Gretchen Precey: Independent social worker, trainer and consultant.
Dr Paul Davis: Consultant general and community paediatrician.
What is fabricated or induced illness (FII)?
“Historically what was Munchhausen’s syndrome by proxy and became known as FII in the early 2000s was regarded as a very deliberate, conscious deception, with or without induction of illness in the child by the caregiver. So there we’re talking about really horrible child abuse and quite violent things that parents do to children sometimes.
“The evolution has been very much in terms of looking at a wider spectrum and the much bigger number of children whose lives are then restricted in some way as a result of parental concern about an illness where doctors haven’t found any evidence of illness, and the child’s restriction of lifestyle is deemed to be unnecessary and to some extent due to the behaviour or the views or opinions of the parents.”
What are the signs that FII might be taking place?
“One of the key things is a child whose symptoms only seem to be observed or present when they’re in the relationship with the mother. So the mother may describe a child who throws up constantly or who has seizures or who has severe asthmatic attacks or who’s allergic to lots of different foods, but nobody sees this apart from the mother. So school don’t see it, relatives don’t see it, other people don’t see it…
…Or that the child seems to have their lifestyle particularly limited in a way that other children with a similar complaint don’t seem as restricted as this child is. So it is the kind of variation in how the child is in other settings compared to how they are with the mother.”
“The ones that present more to hospitals, the ones that are more in your face as a paediatrician, present often with quite dramatic illnesses where medics are not able to find any evidence of an underlying disease. And these can be quite worrying when they present recurringly. If you think about it there’s a limited number of things that parents can fabricate without getting found out very easily. It’s very difficult to fabricate something like cancer or diabetes because there is objective evidence of that.
“The kind of presentations we’re talking about with FII include reports of children having fits, children stopping breathing and going blue, children who present with episodes of drowsiness or unexplained loss of consciousness, children who lose blood from any part of their body, children who vomit or have diarrhoea or don’t grow properly, or children with breathing difficulties. We have parents who report [the child] to have asthma but on a huge amount of treatment and it doesn’t appear to be working. So these are all things where children can have episodes of illness and appear normal in between times. So that’s quite easy to lie about those.”