Update on Munchausen syndrome by proxy.
OBJECTIVE
Munchausen syndrome by proxy (MBP) is a complicated form of child maltreatment. Difficulties remain in properly defining the condition, as well as in detection and differentiation from organic illness. This review will discuss the epidemiology and diagnosis of MBP, as well as the role of the physician in sorting out these cases.


RESULTS
Several recent case studies, including two in which children were diagnosed with celiac disease, add to our knowledge of the protean manifestations of MBP. There is growth in our understanding of how sudden infant death syndrome (SIDS) and the symptom complex seen in acute life-threatening events (ALTEs) may in fact represent manifestations of MBP. Recent legal issues in the United Kingdom pose concern for all physicians engaged in child protection work.


CONCLUSIONS
In spite of these challenges, the high mortality and recidivism rates associated with MBP make it imperative that pediatricians be familiar with the condition, the subtle signs and symptoms with which it may present, and methods to best protect the children in their care.
Galvin
Hannah K
HK
Harvard Medical School, Boston, Massachusetts 02115, USA.
Newton
Alice W
AW
Vandeven
Andrea M
AM
D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000517:prevention & control; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016735:Munchausen Syndrome by Proxy / Q000175:diagnosis* / Q000517:prevention & control; D010819:Physician's Role; D013398:Sudden Infant Death / Q000175:diagnosis / Q000517:prevention & control