PEDIATRICS Vol. 83 No. 2 February 1989, pp. 289-292
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Psychologic Morbidity of Children Subjected to Munchausen Syndrome by Proxy

Tona L. McGuire PhD1 and Kenneth W. Feldman MD1

1 The Departments of Psychiatry and Behavioral Science, and Pediatrics, Children's Hospital and Medical Center, University of Washington School of Medicine, Seattle

Munchausen syndrome by proxy is being recognized and reported with increasing frequency, which suggests that it is more common and occurs with a wider spectrum of severity than was previously suspected. In past reports, the difficulties of detecting and documenting the syndrome have been emphasized, as well as its physical morbidity and mortality. The psychologic morbidity of Munchausen syndrome by proxy in six children is described. The children reacted with developmentally appropriate behavior problems ranging from feeding disorders in infants, withdrawal and hyperactivity in preschool-aged children, to hysterical disorders and personal adoption of Munchausen syndrome behavior in adolescents. Parental psychologic and behavioral styles, family dynamics, and responses from legal and children's protective services systems make protection of the child within the home difficult, if not impossible. Even with protection from further physical injury, severe psychologic trauma remains likely. Extreme caution is suggested in allowing these children to remain in the family.

Key Words: child abuse • Munchausen syndrome by proxy • child development • conversion reaction • rumination syndrome

Submitted on October 20, 1987
Accepted on March 2, 1988




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