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Fabrication or Induced Illness Awareness

FII and Perplexing Presentations: What is the Evidence Base for and against Current Guidelines, and What are the Implications for Social Services? (October, 2022)

Abstract

Fabricated or induced illness (FII) and perplexing presentations (PPs) are the terms used by the Royal College of Paediatrics and Child Health (RCPCH) in the UK. FII is presented as if synonymous with Munchausen syndrome by proxy, a rare presentation which is now known in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition as factitious disorder imposed on another (FDIoA). However, FII is not a diagnosis, and the definition is far broader than FDIoA. RCPCH admit that there is a limited evidence base for the prevalence, specificity or sensitivity of FII and the associated ‘alerting signs’, and yet local authorities across the UK have Child Protection Policies developed directly from the RCPCH guidelines. An increasing number of families of children with neurodevelopmental presentations (such as autism), or presentations of complex or less well-known conditions such as Ehlers–Danlos syndrome, are finding themselves being investigated for FII by Social Services, and consequently labelled as potential ‘perpetrators’ of child abuse, on the basis of FII guidelines. The present article discusses the issues relating to FII and PP, how current guidelines are creating implicit and explicit bias against certain kinds of families and the implications for Social Services.

Reference: Fiona Gullon-Scott, Cathie Long, FII and Perplexing Presentations: What is the Evidence Base for and against Current Guidelines, and What are the Implications for Social Services?, The British Journal of Social Work, Volume 52, Issue 7, October 2022, Pages 4040–4056, https://doi.org/10.1093/bjsw/bcac037

Overview – Fabricated or induced illness

Fabricated or induced illness (FII) is a rare form of child abuse. It happens when a parent or carer exaggerates or deliberately causes symptoms of illness in the child.

The parent or carer tries to convince doctors that the child is ill, or that their condition is worse than it really is.

The parent or carer does not necessarily intend to deceive doctors, but their behaviour is likely to harm the child. For example the child may have unnecessary treatment or tests, be made to believe they’re ill, or have their education disrupted.

Reference: NHS Website [May 2023]

What is FII?

Fabricated or Induced Illness

FII is a term used by professionals to describe parents who’s description of their child’s presentation does not match that observed by involved professionals.  

FII is not in itself a diagnosis. It’s a set of characteristics observed by professionals that aren’t understood which cause them to suspect a parent is creating or exaggerating their child’s difficulties, with no identifiable evidence to substantiate their existence. 

FII is not the same as Munchausen’s Syndrome by Proxy.

But, it is fast becoming a something that parents are wrongfully accused of; which in turn prevents children from getting the help they need and, instead, causes life-long trauma.

Reference: Fabricated or Induced Illness (FII) Awareness Website [May, 2023]

New guidance on perplexing presentations and fabricated or induced illness in children [March, 2021]

The new guidance provides procedures for safeguarding children who present with PP or FII and best practice advice in the medical management of these cases to minimise harm to children.

The guidance updates definitions of FII and PP. The new and wider interpretation of FII includes any clinical situation where the parent or carer’s actions are aimed at convincing doctors and other professionals that a child is more seriously ill than is the case. In these circumstances, the parent or carer may be acting on erroneous beliefs about the child’s state of health or, in some cases, deceiving professionals.  There is a risk that the child will be directly harmed by the parent or carer’s behaviour but in some cases, and inadvertently, also by the medical team’s response. 

Reference: Royal College of Paediatrics and Children Health Website [May, 2023] 


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