In the first two years of his life, Alexzander Walker was hospitalised at least fifteen times, his grandmother Tammy Eady Walker told 9News. By the time he was three, she had lost count.
Lethargy, vomiting, failure to eat, seizures, migraines - the symptoms the little boy's mother reported to doctors ranged all over the place, and were hard to connect.
But it wasn't infections, allergies and natural causes that were making the little boy sick. It was his own mother.
Trisha* has Munchausen syndrome by proxy (MSbP), a recognised mental illness that sees caregivers - usually mothers - fabricate or exaggerate illness in a child. © SuppliedTammy Walker, a 57-year-old Californian, did what many fail to do; identify a Munchausen syndrome by proxy perpetrator.
"She would withhold his food and I believe she was also overdosing him on asthma and anti-seizure medication to induce symptoms," Mrs Walker, a 57-year-old Californian said.
"Now, I don't think he even had seizures because no one besides Trisha ever saw him have one.
"She had a history of making up stories and she would fabricate illnesses in herself, but you don't want to believe that someone you love, is making someone else you love sick.
"Eventually I started seeing red flags, little things not adding up, but it wasn't until my second grandchild Arianna started getting sick that my eyes were fully opened."
Fabricating illness in her second child would be Trisha's downfall.
In January 2008, Arianna was transferred to Sacred Heart Children's hospital in Florida after Trisha claimed she had not had a bowel movement in more than a week. © SuppliedAlexzander at four, and Arianna at two. Growing up, the pair had a tremendous bond.
The 21-month-old underwent several tests, including a scope of her small intestines, but the doctors found nothing.
Then an intern went into the bathroom and found soiled diapers.
The intern reported it to a doctor who immediately contacted the Florida Department of Children of Families. Both children both taken into foster care - and after a marathon custody battle, they were eventually given to Mrs Walker.
"The children were removed from care, but Trisha never had formal penalties brought against her. In our case they only ever contacted child services, they didn't even contact the police to start prosecution or investigation," Mrs Walker said.
When it comes to her grandchildren's health, she has little sympathy for her former daughter-in-law.
"Harsher penalties should be in effect. It should be treated as abuse - not mental illness, because it's a choice. Once you start saying it's a mental illness that mother is set up to use a psychiatric illness as a defence in court," she said.
The issue with MSbP: Mental illness or abuse?
MSbP, also known as Factitious Disorder Imposed on Another, is recognised as a mental illness. Experts argue about its classification, however, because of the legal protection it can give to sufferers whose behavior can cause harm to vulnerable people, especially children. © SuppliedThe first Christmas Alexzander and Arianna spent with their grandma. They had lived with her about a month at this time.
Anne Buist, a perinatal psychiatrist and professor of women's mental health, told 9News MSbP is statistically rare and that she believes the behaviour associated with it should be classified as abuse in the courts.
"I've been working clinically in Australia for more than 30 years and I've had less than five cases of MSbP," the University of Melbourne academic said.
"With MSbP, we haven't been able to identify a primary psychiatric disorder that is eminently treatable, and the presenting thing is abuse. It does need to be dealt with as such, just as long as people don't lose sight of the big picture, for instance, other issues like depression that could be present."
As MSbP cases are rarely diagnosed, Daryl Higgins, Director of the Institute of Child Protection Studies at the Australian Catholic University told 9News that there are challenges with how it's treated in Australia's courts system.
He explained that the main focus of investigators is to remove a maltreated child from harm, but a parent often won't get classified as an MSbP perpertrator.
"There's no reliable data collection on this topic - because its fairly rare, but also difficult to diagnose. Its really only when its causing harm, and there's a need for court intervention that it could be captured," he said. © SuppliedAlexzander was the focus of much of his mother's alleged MSbP behaviour.
"From a child protection perspective, the concern is not primarily about the diagnosis of the parent, but about the harm that is observed in the child regardless of the cause."
In a statement from the Department of Family and Community Services (FACS), a spokesperson also told 9News that when a child is removed from care, they will ultimately work to re-unify the family.
"FACS works closely with NSW Police and other government and non-government agencies to investigate allegations of abuse and neglect involving children.
"Our first priority is to preserve families and work with them to keep children safe at home with their parents wherever it is possible.
"If children are removed, we will continue to work with parents to restore children to their care where it is safe to do so," they said.
One tell-tale sign of MSbP is a lack of anxiety about what is happening, experts say.
"They get very involved, but they don't tend to have the anxiety that a lot of mothers I see do. Really, it's a form of attention seeking. They're seen as caring mothers who are looking after their child so well. It has narcissistic personality tendencies," Dr Buist said. © SuppliedToday, the siblings are just as close and still get to live together thanks to Mrs Walker.
This was the case with Trisha.
"It was all just a desperate, insatiable attempt for constant attention. While Alexzander was on a helicopter one time, being life-flighted, all she could think about was how she needed to get gas and wanted a hamburger. It was callous and cold," Mrs Walker said.
"Trisha was an empty cup that could not be filled, no matter how much love I poured into her. No matter how much attention she was getting, she had to get even more. I still get angry at myself that I let her deceive me for so long."
These days, the family has no contact with Trisha. The last Mrs Walker heard she was in Alabama living with a new boyfriend. She stopped trying to contact her children six months after custody was granted to Mrs Walker. © SuppliedArianna performing with Royal Stage Christian Performing Arts in 2015.
Today, Alexzander is almost 15 years old. He has special needs, a likely result of Trisha's manufactured illnesses, but his speech, behavioural issues, and social skills have all improved.
"He reads and he talks now, and he's fascinated with airplanes and trains. His language has also come a long way in the last year," Mrs Walker said.
*Last name withheld.
If you are anyone you know needs support please contact Lifeline on 13 11 14.
Contact Raffaella Ciccarelli: email@example.com