There is a lot of misunderstanding out there about Munchausen Syndrome by Proxy (MSbP) including what it is and what it’s not. It’s a tough topic and an important one to understand with the government being more involved in our lives and parenting decisions than ever before. Accusations – true or false – have the capacity to break up families and destroy relationships.

MSbP is a condition where a caregiver makes their charge sick to gain some reward. The reward may be attention, sympathy, validation, or anything else the caregiver receives in return for their patient being ill. Typically, the relationship involved is that between a parent and child. MSbP is considered to be abuse. Harm undeniably comes to the recipient of the abuse and cases of death have been reported.

This syndrome is not poor parenting. Disagreeing with medical professionals or getting a second opinion does not indicate MSbP. Those things can undeniably place a child at risk when taken to the extreme, but a label of Munchausen Syndrome by Proxy is inappropriate. The words we use matter.

If it’s abuse or neglect, why does it matter what particular label we use? When you report someone to a medical professional or Child Protective Services, how you document the problem in the report will decide the initial direction of the investigation. If the parent you’re reporting isn’t following the doctor’s orders because they disagree but you state it as MSbP, the investigation will center on whether or not the parent is making the child sick and providing proof to that effect. It draws attention and energy from what that child needs, which is mandated adherence to the doctor’s orders.

Muddying the definition and misidentifying the syndrome also hurts efforts to increase awareness and identify real cases of MSbP. MSbP is hard to catch at times depending upon the experience of the medical professionals involved. The ones who have seen it in action know how to tell. Not all have seen it – its occurrence is rare. When the doctors aren’t knowledgeable on the topic friends and family can be a critical step in getting the underlying cause of the child’s medical difficulty identified.

There are a few concepts that will shed some light on the difference between poor choice and MSbP:

• Second Opinion vs. Doctor Shopping – Second opinions are common place and critical to making the correct decision when the path forward is unclear, or the stakes are high. Once you have seen three or more doctors you’re meandering into the range of what’s called “doctor shopping.”
  It’s suspicious because it gives the appearance that instead of taking a qualified expert’s opinion you’re looking for a specific answer instead. This path is an approach MSbP sufferers use to find an unsuspecting doctor who will play into what they want to occur whether it be a minor medical intervention like a medication or a major one such as surgery.
• Disobeying the Doctor vs. Intentionally Making Your Child Ill – Doing either one of these is horrible. They’re also very different. Sometimes parents make bad decisions on behalf of their children. Instead of getting a second opinion they might just tell themselves the doctor is wrong and ignore their instructions, never following up. That’s OK if you’re managing your medical care but if you have a dependent and the doctor says care is needed – you don’t necessarily have a choice. That is, however, very different from intentionally making your child sick.
  The former is bad; the latter can’t be anything else but medical abuse. When you make an accusation of MSbP you’re telling the person you report to that the caregiver is mentally ill and that the person receiving care is being harmed. I will not list methods here in detail for fear someone mentally ill might stumble across this article and use them. I will say poisoning is extremely common and you’re unlikely to catch the perpetrator in action. If you suspect you know what the caregiver is using, contact the child’s medical professional and they will find a way to provide evidence.
• Advocating for Care vs. Pushing Medical Intervention – Children with disabilities and children who are medically complex need an advocate desperately. Medical professionals are simply too busy to give the kind of attention to every detail needed to coordinate a child’s care between multiple specialists and across various hospitals. It’s unusual for a parent to pick a medical intervention, especially an invasive surgery, and insist it is performed without it being recommended to them prior.
  They sound similar, but they’re very different in the core motivation. One way to differentiate, MSbP sufferers will tend toward extreme resolutions and unnecessary and dangerous procedures that may be extremely invasive. Advocates tend more toward questioning and might get a second opinion about a procedure if it’s brought up as a future option to avoid having the procedure done unnecessarily. In essence, an advocate will seek to prevent their child’s pain while an MSbP sufferer will attempt to maximize their reward. Typically, maximizing the reward – usually in this case sympathy and attention – is accomplished by having the child go through the most painful and agonizing route possible.

As knowledge of MSbP has increased, more medical professionals are pushing to place it under the umbrella of Medical Abuse. That is, after all, what it entails. The motivation behind the abuser isn’t as important as recognizing the abuse and removing the abused individual from their care. If you’re unsure of why a caregiver is causing harm and still believe they are Medical Abuse may be a better term to use. That way the focus remains on removing the abused person from the environment with time provided later to evaluate the caregiver.

More information can be found at WebMD.