CHILD-ABUSE PRESENTING AS MUNCHAUSEN-BY-P ROXY SYNDROME

The diagnosis of Munchausen by proxy syndrome, a subtle form of child abuse, is very difficult. One reason is a seemingly well caring ''idea l'' mother who is mainly responsible for the fabricated illness of her child, the other biologically and technically well trained medical do ctors maltreating the children unwittingly Doctors are often separated from each other by their subspecialities but nevertheless directly ap proached by the mothers. The latter frequently have a medical educatio n. A warning list of ''red flags'' of symptoms and clinical situations should sensitise the pediatrician for artificial illnesses and enable him to start diagnostic work-up early. One responsible doctor should coordinate all activities. The crucial step is a separation of mother and child, but a team approach involving child psychiatry, child wellf are organisations and legal authorities is mandatory. Therapeutic opti ons for the perpetrators are minimal. The prognosis is poor if such a child is not separated from his family or retransferred too early. Res earch to understand psychopathology and to develop new therapeutic opt ions is needed.