Medicines for Fabricated or induced illness

What it is

Fabricated or induced illness (FII), formerly known as Munchausen syndrome by proxy, is a rare but very serious form of child abuse in which a parent or carer fabricates, exaggerates, or deliberately produces symptoms of illness in a child in their care. This can take different forms — for example, making up or lying about symptoms or medical history, exaggerating a child’s genuine symptoms, tampering with samples or records, or actively causing the child to become ill or injured (such as by giving harmful substances or interfering with treatment). As a result, the child may be presented as ill when they are not, or made more ill than they are, and may undergo unnecessary and potentially harmful medical tests, procedures, and treatments, as well as suffering direct harm; the child’s health, development, and wellbeing can be seriously affected, and in the most severe cases the child’s life can be at risk. FII is a form of child abuse, and — importantly — the priority in these situations is the safety and protection of the child. The motivation of the carrying-out adult is often complex and may involve their own psychological difficulties or needs, but, regardless of the cause, the focus of the response is on recognising the situation and protecting the child. FII can be very difficult to recognise, because the concerns are often subtle, the presentations can be confusing, and the possibility is understandably difficult to consider; it may be suspected when there are unexplained, inconsistent, or implausible symptoms or medical histories, when reported symptoms do not fit with findings, when there is a pattern of extensive medical contact without clear cause, or other concerning features. Because FII is a safeguarding (child protection) matter, any concerns are handled through established safeguarding processes, involving careful assessment, coordination among the professionals involved, and the involvement of safeguarding and, where necessary, social care and other agencies, with the child’s safety and welfare as the paramount concern. Support and, where appropriate, help for the adult involved may also be part of the response, but not at the expense of the child’s safety. The key messages are that fabricated or induced illness is a rare form of child abuse where a carer fabricates or produces illness in a child, that it can seriously harm the child, and that the priority is recognising it and protecting the child through safeguarding processes.

How it is treated

The approach to fabricated or induced illness centres on recognising the possibility, careful and coordinated assessment, and, above all, protecting the child through established safeguarding (child protection) processes, with the child’s safety and welfare as the paramount concern. Because FII is a form of child abuse that can seriously harm a child, and because it can be difficult to recognise, an important aspect is professionals being alert to the possibility when there are concerning features — such as unexplained, inconsistent, or implausible symptoms or medical histories, reported symptoms that do not fit with examination or test findings, a pattern of extensive or unusual medical contact or interventions without a clear medical explanation, symptoms that only occur in the presence of a particular carer, or other concerning signs. Recognising FII is difficult and must be approached carefully and thoughtfully, avoiding both missing genuine illness and missing abuse. When FII is suspected, it is handled as a safeguarding matter through established child protection processes: this involves careful, coordinated assessment among the professionals and agencies involved (which may include paediatricians, other health professionals, safeguarding leads, social care, and, where necessary, other agencies), sharing information appropriately, and following safeguarding procedures, with the child’s safety and welfare as the paramount concern throughout. Careful gathering and review of the medical and other information (for example, distinguishing reported symptoms from observed findings) help clarify the situation. The immediate priority is always the protection and safety of the child, and measures are taken as needed to protect the child from harm, including from unnecessary and potentially harmful medical interventions. The needs of the child — including their health (ensuring genuine health needs are met while avoiding harm), development, and emotional wellbeing — are addressed. The adult who has fabricated or induced the illness may have their own psychological difficulties or needs, and support or intervention for them may be part of the wider response (and is important), but this does not take priority over protecting the child. Because these situations are complex and serious, they are managed by experienced professionals following safeguarding frameworks, and anyone with concerns that a child’s illness may be fabricated or induced should raise them through the appropriate channels (such as with health professionals, safeguarding leads, or, if a child is at immediate risk, social care or the police). The reassuring and important messages are that fabricated or induced illness, although a rare and serious form of child abuse, is responded to through established safeguarding processes with the child’s safety as the paramount concern, that careful, coordinated assessment by experienced professionals is used to recognise and address it, and that protecting the child is the priority, with support for the adult involved as part of the wider response; so recognising concerns, following safeguarding processes, and protecting the child are the key aspects.