Introduction

Munchausen syndrome by proxy (MSBP), first described by Professor Roy Meadow in 1977, is a form of child abuse where there is persistent fabrication of symptoms of illness on behalf of an unsuspecting or helpless victim that causes the victim to be regarded as ill by others (Meadow 1977). Methods of fabrication include: (1) fictitious history (false reporting of symptoms), (2) simulation, (3) induction, (4) withholding medications in a chronically ill child (e.g., in a child with asthma). The perpetrator may use more than one of the above methods. Criteria have been established (Table 3.1). MSBP can occur in individuals with a “true physical disorder” in which case the symptoms are exaggerated to the point that the child is subjected to multiple unnecessary treatments and/or investigations (Rosenberg 1987).

In a survey of all pediatricians in England and Ireland, the two-year combined annual incidence of MSBP was at least 0.5 per 100 000 children and at least 2.8 per 100 000 for children under one year of age (McClure et al. 1996). As of 1997, there were close to 300 articles published on MSBP in professional journals worldwide, with authors representing disciplines such as medicine, law, nursing, psychology, psychiatry, and social work. In more than 300 cases described by Meadow (1977), the perpetrator was the child's biological mother in ∼90% of the cases (another female caregiver, baby-sitter, or nurse in ∼5%, and the child's father in ∼5%).