Fabricated or induced illness – advice for practitioners

Fabricated or induced illness (FII) is a rare form of child abuse. It occurs when a parent or carer, usually the child’s biological mother, exaggerates or deliberately causes symptoms of illness in the child.

In fabricated or induced illness, the parent may present the child as ill when they are healthy, deliberately induce symptoms of illness, manipulate test results, or exaggerate or lie about symptoms.

Where concerns exist it requires professionals from all agencies to work together at an early stage so that all information available can be evaluated and an understanding of the needs of the child assessed.

MSB follows the GMSP ‘Safeguarding Children and Young People Subjected to Fabricated or Induced Illness Protocol‘ and this can be found in the relevant section of the greatermanchesterscb.proceduresonline.com

Why does fabricated or induced illness occur?
The parent or carer may benefit from the attention in some way. There may be somatoform disorders in the carer, where they have multiple, ongoing medically unexplained symptoms. Personality disorders can have an impact, and, the opportunity for financial gain. Often, many of these issues occur together.

Fabricated or induced illness is often unreported, undetected, and is emotionally harmful. It is very complex issue. Usually involving the child’s mother, most cases are children under five at the start. It is, however, very rare. In one two-year study, they found just 89 cases.

Fabricated or induced illness is really an interaction between three key variables: the child’s health, the parent’s view, and the medical view. Fabricated or induced illness covers a wide range of behaviours in carers, from anxiety to deliberately causing symptoms. Some psychiatric illnesses and conditions may also affect the carer’s perception.

Indicators of fabricated or induced illness
There are 3 main ways of the carer fabricating or inducing illness in a child:

• fabrication of signs and symptoms, including fabrication or exaggeration of past or current medical history
• fabrication or exaggeration of signs and symptoms and falsification of hospital charts, records, letters and documents and specimens of bodily fluids
• induction of illness by a variety of means.

The above are not mutually exclusive.

Some of the indicators of fabricated or induced illness, include:

• the medical history doesn’t make sense
• treatment is ineffective
• the symptoms disappear when the carer isn’t around, and
• they can be seen repeatedly by different professionals looking for different things.

In all cases, the child’s normal life is restricted. Cases of fabricated or induced illness are very complex. Where fabricated and induced illness is suspected, referrals should be made without alerting the child’s carer.

Further resources
The NHS website provides an overview of fabricated or induced illness and information about signs, causes and what to do if you suspect a case. Find this on the website at  www.nhs.uk/Fabricated-or-induced-illness

The Ireland Health Service Executive has a good basic outline on its website at www2.hse.ie/conditions/mental-health/fabricated-or-induced-illness

The RCPCH have published Fabricated or induced illness (FII) by carers – a practical guide for paediatricians which sets out the specific responsibilities of paediatricians to help safeguard these children and can be downloaded from their website at www.rcpch.ac.uk/resources/fabricated-or-induced-illness-fii-carers-practical-guide-paediatricians

Statutory guidance:

• Government guidance Safeguarding children in whom illness is fabricated or induced (2008)  is available on the gov.uk website at www.gov.uk/safeguarding-children-in-whom-illness-is-fabricated-or-induced
• a supplementary guidance to Working Together – Safeguarding Children in whom illness is fabricated or induced is also available from the website at assets.publishing.service.gov.uk/Safeguarding_Children_in_whom_illness_is_fabricated_or_induced.pdf