Munchausen syndrome by proxy: a profile for medical child abuse.

The term Munchausen Syndrome by Proxy describes a pattern of physical abuse in which a perpetrator produces or fabricates illness in a victim. Victims are almost always children. We alternatively call this behaviour medical child abuse. Our report describes five recent cases. Two presented with infantile apnoea, one with alleged hypoventilation, one with recurrent vomiting and one with recurrent infections. Three of the perpetrators were mothers, two were fathers. In three cases diagnoses were confirmed by covert video surveillance. Contrary to popular beliefs, this behaviour is not rare and is not a syndrome of any known psychopathology. It is simply another, very dangerous, form of child abuse. Reported victim mortalities range from 9% to 31%. To ensure child safety we suggest the medical, legal and law enforcement communities begin to view this entity more as a profile of criminal abusive behaviour and less as a medical syndrome.