Munchausen's syndrome by proxy and its professional participants

Physicians and legal and protective service agencies may unwittingly participate in Munchausen's syndrome by proxy (MSP) when they fall to recognize MSP, treat the true disorder, and effect a favorable outcome for the child. Five patients with MSP are described, emphasizing a variety of presentations, often with a delay in diagnosis. In addition, features in the family unit are identified to aid in early recognition of the disorder, and a management protocol used at Children's Hospital of Pittsburgh is presented. Finally, the need for better care, recognition, and reporting to help determine the true incidence of the disorder and aid in educating involved professionals is emphasized.