. Medical providers are considered a mandatory reporting entity, but many do not recognize the syndrome or get “sucked into” the sympathy for the caregiver.

“Even when fabricated illness is reported to child protective services, many children are not protected from further harm. In a 2-year surveillance study in the UK, approximately one-third of the children (46 of 119) were allowed to return home. Approximately one-quarter of the children still had signs or symptoms of abuse at follow-up. Only one-third of the children were placed in caregiving arrangements outside the control of the alleged offending parent.” (American Academy of Pediatrics, 2013) 

Estimates suggest that about 1,000 of the 2.5 million cases of child abuse reported annually are related to FDIA. “This disorder can lead to serious short-and long-term complications, including continued abuse, multiple hospitalizations, and the death of the victim. Research suggests that the death rate for victims of FDIA is about 10 percent.” (Cleveland Clinic, 2014). 


American Academy of Pediatrics. (2013, 08 26). Caregiver-Fabricated Illness in a Child: A Manifestation. Retrieved from American Academy of Pediatrics Publications: 

Cleveland Clinic. (2014, 11 26). Cleveland Clinic. Retrieved from Munchausen Syndrome by Proxy: 

Criddle, L. (2010, 12). Monsters in the Closet: Munchausen Syndrome by Proxy. Retrieved from Critical Care Nurse: 

MedPage Today. (2014, 10 29). Munchausen by Proxy: A Case Study of Abuse. Retrieved from MedPage Today: 

National Library of Medicine. (2015, 07 28). MedLine Plus. Retrieved from Munchausen syndrome by proxy: