A mother brings her 7-year-old daughter to the ED with a reported illness of 3 days where the child has been weak and not eating her usual amount.

A mother brings her 7-year-old daughter to the ED with a reported illness of 3 days where the child has been weak and not eating her usual amount. The mother also reports that she noticed her daughter’s urine to be of a reddish color and that her stools have been smaller in caliber. She brings a specimen of her daughter’s urine with her. She reports that her daughter has been hospitalized multiple times before for similar reasons and dehydration. Upon physical examination, the patient is without distress, quiet, and states that she feels tired. Her chest is clear to auscultation, her abdomen is benign and her neurologic examination nonfocal. A urinalysis performed fails to show any blood or myoglobin in the child’s urine. Which of the following should be included in the differential diagnosis of this child?

a. Malingering

b. Factitious disorder

c. Munchausen syndrome

d. Munchausen syndrome by proxy

e. Conversion disorder

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