Fabricated or induced illness (FII) by carers - a practical guide for paediatricians

Fabricated or induced illness by carers (FII) can cause significant harm to children. It involves a well child presented by a carer as ill or disabled, or presented with a more significant problem than he or she has in reality, and suffering harm as a consequence.

This document sets out the specific responsibilities of paediatricians to help safeguard these children. Although systems vary, the overall guidance in this document applies to all four nations of the UK.

Key messages

There are particular challenges for paediatricians and other professionals in terms of managing a fabricated or induced illness (FII) case.

Within this document the concept of the FII spectrum is presented – five examples are outlined, describing parents’ anxiety, misperceptions and abnormal beliefs, carers’ psychiatric illness, the unrecognised genuine medical problem and presentations where the carer has genuinely fabricated or induced illness in their child.

Background

In 2002, the RCPCH published Fabricated or Induced Illness by Carers, which aimed to assist paediatricians in the management of such cases. Since 2002, the Government in England and Wales has published safeguarding guidance commonly referred to as Working Together alongside specific guidance relating to FII.

In light of this guidance it was felt to be timely to review the 2002 document. This report provides updated guidance and aims to encourage earlier recognition and an optimal response by improving the competence and confidence of paediatricians who encounter FII.

While this document was written for paediatricians, it is anticipated that it will be relevant to other health professionals in particular GPs and nurses. This document replaces the 2002 publication.

About this document

This document sets out the specific responsibilities of paediatricians working within the multi-agency framework as specified by Local Safeguarding Children Boards (LSCBs) in relation to children who may be subject to FII and who may be ‘in need’ under section 17 of the Children Act 1989. Although safeguarding systems and structures may vary, the overall principles and guidance in this document are applicable to all four nations of the UK.

This includes children who are suffering significant harm and those who are at risk of suffering significant harm. The document should be used in conjunction with LSCB procedures (formerly Area Child Protection Procedures) and the Framework for the Assessment of Children in Need and their Families.

There is no specific government guidance on FII in Scotland and Northern Ireland and paediatricians have previously relied on local child protection guidance documents and the previous RCPCH report. Although safeguarding systems and structures may vary, the overall principles and guidance in this document are applicable to all four nations.

This document is based on the current literature and guidance on FII and related conditions. However, a new formal systematic review of the literature was not conducted. It starts by looking at the background and epidemiology of FII and its effect on children. It then looks at how a paediatrician should recognise FII, manage a case before and after the strategy discussion and when to refer to Children’s Social Care. The document also looks at how to work with children and families, and finally deals with record keeping and training.

In line with statutory guidance, Safeguarding Children in Whom Illness is Fabricated or Induced, this document uses the term ‘carer’ to mean parent or carer.