Researchers first documented the serial nature of MSBP victimization in a study of 18 children in five families. In each family only one child was involved at any given time and five children appeared to be totally unaffected; 31 percent of the victimized children died. Large majorities of MSBP offenders have backgrounds in health professions, manifested Munchausen syndrome themselves, received previous psychiatric treatment, and attempted suicide. This article addresses issues related to investigative techniques, victim interviewing, victim safety, false allegations, child custody cases, substitute victims, and the role of MSBP in domestic abuse and child homicide cases. While police investigators may find it hard to believe that an adult seemingly concerned about a child's health could be causing the child's symptoms, a growing list of cases proves that MSBP represents a substantial challenge to the criminal justice system. 6 notes