Is Munchausen syndrome by proxy really a syndrome?

Abstract

SPECIFICITY Dr Morley is right that many of the criteria used to identify situations in which Munchausen syndrome by proxy should be suspected are relatively non-specific and cannot be considered as diagnostic on their own. Nevertheless the presence of several criteria does, if nothing else, raise the chances that the child is at risk. All paediatricians would obviously agree that it is crucial to listen carefully to the information provided by the carers and I am sure we would all also agree that at times we fail in this respect. Although it is obviously true that the child will probably spend more time with the carer under suspicion than other family friends and relatives, natural recurrent events usually are witnessed by others at some time or another. It is therefore essential to obtain independent corroborative evidence rather than relying on the statement of the carer. It is also important to stress that the onset of the event must be seen as otherwise the cause will remain in doubt.2 Inconsistent histories are a more useful pointer than has been claimed by Dr Morley. Much weight has been placed on the importance of identifying inconsistencies in the description of events in the diagnosis of child abuse. If they are helpful in that condition they are also useful in the identification of Munchausen syndrome by proxy. It is possible to make a case that the only diagnostic role of overt cardiorespiratory (or electroencephalographic)3 monitoring is that a sequence of events can be documented which may differ very considerably from the history described by the carer. Sadly, along with child physical and sexual abuse Munchausen syndrome by proxy does occur and can constitute a real threat to the survival of the child. Inevitably if we are to identify these children, we will have to suspect some carers who are totally innocent. Dr Morley's article reminds us of the effects of these suspicions on the carer and the family. We cannot, however, put our heads in the sand and pretend that Munchausen by proxy does not occur.