Munchausen syndrome by proxy describes the condition in which child presents a physician with a factitious illness with the corroboration of the mother who fabricated the illness. Since 1977, the diagnosis of factitious illness in children has been increasingly recognized. Although Munchausen syndrome by proxy may in some cases be managed effectively with psychiatric intervention, a parent with Munchausen syndrome is less likely to respond to even aggressive treatment. A mother who produces factitious illness in her child experiences a deep emotional need to be the recipient of medical care and nurturing. Of families diagnosed with this syndrome, the father is typically only involved on the periphery of the ongoing medical care. An aggressive approach to court-ordered separation of the mother and children is critical to insuring the subsequent safety of the children. Although the mother in this case study was separated from the daughter following diagnosis, subsequent visitations resulted in a recurrence of factitious disease. This family has been followed through three years of subsequent care which permitted the family to be reunited with decreasing levels of supervision. 1 figure, 2 tables, and 12 references (Author abstract modified)