Fabricated or induced illness (FII)
Fabricated or induced illness (FII) in a child by carers is considered to be a rare but potentially under reported form of child abuse. It occurs when someone who is caring for a child, usually the child’s biological mother, fakes or deliberately causes symptoms of illness in the child. There are three main ways of the carer fabricating or inducing illness in a child. These are not mutually exclusive and include:
- Fabrication of signs and symptoms. This may include fabrication of past medical history;
- Fabrication of signs and symptoms and falsification of hospital charts and records, and specimens of bodily fluids. This may also include falsification of letters and documents;
- Induction of illness by a variety of means.
FII can involve children of all ages, but the most severe cases usually involve children under five.
NICE guidelines regarding ‘When to suspect child maltreatment’ (2009) identifies the following ‘alerting features’ for medical practitioners as raising suspicions regarding FII:
Suspect fabricated or induced illness if a child’s history, physical or psychological presentations or findings of assessments, examinations or investigations leads to a discrepancy with a recognised clinical picture and one or more of the following is present:
- Reported symptoms and signs only appear or reappear when the parent or carer is present
- Reported symptoms are only observed by the parent or carer
- An inexplicably poor response to prescribed medication or other treatment
- New symptoms are reported as soon as previous ones have resolved
- There is a history of events that is biologically unlikely (for example, infants with a history of very large blood losses who do not become unwell or anaemic)
- Despite a definitive clinical opinion being reached, multiple opinions from both primary and secondary care are sought and disputed by the parent or carer and the child continues to be presented for investigation and treatment with a range of signs and symptoms
- The child’s normal daily activities (for example, school attendance) are being compromised, or the child is using aids to daily living (for example, wheelchairs) more than would be expected for any medical condition that the child has
Fabricated or induced illness is a likely explanation even if the child has a past or concurrent physical or psychological condition.
Potential School Actions
School staff will need to follow the procedures outlined in their child protection/safeguarding policies and discuss concerns with the designated member of staff for child protection.
The Solihull LSCB web pages provide comprehensive guidance and advice on FII and what professionals should do if its presence is suspected.
Concerns that a child is suffering or likely to suffer significant harm as a result of illness fabricated or induced by a carer may be raised by a number of different types of professionals including school staff.
The Solihull LSCB advice is:
- Professionals who have identified concerns about a child’s health must discuss these with the child’s GP or consultant paediatrician responsible for the child’s care
- If any professional considers their concerns about fabricated or induced illness are not taken seriously or responded to appropriately, these should be discussed with their named doctor or named nurse. (Community Paediatric Team Lead Dr Alan Stanton, Tel. 0121 7464475 / School Nursing Service Clinical Lead Jeanette Satterthwaite, Tel. 0121 7464459)
- At no time should concerns about the reasons for the child’s signs and symptoms be shared with parents if this information would jeopardise the child’s safety and compromise the child protection process and/or any criminal investigation.
- When a possible explanation for the signs and symptoms is that they may have been fabricated or induced by a carer and as a consequence the child’s health or development is or is likely to be impaired, a referral should be made to the Children’s Social Work Services in accordance with the referrals procedure
Involving other agencies and signposting
NHS Choices provides and information on Fabricated and Induced Illness.
For more detailed guidance see the DSCF 2008 document ‘Safeguarding Children in Whom Illness is Fabricated or Induced‘
The NSPCC have produced a research briefing entitled Fabricated or induced illness in children: a rare form of child abuse? Anne Lazenbatt and Julie Taylor (July 2011) that will be of interest and use where FII is suspected.
Specialist Birmingham and Solihull Mental Health NHS Foundation Trust and adult mental health psychiatric advice may be helpful.
Updates and changes
These pages are updated regularly and should be used as the main source of information. Printed versions should be used with care as they can become out of date.