Diagnosis and management of Munchausen's Syndrome by Proxy

A systematic literature review was conducted to identify and synthesise the relevant literature on the epidemiology, presentation, assessment and management of Munchausen's Syndrome by Proxy (MSP). This included collating information from published and unpublished sources. The purpose of the review was to provide an overview of the status of research into MSP. The results indicated that there are common areas of research and theorising on MSP. These areas were divided up into the following categories: definitions of MSP, diagnosis and recognition of MSP and management of MSP. The results of the literature review were summarised using the above-mentioned categories. The most widely accepted definitions of MSP included the International Classification of Diseases (10th edition) (ICD-10), (1994), Rosenberg (1987), The Diagnostic and Statistical Manual (4th edition) (1994) and Kelly and Loader (1997). The most common presentations of MSP identified included seizures, diarhhea, apnea and fevers. The most common forms of assault identified included suffocation, giving of drugs and poisoning. Mother-perpetrator features, child-victim features and family features were identified as categories used to help with the identification of MSP. Appropriate management of MSP included careful consideration of child protection factors with the emphasis on comprehensive assessment and management.