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One of the things that medical practice teaches the observer of human nature is that no behavior is so bizarre that humans are incapable of it and will not indulge in it. Indeed, they often seem to take delight in inventing new forms of destructive and self-destructive conduct to assert their freedom from the dictates of reason and good sense. I have not been entirely immune from this tendency myself.

Among the stranger patterns of behavior that doctors encounter is that of parents, overwhelmingly mothers, who deliberately exaggerate, make up, or physically induce symptoms in their young children so that they are investigated, often extensively, by doctors. The first two mothers whom I ever encountered who did this put blood in their child’s urine and interfered with thermometers in order to make it appear that their child was suffering from fever.

An article in a recent edition of the Lancet reviews what is known about this very odd and dangerous conduct (6 percent of children whose mothers induce symptoms in them are eventually killed by them, and 25 percent of them have siblings who have died in suspicious circumstances).

How common is this behavior? The article reviews the various estimates. In part it is a matter of definition, which is why the estimates vary between 2 and 89 per 100,000 children. This variation alone suggests a dimensional rather than a categorical phenomenon. An Italian study found that 0.5 percent of children seen in a pediatric clinics were the victims of factitious illness reported or induced by their parents. The authors do not speculate on variations in prevalence in time or between cultures, which might give a clue as to the possible causes of this conduct. The data are simply insufficient for them to comment.