Although some victims have died due to such abuse, most victims suffer a degree of either physical or psychological damage, either at the hands of the perpetrator or through diagnostic and therapeutic interventions ordered by unwitting physicians. The abuse in these cases is clearly premeditated, which makes it different from impulsive child abuse syndromes. In the past decade a new twist to Munchausen Syndrome by Proxy has emerged. The authors call this new phenomenon "Forensic Munchausen Syndrome by Proxy." This involves the fabrication of allegations of child sexual abuse by a parent in the context of a child custody dispute. Typically, divorcing parents or families bring their children into the hospital on their visitation weekend or after the child is returned to the custodial spouse, complaining that the other parent is abusing the child either sexually or physically. Three cases are summarized to show the features and dynamics of such parental behavior. This article lists some warning signs that Forensic Munchausen Syndrome by Proxy may be operating in a given case. The signs are as follows: only one parent brings the child to the hospital emergency department; the parents have pending domestic litigation in a divorce and/or child custody dispute; the caregiver submits a chief complaint of sexual abuse by the spouse; there is no physical evidence or adult witness to corroborate the accusation; and the child may freely admit abuse with mannerisms and words that suggest careful coaching. 6 references