Munchausen Syndrome by Proxy Overview

Munchausen syndrome by proxy, now formally known as factitious disorder imposed on another, can take the form of child abuse in which a mother makes up or induces illnesses in her child. The mother uses the child's illnesses to join the child in the sick role and gain attention.

In the vast majority of cases, the mother is the one abusing the child this way; in other cases, the father, grandparent, or even babysitter may be the abuser. Some mothers go beyond making up symptoms to actually causing symptoms.

In time, the child can come to believe that he or she really is sick. Some abused children fear to contradict their mothers or feel that no one will believe the truth if they tell it.

Mother taking care of sick 6 year old child
Tim Hale / Getty Images

Syndrome Difficult to Identify

Some of the reasons why Munchausen syndrome by proxy is difficult for healthcare providers to identify are:

  • The child has a combination of symptoms that do not conform to any known disease or disorder
  • Healthcare providers are not familiar with Munchausen syndrome and don't consider it to be a possible diagnosis
  • The physician tends to believe the very persuasive and compelling medical history the mother gives; she knows medical terminology and may have even worked in health care herself
  • The child has often been taken to different healthcare providers over time, at different hospitals, and there is no communication among these providers

Potentially Deadly Results

Some mothers may severely hurt their children in order to cause symptoms. A mother may poison her child with medications, chemicals, or salt, give laxatives to cause diarrhea or syrup of ipecac to cause vomiting. Some may go as far as suffocating the child for brief periods of time to cause respiratory and nervous system problems.

Sometimes the abused child dies as a result of the induced medical procedures, such as surgery, done to treat the child's strange symptoms.


This disorder can lead to serious short- and long-term complications, including continued abuse, multiple hospitalizations, and the death of the victim. (Research suggests that the death rate for victims of Munchausen syndrome by proxy is about 10 percent.) In some cases, a child victim of Munchausen syndrome by proxy learns to associate getting attention to being sick and develops Munchausen syndrome imposed on self. Considered a form of child abuse, Munchausen syndrome by proxy is a criminal offense.


There is no known way to prevent this disorder. However, once a diagnosis is clearly established,the safety of the child becomes paramount. Removing the child or other victims from the care of the person with Munchausen syndrome by proxy may be necessary to prevent further harm to the victim.


In Munchausen syndrome by proxy, the treatment needed is not of the "ill" child but of his or her mother. Parents who abuse a child this way have a psychological problem that requires professional intervention.


Generally, Munchausen syndrome by proxy is a very difficult disorder to treat and often requires a supportive multidiscliplinary treatment approach.. Social services, law enforcement, children's protective services, and physicians must function as a team to stop the behavior.

1 Source
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  1. Sousa Filho D de, Kanomata EY, Feldman RJ, Maluf Neto A. Munchausen syndrome and Munchausen syndrome by proxy: a narrative review. Einstein (São Paulo). 2017;15(4):516-521. doi. 10.1590/S1679-45082017MD3746. Published December, 2017.

Additional Reading
  • Abdulhamid, I. & Siegal, P. Munchausen syndrome by proxy.

  • Cleveland Clinic. Munchausen syndrome by proxy.  

  • Donavon Mason, D. Munchausen syndrome by proxy.

By Mary Kugler, RN
Mary Kugler, RN, is a pediatric nurse whose specialty is caring for children with long-term or severe medical problems.