The term Munchausen by proxy syndrome was coined by Sir Roy Meadow in 1977. MPS is an uncommon form of child abuse in which a caretaker, usually the mother, falsifies, simulates, or induces symptoms of physical illness in a child. The perpetrator then presents the child for medical attention, acting the part of an attentive, caring, and nurturing parent. Reasons for this deceptive form of abuse are diverse; however, in many cases the parent uses the child as a proxy for the parent to meet a psychological need to maintain interaction with members of the medical community. There has been much debate about MPS regarding definition, parameters of behavior to be included within the syndrome, and proper nomenclature. There is discussion about whether this syndrome is best described and managed as a form of child abuse or as a psychiatric disorder. Many of the perpetrators manifest no psychiatric illness other than the behavior associated with MPS. A major impediment to the diagnosis of MPS is the failure to consider the possibility that a parent could do something so awful. Once suspicion is aroused, it is advisable to proceed with a multidisciplinary team, since such cases are complex, and considerable information must be obtained. Psychotherapy with perpetrators of MPS is not yet well understood, although useful information is being developed. Berg and Jones (1999) have described an intensive inpatient therapeutic process that has had the desired effect. 59 references