Munchausen syndrome by proxy: Clinical review and legal issues


  • Bernard Kahan M.D.,

    Assistant Professor of Psychiatry & Pediatrics and Director of the Medical/Psychiatric Unit, Corresponding author
    1. Emory University School of Medicine and Egleston Children's Hospital
    • The Emory Clinic, 1365 Clifton Road, Atlanta, Georgia 30322, USA
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  • Beatrice Crofts Yorker R.N., J.D.

    Chair of the Department of Psychiatric/Mental Health Nursing
    1. Georgia State University, Atlanta, Georgia
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Well-established policies and procedures govern the identification, management, and treatment of most variations of child abuse. For many therapists, such cases have become “routine”. Munchausen syndrome by proxy is an under-recognized form of child abuse in which a parent feigns or creates illness in a child specifically to have the child subjected to unnecessary diagnostic tests and treatments by medical practitioners. Variations range from false reports of fevers or allergies, to life-threatening abuse, such as surreptitious poisonings or injections with toxic substances. This article reports a case example of Munchausen syndrome by proxy, provides a review of historical, diagnostic and management issues, and discusses legal issues relevant to detection of the perpetrator and protection of the child victim.