Factitious illness by proxy in children

Abstract

Factitious illness by proxy in the pediatric setting refers to a situation where an adult carer, who is usually the mother, either causes or falsifies illness or injury in a child to gain medical attention and to initiate extensive investigations. It is uncommon in pediatric forensic practice. Although originally called “Munchausen syndrome by proxy,” this term has been criticized, as the same apparent diagnostic term was being applied to two quite different individuals. The issue that arose concerned who was actually suffering from the syndrome: was it the individual responsible for the deception (the Munchausen component) or the victim (the proxy)? As our understanding has evolved, it has become obvious that no one really suffers from “Munchausen by proxy,” as it refers to a particular set of circumstances rather than to a diagnostic entity. This is not to say that the term has not been extremely useful in focusing attention on certain parents who have repeatedly hurt their children to gain medical attention. However, the term should not imply that those circumstances, in themselves, constitute a specific psychological process with clearly defined, fixed criteria. The characteristic features are summarized in the following chapter in which the terms Munchausen by proxy, Munchausen syndrome by proxy, and factitious illness by proxy will be used interchangeably, given that these terms have all been used in publications.