Fabricated or induced illness in children

Munchausen by proxy comes of age

In 1970 the Department of Health issued a small orange booklet, The Battered Baby. For 25 years the association of fractures and subdural haematoma with wilful violence had been known, but Kempe had coined this emotive title only eight years before. That form of abuse is now only part of the whole range of harm to children that society has recognised. Last month the Department of Health continued the story by issuing multidisciplinary guidance on fabricated or induced illness in children.

Significant harm to children such as smothering or poisoning which simulated illness and which involved and deceived doctors has been known for at least 40 years. It took the honesty of Roy Meadow to describe his personal experience and his journalistic flair to label it “Munchausen by proxy” in 1977.1 His article drew the world's attention to fabricated or induced illness and led to more accounts, to reviews,2 and to research—though research has not been helped by arguments about what is or is not Munchausen by proxy.3

Even today one has to state clearly that some carers, including parents, do harm children, and that they sometimes involve health professionals in doing so. Doctors and others may not only fail to understand the origins of …