[Hypochondriasis by proxy in children: report of two cases]

OBJECTIVE: To emphasize important aspects for the diagnosis and approach of patients with history of child abuse, related with the Munchausen Syndrome by proxy, and its variant, Hypochondriases by proxy. METHODS: The authors describe two cases followed in the Pediatric Service in a terciary hospital of Salvador, Bahia, in which they found aspects of the medical history and physical examination of these children and in the mothers' behavior compatible with Munchausen by proxy (Factitious disorder by proxy). RESULTS: In the two cases presented, we observed a standard in the clinical history, described as recurrent inpatient and outpatient medical support, through the last three years, without the identification of abnormal results. These facts do not decreased the certainty of the mothers about their children's disease (hypochondriases by proxy). Furthermore we observed cooperation on the part of the children by incorporating the role of the sick one, which made their school and social adaptation more difficult. CONCLUSIONS: The pediatrician must be aware of the diagnosis of Munchausen Syndrome by Proxy and its variation, hypochondriases by proxy, in those cases of unsuitable and recurrent disease, lack of symptoms and signs in the absence of parents, and diagnostic methods with meaningless results. When absolutely certain about diagnosis, the physician must establish the risk for the child (increased mortality in these cases) and suggest psychotherapy for the mother or perpetrator.