Munchausen syndrome by proxy abuse perpetrated by men

Fifteen families are described in which one or more child incurred factitious illness abuse as a result of the father’s false story and actions. The degree of direct physical harm, and the chance of death, was high in those families in which the father had Munchausen syndrome or marked somatising disorder. Eleven children died and another six survived repetitive smothering or poisoning. Although the extent of the risk to children living with a parent who has marked somatising disorder is unsure, theremust be vigilance on behalf of those children. (Arch Dis Child 1998;78:210–216)