Management of Munchausen syndrome by proxy.

The label of Munchausen syndrome by proxy may be applied to anyone who persistently fabricates symptoms on behalf of another so causing that person to be regarded as ill.1 In paediatrics it is usually the mother who is the persistent fabricator of symptoms and signs so causing illness, danger, and unnecessary investigations and treatments for her child. There is considerable overlap with other forms of child abuse as well as with the usual behaviour of normal parents when a child is ill. Even though the fabrication of symptoms and signs may continue for several years and be gross, it can be most difficult to detect. Nevertheless effective management for the child and the family is even more difficult. In the past six years I have had unusual opportunities to learn about the condition, meet the families concerned, and be involved in the management. This article discusses some of the common and difficult management problems.