Child Abuse: Munchausen’s Syndrome By Proxy

Recognizing MSBP

Because cases of MSBP are often times first recognized in hospitals or doctor’s offices, it is imperative that the medical community be aware of this type of abuse. MSBP should be suspected if illnesses in children remain unexplained after medical testing, and there is a history of multiple visits to different hospitals and physicians.

Primarily, observing an ill child during a hospital stay can support a suspicion of MSBP. In such instances, the suspected victim should be placed in an open ward, where there is less opportunity for the offender to continue the abuse. This also gives hospital personnel a chance to observe any changes in the patient’s symptoms. If the symptoms cease and then recur when the victim is again readily accessible to the offender, in all likelihood, MSBP is taking place.

A Team Approach

When law enforcement officials are contacted concerning suspected cases of MSBP, it is critical to use a multidisciplinary approach to the case. Medical staff, child protection teams, social services personnel, and hospital administrators, as well as prosecutors and law enforcement personnel, should assist in the investigation.

The early involvement of prosecutors is especially helpful in MSBP cases because there is little existing case law to which investigators can refer for guidance. Therefore, it is important to coordinate the investigation with those who will prosecute the case.

Medical staff, including physicians and nurses who have attended the victim, may suspect abuse before law enforcement’s involvement in the case, and therefore, may be able to contribute valuable information to the investigation. However, for security reasons, investigators should limit the number of staff who are aware of the investigation. Investigators should gain the cooperation of some primary care personnel during the investigation, and after the investigation is completed, officials should strongly consider seeking psychological treatment for both the victim and the offender.

Many States require that investigators inform social services of any child abuse investigations they conduct. Those in social services can help investigators follow particular guidelines and meet set time constraints for resolving this type of case. It may also be necessary to have social services waive certain requirements because MSBP investigations are sometimes lengthy due to the confidentiality aspect.

Child protection teams work directly with the medical staff and serve as excellent liaison between law enforcement and medical personnel. Because inter-agency agreement is important in these investigations, it is a good idea to hold regular meetings to discuss how the case is being managed. Cooperation between all of the involved agencies is imperative in cases such as these.

Although all team members should approach cases from their respective jurisdictions, the common goal should be to ensure the safety of the victims. If the abuse is not stopped, the family will relocate, and the abuse will continue. As the cycle of abuse continues, the victim is subjected to further risk of permanent injury, painful medical tests, or even death.


In order to stop the cycle of abuse, investigators must obtain sufficient admissible evidence to convict the abuser. A particularly effective way to obtain proof in MSBP cases is to use concealed cameras to videotape evidence. For example, ceiling cameras can record a wide range of movement, and they can be easily hidden in hospital rooms.

However, placement of video cameras in hospital rooms will likely require a court order.1 In making application for such an order, investigators should stress the necessity of videotape evidence so that judges will better understand exactly what is needed in MSBP cases.