FAQ: Understanding Medical Child Abuse & Munchausen by Proxy
What Is Medical Child Abuse?
Medical Child Abuse—commonly referred to as Munchausen by Proxy—is a form of child abuse in which a caretaker induces, exaggerates, or fabricates symptoms of illness in order to intentionally mislead healthcare professionals into providing unnecessary treatment. Medical Child Abuse is one of the most lethal forms of child abuse. In over 95 percent of cases, the perpetrator is the victim’s mother.
Perpetrators of Medical Child Abuse are highly manipulative and persuasive, and feed off the attention of medical professionals, sympathetic friends and family, strangers on the internet, and whomever else they can pull into their deceptions. Perpetrators seek attention, sympathy, and recognition for being the heroic parent of an ill child. Though Medical Child Abuse cases frequently involve fraud, financial gain is a secondary motivation. Medical Child Abuse is distinct from Malingering, in which someone feigns illness for the purpose of financial gain.
Is Munchausen by Proxy a Mental Illness?
Medical Child Abuse is child torture. Though an underlying psychological condition drives the behavior of perpetrators, experts unanimously agree that it should be considered abuse, first and foremost. The success rate for treating perpetrators with Munchausen by Proxy—also known as Factitious Disorder Imposed on Another—is vanishingly small and requires full accountability and cooperation of the perpetrator.
Media portrayals of Medical Child Abuse have perpetuated misinformation about this crime, including the common nomenclature that perpetrators “suffer” from Munchausen by Proxy. Perpetrators are not delusional, and they’re not hypochondriacs. They understand what they’re doing when they’re doing it, and they understand that it’s wrong. The majority of perpetrators actively induce symptoms in their victims, most commonly through suffocation and poisoning. Perpetrators are extremely dangerous; the welfare of the child must be foremost in the minds of anyone who suspects this abuse may be taking place.
What Are the Effects on Victims?
Medical Child Abuse cases end one of three ways: Perpetrators are separated from their victims by the courts, perpetrators move on to a younger victim, or the victim dies. Survivors of Medical Child Abuse face lifelong physical and psychological challenges including Post-Traumatic Stress Disorder, betrayal trauma, and an aversion to seeking medical attention even when urgently needed. Because awareness and understanding of Medical Child Abuse is so lacking, survivors often struggle to find the help and support they need.
What Are the Warning Signs of Medical Child Abuse?
The American Professional Society on the Abuse of Children reports the following common signs of Medical Child Abuse:
Reported symptoms or behaviors that are not congruent with observations. For example, the abuser says the child cannot eat, but the child is observed eating without the adverse symptoms reported by the abuser.
Discrepancy between the medical record and the abuser’s reports of the child’s medical history.
No medical explanation for reported problems despite extensive medical assessments.
Unexplained worsening of symptoms or new symptoms that correlate with abuser’s visitation.
Laboratory findings that do not make medical sense, are clinically impossible or implausible, or identify chemicals, medications, or contaminants that should not be present.
Symptoms resolve or improve when the child is separated and well protected from the influence and control of the abuser.
The caregiver, other individuals, or animals in the home have had unusual or unexplained illnesses or conditions, possibly similar to the child’s presentation (e.g., seizure disorder).
Conditions or illnesses significantly improve or disappear in one child and then appear in another, such as when another child is born and begins to have similar or other unexplained symptoms.
Caregiver is reluctant to provide medical records, claims that past records are not available, or refuses to allow medical providers to discuss care with previous medical providers.
The abuser reports that the other parent is not involved, does not want to be involved, and is not reachable.
A parent, child, or other family member expresses concern about possible falsification or high healthcare utilization.
Observations of clear falsification or induction by the caregiver. This can include false recounting of past medical recommendations, test or exam results, conditions, or diagnoses.
(APSAC Practice Guidelines 2017). Access the full practice guidelines for professionals here.