Confusion and controversy surrounds the diagnosis of Munchausen by proxy syndrome, particularly concerning its differentiation from other forms of child abuse. A case has been made to dispense with the diagnosis altogether; however, restricting the term to those cases in which a parent fabricates symptoms or signs of illness in his or her child or tampers with pathology specimens could be more helpful. This would exclude those parents who repeatedly harm their child and place greater emphasis on the role of doctors in the aetiology of this syndrome.
In 1977 Meadows first described ‘parents who, by falsification, caused their children innumerable harmful hospital procedures, a sort of Munchausen by proxy syndrome’. Since then, the term Munchausen by proxy syndrome has been embraced enthusiastically by the medical profession, although it is often not clear who actually has the ‘syndrome’, the parent or child.