Medical Child Abuse

Information has been excerpted from VisualDx clinical decision support system as a public health service. Additional information, including symptoms, diagnostic pearls, differential diagnosis, best tests, and management pearls, is available in VisualDx.


Munchausen syndrome by proxy, also termed medical child abuse, is a psychiatric condition characterized by the infliction of illness or injury by one individual onto another. This is often a parent causing illness to their child for psychiatric reasons rather than to inflict harm.

Clinical presentation can vary widely as affected individuals can appear as injured or ill from any number of diseases, but commonly these patients are high utilizers of the health care system who have symptoms that are not well explained by a known medical condition. Children affected by Munchausen syndrome by proxy can present with fabricated stories of medical illness or inflicted medical illness by their caregiver, and they are consequentially subject to extensive medical testing and treatment.

Many patients will improve during hospital observation but worsen after discharge when they return to their abusive environment.

Related topics: child abuseMunchausen syndrome

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Munchausen syndrome by proxy requires a high index of suspicion from the clinician and has no specific or sensitive laboratory, imaging, or physical examination findings. Evaluating for inconsistencies among the history, physical examination, and medical testing results is paramount to considering the diagnosis. Querying multiple caregivers to identify medical history inconsistencies is also important. There may be a history of frequent changes in medical providers.

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