Munchausen Syndrome by Proxy (MSBP) is defined as a form of child abuse where an adult falsifies their child’s physical and/or psychological signs and symptoms causing this child to be regarded as ill or impaired.  MSBP is difficult to detect and there are no solid statistics on its incidence.  Many health care providers do not know the signs and symptoms and some do not even know the syndrome exists.  The perpetrator is usually the mother (90%) who intentionally falsifies this information to meet her own self-serving psychological needs.  Perpetrators either falsify information (including contaminating laboratory specimens) or induce illness (e.g., administering medications).  Mothers are overwhelmingly white, between 20 to 30 years old, and usually married.  Seventy percent of them have eating disorders or weight problems.  

This article cautions nurses to be aware of warning signs.  These include: symptoms that don’t make sense, similar sibling illnesses, parental refusal to accept non-medical alternative causes of symptoms, and symptoms witnessed only by the parent.  Nurses must document what parents report as the child’s symptoms and keep written records that are objective, accurate, detailed, and legible.  Nurses should also describe mother’s behavior, including interaction with the child, spouse and staff and their own observations of the child’s symptoms.  Note any discrepancies in the history each time it is taken.  This article goes on to explain how to handle suspected MSBP cases in the hospital setting (video surveillance, child protective services, confronting parent, psychiatric treatment, etc.). 

(Thomas K.  J of Pediatric Nursing 2003; 18(3): 174-180.)

Comment:  I included this article because many parents demand excessive school health services or report their child as ill for reasons that seem similar to Munchausen Syndrome by Proxy.  – H.T.