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Please note that this insight was first published in April 2021, and therefore whilst the subject matter is still relevant, it may not represent the most up to date information in this area.
Why do I need to know about fabricated or induced illness (in 60 seconds)
There is an on-going debate about terminology that is used to describe what was once referred to as ‘Munchausen Syndrome by Proxy’. Currently the Royal College of Paediatrics and Child Health (2021) recommend the use of terms including Medically Unexplained Symptoms (MUS), Perplexing Presentations (PP) and Fabricated or Induced Illness (FII) to describe this form of physical abuse.
Research suggests that a significant number of children will be well known to health professionals and many will have a confirmed co-existing physical or mental health condition, which makes detecting this form of abuse challenging for professionals. However, despite the challenges there has been a significant shift towards earlier recognition and response, which will have significant implications for schools.
Fabricated or Induced Illness is based on a parent or carer’s underlying need for their child to be recognised and treated as ill or more unwell/more disabled that the child actually is and may involve physical, and/or psychological health, neurodevelopmental disorders and cognitive disabilities. There are two possible motivations underpinning the parent’s need:
- The parent experiences a gain from the recognition from the recognition and treatment of their child as unwell. The parent is using the child to fulfil their needs, disregarding the effects on the child and;
- The parent’s erroneous belief, extreme concern and anxiety about their child’s health.
Children can experience physical harm, emotional harm and neglect as a result of this form of abuse which includes:
- The child’s health – repeated and unnecessary appointments/tests, induction of illness (poisoning/suffocation);
- Effect on the child’s development and daily life - including limited and interrupted school attendance and education, the child’s normal activities are limited, the child assuming a sick role and the child being socially isolated;
- The child’s psychological health and well-being – the child may be actively colluding with the parent’s illness deception and the child may be confused and anxious.
As professionals working with children and young people daily, staff in schools are in a prime position to identify inconsistencies in what they are being told about the needs of the child versus how the child is presenting and initial alerting signs are commonly identified within school and educational settings.
Numerous Serious Case Reviews tell us that there is also a need for schools to maintain a respectful uncertainty and ensure that they challenge where necessary – including challenging the parent and health professionals, regardless of where they may be on the perceived hierarchy within the health system.
School staff are also best placed to hear the voice of the child – something which is often lost in cases of Fabricated or Induced Illness.
Introduction
Due to the nature and levels of workloads that professionals must deal with daily, as soon as the word ‘illness’ is seen there is a natural response to classify that as a health issue and – at most – make a mental note to speak to the school nurse about it.
Indeed, this sense of illness being a health issue is, in some sense, reinforced by the Department for Education. If you search through Keeping Children Safe in Education 2020 for the term, or its shorthand of FII, you will find only one mention in the “Additional advice and support” section of Annex A, simply a link to the 2008 government guidance, Safeguarding children in whom illness is fabricated or induced. Fabricated or Induced Illness is also briefly mentioned in Ofsted guidance for inspectors as an area where safeguarding action may be required to protect children and learners, but again little there is substance behind it.
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