Fabricated or induced illness - Diagnosing fabricated or induced illness

It can be very difficult for healthcare professionals to diagnose a case of fabricated or induced illness (FII).

Healthcare professionals will naturally assume that a parent or carer will always act in the best interests of a child in their care, unless there is compelling evidence to suggest otherwise.

If FII is suspected

If a healthcare professional suspects FII, they will usually refer the case to a community paediatrician.

A senior paediatrician will examine the medical evidence to determine whether there is a clinical explanation for the child’s symptoms. They may also seek further specialist advice and arrange further testing.

What happens next?

If the senior paediatrician also suspects FII, they will put together a detailed record of all the available information that is related to the child’s medical history. This is called a chronology.

They will also contact the local authority’s child protection team (CPT) to inform them that concerns have been raised about the child’s safety and that an investigation is underway.

CPTs are teams that consist of a number of different professionals. They are employed by local authorities that are responsible for protecting children from abuse and neglect.

Other agencies that are involved with the child’s welfare, such as their school or social services, may be contacted in case they have information that is relevant to the chronology, such as the child being absent from school. It's important to assign a person to construct the chronology, as this is a critical part of the assessment process.

Covert (secret) video surveillance may be used to collect evidence that can help to confirm a suspected case of FII.

Only the police have the legal authority to carry out covert video surveillance. It will only be used if there is no other way of obtaining information to explain the child’s symptoms. This power is rarely used in practice.

Once the chronology is complete, the information will be presented to the CPT and the police. The CPT, police and medical staff will meet to discuss the best way to proceed with the case.

Child protection plan

If the child is thought to be at immediate risk of physical harm, social services will remove the child from the care of the parent or carer. The child could be placed under the care of another relative or under the care of social services in foster care.

In many cases of suspected FII, the child is already in hospital. They will then be moved to a safe place inside the hospital so that their medical assessment can continue. Alternatively, the carer may be banned from the child's ward.

A child will be taken into care in almost all cases that involve physical harm and in around half of cases where the mother is only fabricating, not inducing, symptoms of illness.

If it's thought that the child is at risk of significant physical or mental harm, a child protection plan will be drawn up.

The child protection plan will take into account the child’s health and safety needs, as well as their educational or social needs. For example, the child may have been deprived of regular education because their parent or carer kept them away from school, due to a fabricated illness.

As part of the child protection plan, the parent or carer may be asked to have a psychiatric assessment or family therapy. If they refuse to comply with the child protection plan, the child may be removed from their care.

Police investigation

If the police decide that there's sufficient evidence to bring criminal charges, they will begin to investigate the case.

More information

The following documents contain more information about the recommended guidelines regarding the protection of children in cases of FII:

• Fabricated or Induced Illness by Carers (FII): A Practical Guide for Paediatricians (PDF, 836kb) – produced by the Royal College of Paediatrics and Child Health.