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A parent may fabricate symptoms or induce serious illness in a child in order to establish close contact with a physician or other health care provider or institution. The author believes this behavior is far more prevalent than has formerly been surmised; it represents a significant public health problem of which physicians must be aware. It is seen more often in women than in men, and most often in individuals who were inadequately loved in childhood. It is characterized by pathological lying, imposture, compulsive and repetitive mistreatment of the child, fascination with risk to life, and excitement when the child is at the point of death. These parents are caring and concerned; but at the same time they coldheartedly endanger their children. The author proposes that this syndrome is a perversion, a variant form of masochism in which the child is viewed and used as a fetish to obscure the painful distinction between reality and fantasy and thus to assuage the parent's early trauma or incomplete mourning. The distress of the child-fetish facilitates the parent's obtaining masochistic emotional gratification from an intense unbroken connection to a loved and feared parental surrogate, the physician.