There is a rare disorder and the exact

are many types of child maltreatment, but Munchausen by Proxy is one of the
most difficult abuses to detect. Munchausen by Proxy (MSBP) is defined as a
psychological disorder that involves the embellishment or fabrication of an
illness, by a parent or a caregiver. This type of syndrome is a rather rare
type of behavioral disorder and is mainly induced by a mother. The person
affected by this disorder gains attention by seeking medical help for
exaggerated symptoms of a child in his or her care (Munchausen Syndrome by
Proxy – Topic Overview, 2005).  The adult
puts on a facade of being a dedicated and loving caregiver but when alone with
the child she or he will deliberately subject them to abuse to intentionally making
them sick. The perpetrator will falsify medical history and symptoms to meet
their own disturbed psychological needs. Munchhausen by proxy is a rare
disorder and the exact cause of this type of abuse is unknown (Munchausen
Syndrome by Proxy – Topic Overview, 2005). Professionals conceive that both
biological and psychological factors are involved with this disorder. It has
been found that many people that have been diagnosed with MSBP were physically,
emotionally, or sexually abuse during their childhood (Pietrangelo, 2016). Children
who are victims to this type of abuse often undergo extensive emergency care,
unnecessary procedures, and painful surgeries. A caregiver with MSBP will
deliberately create symptoms in a child by poisoning, suffocating, starving
them, or withholding medications they may need (Munchausen Syndrome by Proxy –
Topic Overview, 2005). Since identifying this disorder is very difficult
because of the deceitfulness involved, doctors must rule out any possible
illness before making a diagnosis of MSBP. 
Understanding the indicators and symptoms is extremely crucial to detecting
this type of child abuse. If a case is reported it requires police
investigation, legal prosecution, and treatment for both abuser/abused.

of this disorder can be extremely hard to recognize and detect. A parent will
appear to be very caring and loving of their child which typically makes it
easy for doctors and family members to overlook the likelihood of MSBP (Pietrangelo,
2016).  Doctors will only begin to become
suspicious when a child is brought in frequently with injuries or sicknesses or
when the caregiver exhibits attention-seeking behavior and exaggeration of the
child’s symptoms (Pietrangelo, 2016).  Most
symptoms of the child’s sickness will clear up if hospitalize but as soon as
they return home with the caregiver the symptoms mysterious return. Most doctors
first try to rule out all specific illnesses. When the child continues to
present with unexplained sicknesses further investigation will take place to
insure the safety and well-being of the child.

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a doctor determines that a caregiver is in fact intentionally abusing their child,
law requires them to report any suspicions to proper authorities. Officers
should follow the same procedures as they would for investigating any other
type of child abuse or neglect claims (Kulbarsh, 2011).  The child will be interviewed as well as the perpetrator.
There are issues and hurdles that make these interviews complicated.  For instance, children are sometimes too
young to explain exactly what has been occurring. They may also not understand
that their parent or caregiver is intentionally make them sick. Interviewing
child victims requires understanding and adherence to certain procedures. When
it comes to interviews with the suspect they are usually very experienced with
lying and can be in denial of the abuse (Kulbarsh, 2011). In some cases, the
abuser may not even realize the magnitude of the problem until it has been
brought to their attention. It is important for officers to discuss offenders’
families and personal histories to build a rapport and be aware that the abuser
has most likely been the victim of abuse themselves.

people with MSPS frequently move from different doctors and hospitals making it
difficult for law enforcement to establish a pattern of abuse (Kulbarsh, 2011).  It is crucial that law enforcement review
medical records from all hospitals and doctors to provide evidence of the
abuse. Interviewing any medical personnel that treated the victim can possibly
provide more insight to how the suspect had been injuring the child (Kulbarsh,
2011). Being able to compile detailed social history of the family could shed
light on other injuries, illnesses, and possible deaths of other children.
Finally, a search warrant should be issued for the family’s home to collect
evidence of the assaults.

To stop
this cycle of abuse, officers need to attain sufficient admissible evidence to
convict an offender (Hanon, 2013). One effective way to obtain proof is by
recording the offender at the hospital. If video cameras are used, then a court
order will likely be required. Sound is usually not a major element in videotaping
of MSBP cases. Most of the abuse is done through simulation such as poisoning
and suffocation. Obtaining a court order is considerably less complicated since
judges do not have to deal with wiretap laws (Hanon, 2013). If the investigator
suspects that the child is being poisoned then tubing, I.V.’s, and needles need
to be collected for evidence and should be marked to maintain the chain of
custody. It should include date, initials of person obtaining the evidence and
the child’s name. All materials collected will be transported to the State
laboratory where the officer and lab personnel need to sign a chain of custody
form (Hanon, 2013). Local procedures may vary, but officers should recognize
and follow all jurisdictional measures for handling evidence (Kulbarsh, 2011). If
the chain of custody is not properly documented and maintained, it could cause
a very negative outlook for the case in court. In some occasions it might even
allow the abuser to be found not guilty of the crime they perpetrated onto
their own child.

there is sufficient proof of an MSBP case, an investigator should take the
offender into custody immediately. This will prevent any further injury to be
done to the child, or self-inflicted injury by the offender. If possible,
officers should not arrest the offender in front of the victim because this
will cause unnecessary trauma to the child. 
Investigators may ask help from medical personnel who can explain the
situation to the child (Kulbarsh, 2011). 
Sadly, some ways this disorder concludes is the death of the child, or the
perpetrator transfers the abuse on to another child within the family. In most
cases though, the suspect is caught and prosecuted by the justice system.

example of how this disorder presents itself is the case of Blanca
Montano.  On February 2011, Blanca
Montano took her two children to an Arizona Hospital with flu-like symptoms.
Testing determined that both of children had an infection, which was diagnosed
as E. coli (Weaver, 2017).  Doctors
treated both the son and daughter but only the son was released while the
daughter just got sicker and sicker. The little girl was transferred to
intensive care and over the course of her hospital stay she contracted nine
different infections (Weaver, 2017). Staff at the hospital noticed that every
time the girl was alone with her mother her condition deteriorated.  The little girl was subjected to a
laparoscopic surgery, and a bone marrow biopsy, but doctors could not determine
a cause of the infection (Weaver, 2017). The staff grew suspicious of her
behavior because Montano was exhibiting indicators of Munchausen Syndrome by
Proxy. They decided to install a camera in the girl’s hospital room to monitor
Montano interactions with her daughter. It was confirmed that Montano was in
fact contaminating her daughter’s IV line while covering the camera lens.  The staff reported their concerns to Tucson
Police Department where they launched an investigation into Montano suspicious
behavior (Weaver, 2017). Police contacted CPS, who quickly barred Montano from
visiting her daughter. This helped confirm that Montano was intentionally
making her daughter sick because the little girl began to improve significantly
(Weaver, 2017). Police arrested Montano for poisoning her own daughter and
charged her with one count of child abuse (Weaver, 2017). During the trial the
prosecution alleged that she was simply looking for attention. Montano was
found guilty and sentenced to 13 years in prison for what she did to her
daughter (Weaver, 2017).

cases like Blanca Montano’s will be prosecuted which will help serve justice
for the victim, but it can be a difficult process convincing a jury that
mothers are intentionally harming their children. Many prosecutions rely on
expert testimony regarding the forms of abuses that appear in MSBP, such as
suffocating, injecting poisonous substances, or infantilizing (Goldman &
Yorker, 1999). Various types of evidence can be used to prosecute caretakers.
Examples include covert video surveillance, eyewitness accounts of suspected
abuse, and finding toxic levels in the child’s blood (Goldman & Yorker,
1999). Physicians and nurses may testify regarding their knowledge of behaviors
they observe, and they can also be called to testify as “expert” witness. As an
expert witness they are often asked to provide their opinion on whether they
believe the defendant meets the criteria of having MSBP. Expert testimony is
not automatically admissible in court, as there are several obstacles that must
be handled before it can be admitted (Goldman & Yorker, 1999). For example,
the problem of admissibility of expert testimony occurred in the case of People
v. Phillips. In 1981, Priscilla Phillips was found guilty of murdering one of
her daughter’s by using a sodium compound to poison her and endangering the
health of another daughter (Vollaro, 1993).  Phillips adopted Tia whom was continually
hospitalized for diarrhea and vomiting. 
All tests that were done on the Tia came back with no abnormalities
except for blood tests that repeatedly showed high levels of sodium. A little
after a year of Tia being constantly sick she died and doctors where perplexed
by the circumstances surrounding her death. Shortly after Tia passed away
Phillips adopted another little girl named Mindy who also started to have
issues with diarrhea and vomiting. Blood tests were done and came back with
elevated sodium levels just like Tia’s blood work. The pediatrician who took
care of both girls decided to explore why Mindy was presenting with the same
exact mysterious illness as Tia.  Child
Protective Services was eventually contacted, and abuse charges were filed on
behalf of both daughters. As part of the prosecution’s case it was suggested
that MSBP was the motive for Phillips poisoning Tia and attempting to poison
Mindy (Vollaro, 1993). A psychiatrist was called in to testify as to the signs
and symptoms of MSBP. The psychiatrist had never treated anyone with this
disorder nor had he ever treated Phillips. The testimony was based solely on
reports he had read in medical journals. On appeal, defense argued that the
expert’s diagnosis of MSBP was not reliable because the expert testimony was
admitted based exclusively on reports of others and MSBP was not widely
accepted in the medical community (Vollaro, 1993). The court overruled this
objection and held that MSBP is not an unrecognized illness and in the most
recent version of the DSM it is categorized as a mental illness (Goldman &
Yorker, 1999).  This case shows how the
expert is the most valuable witness in the prosecutor’s case involving MSBP.  Establishing the expert’s medical training and
expertise is vital in the role of proving that they can diagnosis the defendant
with the disorder. Juries also need to hear this testimony because they need to
also be able to understand how MSBP really effects a person. Until the community
truly understands the rare intricacies of this illness and convert forms of
this abuse, experts will always be a necessity in most cases. 

Not all
children that are victims of MSBP will be taken away from their abusers. In
less severe cases of MSBP family services try refrain from removing the child
from the home. As with any type of child abuse achieving and maintaining the
safety of the child in the least obstructive setting as possible is the focus.  Generally, removal from the home and
placement in foster care causes total disruption of the child’s life, including
loss of friends, family, and familiar settings. When family members and child
services can maintain safety of the victim in the home then the child will not
be removed. However, if there are any indictors that he/she is at any risk of
harm then steps will be taken to place the child in a safer environment.
Treatment for both the victim and abuser is of paramount importance. When
working with the child, therapists teach the victim coping skills and ways to
understand their underlying feelings of what has happen to them and their
caregiver. Individual psychotherapy will also be incorporated into the
treatment program for both the victim and perpetrator. Ongoing checks of any
medical treatment will be monitored.  In
some cases, the primary-care doctor will be notified by the insurance company
of any use medical services regarding the victim or the victims siblings. If
the caretaker is not willing to admit that there is a problem, then treatment
will more than likely not work. This could cause the abuse to eventually
recommence which is why its so important for ongoing checks to be implemented
into the offenders and victim’s life.

conclusion, MSBP is a form of child abuse that sometimes goes unnoticed and undiagnosed
due to the inability to identify a caregiver covertly abusing a child. It is
often difficult for physicians and law enforcement to believe that loving
mothers are intentionally hurting their own children. This disorder is slowly
being recognized more in the medical community, and law enforcement must remain
attentive to any present cases. Many unexplained deaths of children could have
been avoidable homicides if more awareness of early warnings signs where better
understood. When the medical community, law enforcement, and prosecution work
cohesively together there may be hope for ending this type of abuse of