Question: I was a CPSW worker for 6 years. After several other workers had had this case, I was assigned it and had it for 3 years. One of the 3 children was very ill, but mother seemed to be on top of it and had myriad occupational therapists, and physicians from the XXXXXXX Children's Hospital of XXXXXXX and OSU involved in her care. I stayed in contact with them from time to time. However, the original referral came from the school system concerning the oldest child and her bizarre aggressive behaviors in order not to have to stay in school for the whole school day. It always seemed to me there was some sort of school phobia going on. There were other myriad psychiatric issues with the oldest child and she had two psychiatric hospitalizations which I arranged for her. During the second psych. hospitalization for the oldest child, she felt safe enough to report that mother's boyfriend the, father of th, younger sick child was sexually molesting her. When mother was informed, she immediately got him out of the house and cooperated in a police investigation. The oldest child eventually came home, but continued to have behavioral problems at home and in school. The youngest child eventually became school age. Mother was insistent that the child have certain accommodations at her school, i.e. wearing a helmet, eating only certain foods, being accompanied on the bus, several other things. The school nurse started to have some concerns. Mother was also very difficult with the school and by this time this child even had a feeding tube in her stomach. I had talked with her doctors at The Children's Hospital, and they had prescribed all of these things. It was becoming difficult to arrange transportation to the hospital at times, because we did not always have staff or Medicab available and my superiors were getting weary of this case and providing help for this woman. In any event, the case was closed for CPS. However, the school nurse was very diligent, and the case was reopened for a new investigation. I had gotten permission from the mother previously, for the school nurse to talk to the child's treaters at the hospital, so she had gone ahead and done that. To bring this story to a close, mother was accused of Factitious Disorder inflicted on another person (Munchhausen's by Proxy.) I left CPS two years ago to go back to my former work as a mental health therapist. What I know about Munchausen's by Proxy, and about this case in particular, is that it is very hard to detect and it was not until this child was away from her mother for the better part of the day in school, the symptoms would lessen and even cease and school personnel were the first ones able to witness that. I recently was chastised by a former CPS colleague for not detecting all of this much earlier. I explained to her how detection of this is even difficult for the treaters themselves with whom this child worked for years. What do I do with all of this? How could have known to do anything differently?