Children's Health: Munchausen by Proxy Syndrome

Children's Health: Munchausen by Proxy Syndrome

Munchausen by proxy syndrome (MBPS) is a relatively rare form of child abuse that involves the exaggeration or fabrication of illnesses or symptoms by a primary caretaker.

Also known as "medical child abuse," MBPS was named after Baron von Munchausen, an 18th-century German dignitary known for making up stories about his travels and experiences in order to get attention. "By proxy" indicates that a parent or other adult is fabricating or exaggerating symptoms in a child, not in himself or herself.

Munchausen by proxy syndrome is a mental illness and requires treatment.

About MBPS
In MBPS, an individual — usually a parent or caregiver— causes or fabricates symptoms in a child. The adult deliberately misleads others (particularly medical professionals), and may go as far as to actually cause symptoms in the child through poisoning, medication, or even suffocation. In most cases (85%), the mother is responsible for causing the illness or symptoms.

Typically, the cause is a need for attention and sympathy from doctors, nurses, and other professionals. Some experts believe that it isn't just the attention that's gained from the "illness" of the child that drives this behavior, but also the satisfaction in deceiving individuals who they consider to be more important and powerful than themselves.

Because the parent or caregiver appears to be so caring and attentive, often no one suspects any wrongdoing. Diagnosis is made extremely difficult due to the the ability of the parent or caregiver to manipulate doctors and induce symptoms in their child.

Often, the perpetrator is familiar with the medical profession and knowledgeable about how to induce illness or impairment in the child. Medical personnel often overlook the possibility of MBPS because it goes against the belief that parents and caregivers would never deliberately hurt their child.

Most victims of MBPS are preschoolers (although there have been cases in kids up to 16 years old), and there are equal numbers of boys and girls.

Diagnosing MBPS
Diagnosis is very difficult, but could involve some of the following:

a child who has multiple medical problems that don't respond to treatment or that follow a persistent and puzzling course
physical or laboratory findings that are highly unusual, don't correspond with the child's medical history, or are physically or clinically impossible
short-term symptoms that tend to stop or improve when the victim is not with the perpetrator (for example, when hospitalized)
a parent or caregiver who isn't reassured by "good news" when test results find no medical problems, but continues to believe that the child is ill and may "doctor shop" to find a professional who believes them
a parent or caregiver who appears to be medically knowledgeable or fascinated with medical details or seems to enjoy the hospital environment and attention the sick child receives
a parent or caregiver who's overly supportive and encouraging of the doctor, or one who is angry and demands further intervention, more procedures, second opinions, or transfers to more sophisticated facilities
If you have any concerns about a child you know, it is important to speak to someone at your local child protective services agency — even if you prefer to call in anonymously.

Causes of MBPS
MBPS is a psychiatric condition. In some cases, the perpetrators were themselves abused, physically and/or and sexually, as children. They may have come from families in which being sick was a way to get love.

The parent's or caregiver's own personal needs overcome his or her ability to see the child as a person with feelings and rights, possibly because the parent or caregiver may have grown up being treated like he or she wasn't a person with rights or feelings.

In rare cases, MBPS is not caused by a parent or family member, but by a medical professional (such as a nurse or doctor), who induces illness in a child who is hospitalized for other reasons.

What Happens to the Child?
In the most severe instances, parents or caregivers with MBPS may go to great lengths to make their children sick. When cameras were placed in some children's hospital rooms, some perpetrators were filmed switching medications, injecting kids with urine to cause an infection, or placing drops of blood in urine specimens.

In most cases, hospitalization is required. And because they may be deemed a "medical mystery," hospital stays tend to be longer than usual. Whatever the cause, the child's symptoms — whether created or fabricated — ease or completely disappear when the perpetrator isn't present.

According to experts, common conditions and symptoms that are created or fabricated by parents or caregivers with MBPS can include: failure to thrive, allergies, asthma, vomiting, diarrhea, seizures, and infections.

The long-term prognosis for these children depends on the degree of damage created by the illness or impairment and the amount of time it takes to recognize and diagnose MBPS. Some extreme cases have been reported in which children developed destructive skeletal changes, limps, mental retardation, brain damage, and blindness from symptoms caused by the parent or caregiver. Often, these children require multiple surgeries, each with the risk for future medical problems.

If the child lives to be old enough to comprehend what's happening, the psychological damage can be significant. The child may come to feel that he or she will only be loved when ill and may, therefore, help the parent try to deceive doctors, using self-abuse to avoid being abandoned. And so, some victims of MBPS are at risk of repeating the cycle of abuse.

Getting Help for the Child
If MBPS is suspected, health care providers are required by law to report their concerns. However, after a parent or caregiver is charged, the child's symptoms may increase as the person who is accused attempts to prove the presence of the illness. If the parent or caregiver repeatedly denies the charges, the child would likely be removed from the home and legal action would be taken on the child's behalf.

In some cases, the parent or caregiver may deny the charges and move to another location, only to continue the behavior. Even if the child is returned to the perpetrator's custody while protective services are involved, the child may continue to be a victim of abuse while the perpetrator avoids treatment and interventions.

Getting Help for the Parent or Caregiver
To get help, the parent or caregiver must admit to the abuse and seek psychological treatment.

But if the perpetrator doesn't admit to the wrongdoing, psychological treatment has little chance of helping the situation. Recognizing MBPS as an illness that has the potential for treatment is one way to give hope to the family in these rare situations.

Reviewed by: Michelle New, PhD