I took care of a suspected Munchausen's by proxy child once (in my former
life as a Pediatric Intensive Care Unit RN).  The mother had taken the child
(a preverbal toddler) to a couple of different emergency rooms.  The child
was cyanotic (but recovered rapidly when oxygen was administered)----the
mother claimed that the child had suddenly stopped breathing and that she had
tossed him into the car and rushed to the hospital.  Thorough and lengthy
testing was negative.  The child was sent home, and a few weeks later, the
cycle would begin again.  When the physicians at the first hospital became
suspicious, mother started patronizing another emergency room.

She was finally referred to our hospital---allegedly for more testing, but
actually for observation prior to a psychiatric and CPS referral (physicians
suspected she was smothering the child in or near the emergency room parking
lot).  Mothers with Munchausen's by proxy can be very difficult to deal with
(as I found to my dismay).  They can seem like very loving, attentive and
dedicated mothers, but they relish the sympathy and attention they receive
from medical personnel (and social services, and the chaplain, and their
neighbors...) when their beloved child becomes ill.  Document everything!!!
 I caught the mother feeding the child cow's milk she had purloined from the
Pediatric refrigerator---she had written on the admissions form that the
child was allergic to cow's milk.  She became hostile and sullen when I
refused to let her take the child to the playroom.  I gently explained that
he needed to be on the cardiac monitor in case he had a "spell" (I wasn't
about to let him out of my sight!) and she replied, "But he won't have a
spell!  I can always tell when he's about to have one!"  Needless to say,
this directly contradicted earlier statements about how the "spells" were
sudden and unpredictable...Warn everyone!!!  I had to take a break sometime,
and the child could not be left alone with the mother.  Still, some hospital
personnel had a hard time believing the diagnosis---"But she's so nice, and
she LOVES that child!"

If Munchausen's by proxy is suspected, the child's pediatrician, social
services and CPS should be notified.  There's a very sad (but well
researched) book called From Cradle to Grave (sorry, can't remember the
author)---a woman who murdered her offspring (at least six?) by smothering
them.  Because she went to a different ER each time, medical personnel never
caught on, and attributed the deaths to everything from SIDS to
Werdnig-Hoffman Syndrome.

Sorry to be so depressing.

Ana Rita Guzmán
LLL Leader