Guidelines for Suspecting and Identifying
Munchausen Syndrome by Proxy

NOTE: (Many "experts" seem to have different deviations of the below "symptoms.")

• A child who has one or more medical problems that do not respond to treatment or that follow an unusual course that is persistent, puzzling and unexplained.

Comment: This characteristic with its many or's, would apply to anyone who has a medical syndrome. There are literally thousands of current syndromes with new ones being identified each year. Each child who fits into a syndrome has more than one medical problem! Until the syndrome is found to be matching others, it is bizarre, puzzling and persistent. Many of the syndromes do not have an identified gene and this can make diagnosis difficult.

• Physical or laboratory findings that are highly unusual, discrepant with history, or physically or clinically impossible.

Comment: This is dependent on the interpretation of the doctor and his experience. The discrepancy in history may be due to the way in which the history was obtained and if the questions were asked in the same way as previous interviews. Also, a parent under stress might tend to exaggerate as a way of emphasizing their alarm.

• A parent, usually the mother, who appears to be medically knowledgeable and/or fascinated with medical details and hospital gossip, appears to enjoy the hospital environment, and expresses interest in the details of other patients’ problems.

Comment: Any concerned mother will take the initiative to learn as much as possible when faced with a child who is critically/chronically ill, especially if her child is yet undiagnosed. This is a hallmark of a concerned, advocating mother. On the other hand, if a mother has had a prolonged stay, it would be unusual for her not to connect with other parents as a means of mutual support and as a result share information about one another's children when that is the world they are living in. Also, there must be quite a few people interested in medical knowledge since the television is full of hit shows like "ER", "Chicago Hope", "Rescue 911", "Medical Detectives", -etc...

• A highly attentive parent who is reluctant to leave her child’s side and who herself seems to require constant attention.

Comment: This is another characteristic that any good, loving and advocating mother would have. One would have to ask who is making the claim that the mother requires constant attention. Is it a disgruntled nurse or doctor? Any mother who is truly an advocate will always brush some of the medical staff the wrong way in her endeavor to make things better for her child.

• A parent who appears to be unusually calm in the face of serious difficulties in her child’s medical course while being highly supportive and encouraging of the physician, or one who is angry, devalues staff, and demands further intervention, more procedures, second opinions, and transfers to other more sophisticated facilities.

Comment: Which is it? This characteristic describes a very broad array of emotion. Any mother who has spent much time in the hospital has learned that physicians are hesitant to discuss details if the mother seems emotionally unstable. Also, if a life-threatening event occurs, a mother may maintain a cool exterior, so as not to be escorted from the room. It is quickly learned, that to be an effective advocate, you must keep calm.

If the physician seems to care, the mother will feel gratitude and express it. There is nothing wrong with being ingratiating to a physician that shows compassion.

If a child continues to remain undiagnosed, both the mother and staff can become exasperated. A mother will become desperate and angry if she suspects that the physician has given up and the child is needlessly remaining in the hospital without a clue when things might improve. Also, there was a day when seeking second or third opinions was recommended by the finest physicians!

• The suspected parent may work in the health care field herself or profess interest in a health-related job.

Comment: Countless people who work in the health care field! It is a known phenomenon that parents who have a child saved by medicine aspire to give back what was given to them. Also, the mother of a child, who has endured a lengthy stay, might wish to pursue a career in medicine as a way of feeling that her child's suffering resulted in something good. Certainly that she would have the ability to empathize with others.

• The signs and symptoms of a child’s illness do not occur in the parent’s absence (hospitalization and careful monitoring may be necessary to establish this casual relationship).

Comment: It is obvious that a mother will notice things a nurse would not. A mother spends more than a single shift observing her child and so it is not uncommon that certain symptoms are better documented during a parent's presence. A doctor might see a patient for only 10 minutes per day. It depends on how "in tune" the observer is. Some symptoms naturally improve toward the end of the first year, just about the time a child is taken into "protective custody."

• A family history of similar sibling illness or unexplained sibling illness or death.

Comment: A syndrome many times will affect parents and siblings. (either to a lesser or greater degree)

• A parent with symptoms similar to her child’s own medical problems or an illness history that itself is puzzling and unusual.

Comment: As stated above, a syndrome might be present in the family. The same syndrome might have more prominent symptoms in the child and the parents might examine their own medical history in hopes of helping to find a diagnosis and speed their child's own cure.

• A suspected parent with an emotionally distant relationship with her spouse; the spouse often fails to visit the patient and has little contact with physicians even when the child is hospitalized with serious illness.

Comment: A chronically/critically ill child is known to put stress on the best of marriages. It may appear to be a distant relationship, but the mother and father have very different roles during this time and each has a hard time identifying with the other's stresses. A father may be visiting on week-ends while the physicians are off. During the week he has all the responsibility of a single parent, trying to keep a household functioning. Someone has to keep things together! Also, it is a fact that very few fathers spend much time in an ICU dept. A father might fear breaking down in front of others or feel that he is protecting himself from deeper heartbreak, by not allowing himself to become too attached, worried that the child might die.

• A parent who reports dramatic, negative events, such as house fires, burglaries, car accidents, that affect her and her family while her child is undergoing treatment.

Comment: When it rains it pours. Tragedy seems to come in waves and this is usually due to the fact that stress keeps parents from concentrating on things they normally would be conscientious of. Also, this is again very broad, depending on the length of an illness from months to years, many things can happen in that time.

• A parent who seems to have an insatiable need for adulation or who makes self-serving efforts at public acknowledgement of her abilities.

Comment: Again, who is the observer? Who is interpreting the mother's actions? Do they have an agenda? Is the observer someone disgruntled by a mom who is a good advocate and was the critic simply brushed the wrong way? Maybe the observer is envious. Most mothers who have benefited by support groups and/or charitable foundations will be asked to help in some way, whether it be by speaking at fund-raisers or even allowing their kid to be a poster child. No one works harder in a cause than someone who has "been through it."