Child Abuse: Munchausen’s Syndrome By Proxy

By Kathryn A. Hanon

Investigator Orlando, Florida, Police Department

This article originally appeared in the FBI Law Enforcement Bulletin, December 1991.

The range of investigations for modern day law enforcement officers is unparalleled in the history of criminology. Investigators must use innovative techniques in order to solve today’s more sophisticated, bizarre criminal acts.

For example, cases of an obscure form of child abuse–Munchhausen’s Syndrome by Proxy (MSBP)-are being seen more and more frequently. MSBP is a form of child abuse that involves long-term physical abuse, usually by a parent.

However, in order to conduct MSBP investigations effectively, it is necessary to understand the complexity of the disorder and the unorthodox investigative procedures that may be necessary to prosecute the case successfully. This article discusses the disorder and how officers should approach the investigation of this crime.

Defining The Syndrome

Munchhausen’s Syndrome by Proxy is a form of child abuse in which the abuser fabricates an illness in a child. When the child is taken for medical care, the parent tells physicians that there is no apparent cause for the illness, knowing that this will most likely result in the hospitalization of the victim for tests or observation. It is during this period of hospitalization that the actual abuse usually occurs. In one known case of MSBP, a mother injected fecal material into the victim; in another case, a mother suffocated and then revived her child on several occasions during the hospitalization period.

Symptoms of MSBP are generally recognizable by the time the victim reaches 14 months of age. However, MSBP is usually not diagnosed until the child is approximately 3 years of age. The mortality rate for this type of abuse is high.

There are both mild and severe cases of MSBP. In mild cases, the parent fabricates a history of a non-existent condition in the child. For example, some parents contaminate their children’s feces with blood and claim that they passed the blood.

In severe cases of MSBP, a parent actually harms the child in order to create symptoms of an illness. Suffocation or blood poisoning are typical in this form of MSBP.

Offender And Victim Characteristics

Most MSBP offenders are mothers of the victims. However, there have been cases where the offender was the father or a person outside of the family.

MSBP offenders are uncharacteristically calm in view of the victims’ baffling medical symptoms, and they welcome medical tests that are painful to the children. They also maintain a high degree of involvement in the care of their children during treatment and will excessively praise the medical staff. They seem very knowledgeable of the victims’ illnesses, which may indicate some medical study or training. They may also have a history of the same illnesses being exhibited by their victims.

In addition, MSBP offenders typically shelter their victims from outside activities, such as school or playing with other children, allowing only certain persons to be close to them. They may even speak for the victims when anyone approaches them. MSBP offenders are attentive to their victims, even though they are harming them. They seem to find emotional satisfaction when their child is hospitalized because the hospital staff believes that their attentiveness indicates that they are good parents.

Victims of MSBP can be of either gender. They are often immature for their age, due to their forced dependency on the abusing parent, and female victims may assume multiple roles. For example, they may take on a motherly role as they imitate their closest role model–the offender–and then regress to the role of a sick, weak, dependent child.

Characteristics Of Non-Offending Parent

MSBP victims are rarely abused by their fathers. Passive and indifferent, the father does not play a primary role in the care of the sick child. His hospital visits with the victim are limited, and although he may be suspicious of the baffling course of his child’s illness, he is unable to stop the child’s abuse.

The Victim’s Siblings

There is a good chance that younger siblings of MSBP victims will also be abused. When offenders stop abusing their victims–either because the child gets older and more mature or because the child dies–they may look to their other children in order to continue the abuse. A study of the medical history of these children may indicate whether there is a pattern of abuse within the family.