Illness in the child may be counterfeited in several ways. It may be simulated, produced, or both. Child victims of MSBP are typically under 5 years of age, but many MSBP cases involve older children as well. Older children sometimes adopt the symptoms as their own, believing themselves to be genuinely ill. Almost by definition, MSBP entails a lengthy amount of time from onset of the child's symptoms until correct diagnosis; the average span is about 15 months. Parents who perpetrate MSBP are commonly described as even-tempered, engaging, middle-class, and educated in some aspect of medicine or nursing. Recommendations to facilitate the diagnosis of MSBP, as opposed to a genuine organic illness, are offered. Differences between homicidal MSBP and sudden infant death syndrome are examined, and appropriate interventions in cases in which MSBP is suspected are noted. 44 references