The rise and fall of Munchausen Syndrome by Proxy; a critical review of the history of a child protection issue

Abstract

Munchausen Syndrome by Proxy (MSbP) child abuse was first described by Roy Meadow in 1977. As a paediatrician in Leeds, UK, he identified two children who attended hospital as a direct influence of their mothers fabricating their illness. Since then a plethora of articles have been published, largely in the medical press, relating to similar observations.
This thesis tracks the development of MSbP and its position in the child protection narrative through the next twenty years, exposing the uncertainty around its usage. By the mid-1990's serious doubts arose over the use of the term MSbP and in particular the subjective nature of recognised experts within the field in the UK. A number of pressure groups emerged that opposed the diagnosis of this type of child abuse. In 2003, the Court of Appeal (UK) released three mothers who had been convicted for the murders of their children, in each of these cases, the expert medical witnesses had been associated with MSbP.
I argue that MSbP is a medical constructed form of child abuse and that this is central to its potential demise in the UK, although, it continues to be part of the child protection narrative in the USA and I discuss this matter in some detail. I support this argument by examining and identifying parallels in a "medically constructed" diagnostic tool in child protection.
I conclude to suggest MSbP is a concept in chaos, despite this, it continues to be part of the paediatrician's narrative (Eminson & Jureidini, 2003). In this thesis I argue that the use of the term MSbP is neither in the best interest of the child nor the paediatricians. I conclude by suggesting the way forward in terms of child protection and how this would be better managed from a multi-disciplinary perspective.