Munchausen by Proxy (MBP) Maltreatment Manifesting as Child Sexual Abuse

*MBP perpetrators deliberately feign, simulate, exaggerate, aggravate, or induce "problems" in others. There is virtually no medical or psychological malady that cannot be portrayed in MBP. Definitions follow:

Feign: The perpetrator gives false reports that the child has a problem.

Example 1: The mother of three-week-old David calls 911 to report frantically that the baby stopped breathing and turned blue, but that she resuscitated him with rescue breaths just in time. In fact, the child has been sleeping uneventfully.

Example 2: Knowing that Tamika, age 13, has not exhibited any problems, her mother calls a children's therapist for an urgent appointment. She states that she recently caught Tamika eating food out of the garbage and cutting herself with a knife, and that Tamika claims that a strange lady comes into her room at night.

Example 3 (Suspected Sexual Abuse Case Example): Even though she knows it is untrue, the mother of 6-year-old Danny makes a report to Child Protective Services (CPS) and states that, after his return from visiting his father last weekend, Danny told her that "Daddy made me touch his weenie" and that he is "afraid of Daddy."

Simulate: The perpetrator creates tangible evidence of a problem, but hides her own role.

Example 3: Kim, age 6 months, is a healthy child. Kim's mother mixes up a substance that looks like vomit and places it on and around Kim. Kim's father then comes into the room, sees it, and is told that "Kim has been throwing up again".

Example 4: Randy's mother tells his pediatrician that he has always seemed to be a sad little boy and that she feels he is very depressed. She produces a video of her 4-year-old son in which he repeatedly says he is going to kill himself. The doctor does not know that Randy is just pretending, in accordance with his mother's instructions.

Example 5 (Suspected Sexual Abuse Case Example): Karen's mother rubs her husband's sperm on 3-year-old Karen's panties, presents the panties to law enforcement, and states that she thinks Karen has been sexually abused by her stepfather. The child then undergoes pelvic and anal examinations under anesthesia.

Exaggerate: The perpetrator verbally embellishes a real problem.

Example 6: One-year-old Molly has a fever that has lasted a few days. Although she knows that the temperature has never risen above 100.5, Molly's mother repeatedly calls the pediatrician's office to say that, despite her following the doctor's instructions, Molly's temperature ranges from 103 to 105.

Example 7: Scotty, age 8, is a very active child who tends to constantly be in motion and is sometimes quite obstinate. His mother asks the pediatrician for a referral to a child psychiatrist, stating that he has daily temper tantrums that last for hours.

Example 8 (Suspected Sexual Abuse Case Example): Consuela, age 10, tells her mother that she has "itching between her legs." Consuela does have a slight rash on her inner thighs, but her mother calls the clinic saying that her daughter's "private parts are covered with a terrible oozing rash that smells."

Aggravate: The perpetrator worsens a pre-existing medical or psychological ailment.

Example 9: Jessica, age 6, has juvenile-onset diabetes mellitus for which daily insulin injections are prescribed. Her mother deliberately gives her too little insulin in each syringe, causing her blood sugar readings to be too high.

Induce: The perpetrator deliberately causes a real problem to exist.

Example 10: Infant Sam's day care provider smothers him with a pillow until he stops breathing, then calls a neighbor for help.

Example 11: Ten-year-old Vicky's mother repeatedly mixes pills from her own supply of Valium into Vicky's food. As a result, Vicky appears confused and is often incoherent, and she is eventually admitted to a psychiatric hospital for assessment.

Example 12 (Suspected Sexual Abuse Case Example): The local CPS agency takes custody of 8-year-old Min-Li because, following a visit to her father's home, she was found to have blood on her panties and a small vaginal laceration. Later, it is revealed that no such visit ever occurred and that the mother had nicked the child's vagina with a razor blade to create the laceration.

*Cases that appear to involve only false reports or simulation should be considered as dangerous as those in which induction of illness has been suspected or confirmed.