This article comprises of excerpts taken from a podcast on Community Care Inform about fabricated or induced illness. The full podcast includes discussion of why mothers are typically the perpetrators of FII and how social workers can work with doctors, and is free to access on Spreaker and iTunes. Inform subscribers can access supporting resources including a written transcription and key points from the episode on Inform Children.The experts
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?
Gretchen Precey
“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.”
Paul Davis
“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.”
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As someone who was accused wrongly of fii this is a contentious subject for me. As a result of proving myself innocent and getting a diagnosis for my child i still face the fear every day that a fresh allegation may occur. This needs to be fairly addressed
Dear Kelly. I’m sorry to hear that you have been unfortunately and unfairly accussed wrongly. However i have worked with some parents who were clearly trying to make their children ill repirting all of the above symptoms. This was ver concerning given that dictors could not tell this mother there was nothing medically wrong with the child and challenged in the parent’s presence doctors seemed frightened to say anything for fear that this would result in the mother becoming angry. To this day I’m still surprised that it numerous professionals both from health and social care to work with this family, which led to on and off CPP and finally removal
I question our ability as SW to be able to identify such concerns which sometimes more common than we think. Is this another way for parents to show abuse and control and get away with it? Child-focused practice?
I’ve worked with families where a parent was undoubtedly fabricating an illness, with a clear plan to medicalise a child so that they could be seen as disabled.
However, I’ve also encountered medical and social work professionals who, despite considerable expertise, struggled to distinguish between a case of FII and a case of a parent simply being overanxious and overly pessimistic.
Online information complicates matters: many mundane symptoms are listed as possible signs of severe illness, and while most people brush off low likelihood risks, some always take the most worrying interpretation – consider the old joke about how, if you read a medical encyclopedia for long enough, you’ll eventually conclude that you’re terminally ill. Some parents are certainly hypochondriac, but this isn’t the same as fabricating illness.
Also, a quick browse of health news brings up countless stories of people dying after being given the all-clear by a doctor. These cases get disproportionate coverage, but while most people treat this as a rare occurrence, some will become genuinely convinced that doctors may have ‘missed something’.
In my experience of purported FII, the majority have concluded with the finding that either a) the child really was ill, b) the child had displayed symptoms, observed by others, although they turned out not to indicate serious illness, or c) the parent was overanxious (in some cases with complicating mental health needs) and tended to overreact to every possible sign of illness. The latter can still result in harm, but the required approach is different.
We should bear in mind that if a parent doesn’t seek medical attention when they later turn out to have been ill, they can then be accused of neglect. A risk-averse attitude by medical staff who encourage people to check out every possible symptom with a doctor (particularly for a small child) complicates things further.
Unpicking suspected FII cases can be extraordinarily difficult, and requires a forensic approach. Just as we shouldn’t necessarily take every parent’s account at face value, so we should be careful to oversimplify a case as FII just because a parent’s fear is unwarranted.
As an individual that had a mother with fii to the stage of her calling my aunty whilst I was pregnant with my daughter to inform her that I had stopped the chemo because of my pregnancy. Listening to my aunty sob down the phone line, begging me to abort!! This is when I realised my own mother had for the past 30 years fabricated the truth to meet her needs of the limelight. Understandably children and adults look up to their parents or carers for attachment and that belonging. It is rewarding to see that this illness has more focus and understanding. I will however say I don’t have any further dealings with my mother due to the mental health persona she inflicted on me and the feelings of worthlessness she inscribed upon me.