Munchausen syndrome by proxy in false allegations of child sexual abuse: legal implications.

A review of the literature regarding Munchausen syndrome by proxy in relation to allegations of child sexual abuse is presented. Problems in the diagnosis of Munchausen syndrome by proxy in these cases can be the result of a failure to consider that the allegations may be false, legal issues surrounding the child's testimony, and other biases in professional and legal attitudes towards allegations of sexual abuse. A proposal for a more stringent standard of care is made. Treatment of Munchausen syndrome by proxy is best effected by case management, with the person who made the diagnosis managing the case throughout the treatment. This person should act as liaison to relay information between all the parties involved.