Almost half of the book deals with perhaps the most troublesome and tragic of these disorders: factitious disorder by proxy, an appalling example of child abuse. In this disorder, a caregiver (usually the mother) abuses a child with repeated suffocations, injections of drugs or toxins, and other deliberate injuries. The goal is to elicit sympathetic medical care while aggrandizing the perpetrator's role as a compassionate, concerned parent. Factitious disorder by proxy presents a serious challenge not only to health professionals but also to the legal system. Courts, struggling to determine the best interests of the child, have returned these abused children to their parents.