How "mild" is mild Munchausen syndrome by proxy?

This paper describes four cases of Munchausen Syndrome by Proxy (MSbP), in each of whom the disorder could be considered mild from the physical viewpoint. However, in all cases a severe emotional disturbance was evident in the mother-child relationship, and certain significant features were common to each case, including the dynamics of the development of the disorder. In all, maternal anxiety resulted in the mother perceiving the child as sick, leading to her insistence that he/she receive medical attention. A follow-up over several years showed severe disturbances in the emotional development of all the children. It is thus suggested that mild cases of MSbP may be indicators of severely disturbed mother-child relationships, raising important questions about their proper management.