Medical child abuse and factitious disorder imposed on another: two diagnoses, one child-a narrative review for paediatricians.

UNLABELLED: Medical child abuse (MCA) and factitious disorder imposed on another (FDIA) do not describe the same person. MCA is a diagnosis given to a child harmed by unnecessary medical care initiated by a caregiver; FDIA is a psychiatric diagnosis given to the adult who falsifies illness in another. This review summarises the clinical features, diagnosis and management of MCA in children and relates MCA to FDIA and to the British concepts of fabricated or induced illness (FII) and perplexing presentations (PP). Structured narrative review of PubMed, last updated in September 2026, using the terms Munchausen syndrome by proxy, factitious disorder by proxy, medical child abuse, FDIA, pediatric condition falsification, caregiver-fabricated illness in a child, FII and PP, without age restriction for the perpetrator literature. Of 33,296 records identified, 131 sources were retained after independent screening by two reviewers. A qualitative synthesis was performed. MCA is defined by harm to the child, whatever the caregiver's motivation. FDIA is one possible explanation of the caregiver's behaviour, alongside anxiety, misinterpretation of symptoms, external gain or coaching of the child. FII and PP describe the same situations from the paediatrician's standpoint, PP corresponding to alerting signs before harm is established. Warning signs converge across terminologies: discrepancy between reported and observed findings, multiple providers, escalating investigations, improvement in the caregiver's absence.

CONCLUSION: Paediatricians diagnose MCA from the child's care trajectory; the caregiver's diagnosis belongs to adult psychiatry and is not required to protect the child. Keeping the two diagnoses separate may support earlier recognition and safer management.

WHAT IS KNOWN: • Medical child abuse and factitious disorder imposed on another are underdiagnosed and described under several national terminologies. • Terms are often used interchangeably, blurring who is diagnosed and by whom.

WHAT IS NEW: • The terminologies are mapped onto one distinction: the child's diagnosis versus the adult's diagnosis. • A shared set of alerting signs supports child protection without inferring the caregiver's intent.