Munchausen syndrome by proxy: an outpatient challenge.

Primary health care providers are well aware of the physical findings that suggest a child has been intentionally maltreated. Practitioners must also be aware of a more subtle form of child abuse in which the parent victimizes the child by presenting fictitious medical history that initiates a sequence of unnecessary diagnostic and therapeutic interventions. A 4 1/2-year saga of such a case, an example of Munchausen syndrome by proxy in the outpatient setting, is reported.