Munchausen syndrome by proxy

Five children (3F:2M), in the age group 1 years to 11 years, with Munchause n syndrome by proxy are reported from the Sultanate of Oman. They were seen over a four years period from 1996-1999. In all these children, the mother came up with history of uncontrolled epilepsy. Carbamazepine was the most common antiepileptic drug used. One of these children remained hospitalized elsewhere for nearly 9 months, as a case of uncontrolled status epilepticu s. It took 18 months to 6 years (mean 2.8 years) to establish the diagnosis and the mother was the offender in all. The main lead to diagnosis, was th e disparity between history and clinical presentation to hospital. The carb amazepine levels were several times above the upper limit of therapeutic ra nge, Munchausen syndrome by proxy very much exists here, but is possibly le ss recognized and needs immediate attention to formulate policies to identi fy and manage these children. It is necessary to create awareness even in t he medical community, to recognise this problem. There is an urgent need to develop a child protection council at the national or regional level.