Munchausen syndrome by proxy (MSP) is a disorder in which the caretaker of a child either makes up fake symptoms or causes real symptoms to make it appear that the child is injured or ill.

MSP is primarily a mental illness but is also considered a form of child abuse. The term “by proxy” means “through a substitute.”

This is different from Munchausen syndrome, which causes a person with a deep-seated need for attention to fake sickness or injury in themselves.

Many people with MSP exaggerate or lie about a child’s symptoms to get attention. They may also create symptoms by poisoning food, withholding food, or causing an infection. Some people may even have a child undergo painful or risky tests and procedures to try to gain sympathy from their family members or community. It’s also believed that people with MSP may enjoy the satisfaction of deceiving people whom they perceive to be more powerful than themselves, particularly medical professionals.

MSP can affect anyone, but it’s most commonly seen in mothers of children under age 6. People who have MSP have an overwhelming need for attention and go to great lengths to achieve it, even if it means risking a child’s life. According to the Cleveland Clinic, approximately 1,000 of the 2.5 million cases of child abuse reported each year may be related to MSP.

Since a parent or caretaker with MSP often appears to be caring and attentive, doctors usually don’t suspect any wrongdoing. Diagnosis can also be difficult due to the person’s ability to manipulate doctors and induce symptoms in the child. As a result, MSP goes undetected in many cases. Doctors may begin to suspect child abuse when a child frequently experiences illnesses and injuries. They may also become suspicious if a child’s symptoms worsen when home alone with the caretaker and improve when under medical care.

Treatment for the child usually involves removing the child from the care of the abuser. The abuser may face criminal charges, and long-term psychiatric counseling is often recommended.

It’s important to look for warning signs in both the child and the caretaker.

The warning signs in a child include:

  • a history of repeated injuries, illnesses, or hospitalizations
  • symptoms that don’t quite fit any disease
  • symptoms that don’t match test results
  • symptoms that seem to improve under medical care but get worse at home

The warning signs of MSP in the caretaker include:

  • attention-seeking behavior
  • striving to appear self-sacrificing and devoted
  • becoming overly involved with doctors and medical staff
  • refusing to leave the child’s side
  • exaggerating the child’s symptoms or speaking for the child
  • appearing to enjoy the hospital environment and the attention the child receives

If you experience a desire to harm your child, seek medical help immediately. Child abuse, regardless of the reason, is a criminal offense.

MSP is a rare condition, and its exact cause is unknown. Researchers theorize that both psychological and biological factors are involved. Many people diagnosed with MSP were physically, emotionally, or sexually abused when they were children. Some grew up in families in which being sick or injured was a way to receive love or care. It’s also believed that stress may play a role in the development of MSP. This stress could be due to a previous traumatic event, marital problems, or perhaps a serious illness.

For a caretaker to be diagnosed with MSP, they’ll need to admit to the abuse and submit to psychiatric treatment. However, people with MSP are prone to dishonesty, so diagnosing the condition can be extremely difficult. Additionally, with attention focused on a sick or injured child, it’s easy for doctors and family members to overlook the possibility of MSP.

It’s likely that the doctor will first try to diagnose the child with a specific illness. If a child repeatedly presents with unexplained illness or injury, the doctor may begin to suspect child abuse or MSP. They may also become suspicious if any symptoms suddenly stop or improve when the child isn’t with their caretaker. The doctor’s first duty is to protect the child from abuse by reporting these suspicions to the proper authorities. While under a doctor’s care, the child will be diagnosed and treated for any illness, injury, or emotional trauma.

The treatment for MSP must involve both the child and the adult. It may also be beneficial for the entire family to participate in treatment.

Treatment for the Child

Once it’s determined that the child is being abused, they must be protected. This usually means contacting Child Protective Services and removing all children from the care of the abuser. Any existing physical illness or injury must be treated accordingly. Psychological counseling may also be necessary.

Treatment for the Caretaker

The person accused of child abuse will likely face criminal charges. If MSP is suspected, psychiatric counseling will be recommended. However, treatment may be difficult if the caretaker doesn’t admit that there’s a problem.

Individual or family therapy may help all parties cope with the situation.

Children who are abused by caretakers with MSP can develop multiple illnesses or injuries, some of which may be life-threatening. They can also be subjected to painful and frightening medical procedures. As a result, some children may experience depression and anxiety for many years. They’re also at an increased risk for Munchausen syndrome themselves.

For the caretaker being treated for MSP, psychiatric counseling is often required for many years. It’s a very difficult condition to treat effectively.

For the child, the long-term outlook will depend on the extent of their physical and psychological injuries. Many victims of child abuse are prone to depression and anxiety throughout their lives.

There’s no way to predict who will develop MSP, and there’s no known way to prevent it. However, if MSP is suspected, there are ways to prevent the disorder from escalating.

If you have symptoms of MSP, seek psychiatric counseling immediately, before you hurt your child. If you think a child is being abused, contact the police or Child Protective Services. Call 911 if any child is in immediate danger due to abuse or neglect.

The Childhelp National Child Abuse Hotline is also a great resource for caretakers who need crisis intervention and for concerned people who suspect a child is being abused. There are crisis counselors available 24 hours a day, seven days a week who can help you figure out the next steps. You can reach them at 800-4-A-CHILD (800-422-4453).