Media and clinical case reports of medical child abuse (MCA; also known as caregiver-fabricated illness1) depict dramatic examples of severe child maltreatment. Absent from these reports are accounts of how these cases develop. Recent commentaries have noted the challenges of caring for children with chronic somatic symptoms and the insidious processes through which children’s lives become overmedicalized by well-meaning pediatricians.2,3 In this Viewpoint, we aim to reinforce these important points by explaining how overmedicalization can escalate into MCA.