Serial Munchausen syndrome by proxy.

Five cases of Munchausen syndrome by proxy (MSBP) are presented in which more than one child in the family was victimized. There was a high incidence of maternal psychiatric histories, marital difficulties, and Münchhausen syndrome in the mothers themselves. Seventy-one percent of the children in the families were known to be victims of MSBP; four of these children (31%) died. Multiple-child MSBP may reflect more significant maternal psychopathology than found in other cases of MSBP, or it may indicate the deteriorating consequences to the mother and other children in the family if this syndrome is not identified with the first child and effective interventions made.