Fabricated or induced illness

There may be times when parents or carers present a well child as ill or disabled, or exaggerate symptoms. There are many reasons why this can happen, but it can be physically or emotionally abusive to the child.

Fabricated or induced illness can cause significant harm for the child either because of being made to be ill, or through the treatment that they are given for an illness that they do not have.  The harm is not only physical but emotional with children convinced they are unwell, or even likely to die.

If you have concerns that a child is victim of fabricated or induced illness then a referral should be made to the local authority. You should not seek the consent of the parents prior to a strategy discussion, as research tells us this can heighten the risk to the child.

It is important that this is not just considered an issue for health.  As with all safeguarding matters, it is for everyone to be alert to the potential signs of fabricated or induced illness.  It may be that as someone not involved in health professions you pick up on patterns, etc. that others may not have seen through being too closely involved.

Definition of fabricated or induced illness

“Fabricated or Induced Illness (FII) is a form of abuse associated with a range of poor outcomes for children and young people extending to the serious harm or even death of the child. Behaviours by a parent or carer may result in harm to a child or young person. FII can occur when a child or young person also has a confirmed diagnosis of illness or disability and the two may coexist but the health seeking behaviour or presentation is outside that expected for the condition or disability.”

NHS

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How prevalent is it?

There is little information about the prevalence of fabricated or induced illness, but it is believed many are unreported as there is not necessarily a clear cut pattern of incidents.  For professionals involved in treating the presenting symptoms it is not always easy to step back and consider the overall picture.

Where children are consistently being presented as ill it is important that:

  • there is clear and direct communication between the professionals involved (i.e. not relying solely on the parent to report back on appointments, etc.)
  • a chronology of presentations is maintained
  • case records explicitly state who the source of the information being recorded was and when the information was provided
  • a paediatrician or other suitably qualified medical practitioner (e.g. named nurse) is asked to review the case records from an independent viewpoint and provide an opinion.

Ways of fabricating or inducing illness

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, from encouraging emotional symptoms to physical injury or poisoning.
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Why does fabricated or induced illness occur?

We don’t fully know. Sometimes people have an overwhelming need to be seen as a “caring mother” (90% of perpetrators are mothers), sometimes they gain access to benefits, sometimes it tracks back to the parent’s own childhood experiences. Often parents have mental health issues such as borderline personality disorder with emotional instability, impulsiveness and disturbed thinking. The parent may have psychological or behavioural problems, such as self-harming, drug or alcohol misuse. Some have experienced the death of another child or have experienced historical attachment difficulties either as a child themselves or with older children.

Read more from the NHS about the possible causes of fabricated or induced illness.

Spotting the signs

Schools are well place to notice, prolonged or frequent absence from education. Also parents or carers involved in fabricated or induced illness will seek support and attention from schools. Be aware of the following signs:

  • repeated absence from school.
  • reported symptoms and signs found on examination are not explained by any medical condition from which the child may be suffering.
  • physical examination and results of medical investigations do not explain reported symptoms and signs.
  • there is an inexplicably poor response to prescribed medication and other treatment.
  • new symptoms are reported on resolution of previous ones.
  • reported symptoms and signs are not observed in the absence of the carer.
  • over time the child is repeatedly presented with a range of symptoms to different professionals in a variety of settings.
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What you can do

  • Be alert to potential indicators of illness being fabricated or induced in a child.
  • Produce a chronology, including the source of information.
  • Be particularly aware when illnesses and absences are frequent.
  • Ask to link in with the family GP to see what the school can do.
  • Report concerns to your designated safeguarding lead.
  • Follow your safeguarding procedures.
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FII will usually require a senior paediatrician to examine the medical evidence to determine whether there’s a clinical explanation for the child’s symptoms. They may also seek further specialist advice and arrange further testing. Children’s Services will be looking at the wider range of factors and there may well be a police investigation. Schools’ role is to gather information, assess this and pass it to the investigating team, as well as be there as safe adults for the child or young person.

Resources

  • Fabricated or induced illness: a matter for schools?

    Part of our safeguarding insights section, this is a more in-depth look fabricated and induced illness, the varying presentations and what we know from serious case reviews.

  • Safeguarding children in whom illness is fabricated or induced

    Statutory guidance on protecting children where carers or parents make a child ill or pretend a child is ill.

  • 2017 Anonymous SCR – Child Y (Fabricated or Induced Illness)

    Between November 2015 and March 2017, the Local Safeguarding Children Board (the LSCB) conducted a Serious Case Review (SCR) in relation to the services provided for a teenage boy, referred to in this report as Child Y. Child Y’s circumstances are believed to be an example of fabricated or induced illness (FII) which has severely impaired his health and development. Details of his contact with health professionals and the impact of the treatments that he has received are set out in section 2 of this report. Child Y has a younger teenage sister and her contact with services is also considered, but in less detail.

  • 2018 Anonymous SCR – Children F,G & H (Fabricated or Induced Illness)

    This Serious Case Review relates to a large family where concerns about fabricated and induced illness came to the fore in 2013. Several of the children in the family have extensive medical histories,including invasive surgical interventions. Their perceived medical needs impacted on their educational, social and emotional development. Over a
    significant period, a large number of hospitals and health practitioners were involved with the children; different hospitals treating different children and at times different hospitals treating the same child.

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  • Training resources for DSLs to use in team meetings
  • Reference documents for additional information
  • Handout for school staff summarising fabricated or induced illness
  • Quiz to test staff understanding
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