Munchausen syndrome by proxy is a very special and dangerous form of child abuse. It is characterized by a child withsymptoms and signs of an illness that have been fabricated by an adult, usually the mother. Fabrication of those signsand symptoms leads to many unnecessary and painful investigations and treatments for the victim. Although manyphysicians are familiar with the sexual or physical abuse of children, they are unaware of this particular form of childabuse. Fortunately, awareness among pediatricians will increase as more cases are shared in the literature. Difficultiesremain in defining the condition, as well as in the detection and differentiation from other illness. Although it is a relativelyrare form of child abuse, pediatricians need to have a high index of suspicion when faced with seemingly inexplicablefindings or treatment failures. Diagnostic strategies should be case-specific and a multidisciplinary approach suchas from a Child Protection Team is crucial for proper management and effective treatment planning in these cases.This review will discuss the epidemiology and diagnosis of Munchausen syndrome by proxy, as well as the role of thephysician in sorting out these cases.