The abuse that occurs in cases of fabricated or induced illness (FII) takes a range of forms, but there are warning signs to look for.
Warning signs
Warning signs that may indicate that a child is being subjected to FII, also known as Munchausen syndrome by proxy, include:
- the parent or carer reports signs and symptoms that are not explained by any known medical condition
- physical examination and diagnostic tests do not explain the reported signs and symptoms
- the affected child has an inexplicably poor response to medication or other treatment
- the only person claiming to see noticeable symptoms is the parent or carer
- if a particular health problem is resolved, the parent or carer suddenly begins reporting a new set of symptoms
- the child’s daily activities are being limited far beyond what you would usually expect as a result of having a certain condition, for example, they never go to school or have to wear leg braces even though they can walk properly
- the parent or carer seeks multiple opinions from a range of different healthcare professionals
- the parent or carer often has good medical knowledge or a medical background
- although the parent or carer is very attentive to the child and stays with them constantly in hospital, they do not seem too worried about the child's health
- the parent or career often tries to maintain a close and friendly relationship with medical staff but can quickly become abusive or argumentative if their own views on what is wrong with the child are challenged
- the other parent has little or no involvement in the care of the child
- the parent or carer encourages medical staff to perform often painful tests and procedures on the child (tests that most parents would only agree to if they were persuaded that it was absolutely necessary)
- the parent or carer has a history of frequently changing GPs or visiting different hospitals for treatment, particularly if their views about the child’s treatment are challenged by medical staff
- there is direct evidence that the child’s symptoms are being fabricated, for example, if testing finds that the blood in a baby’s nappy is menstrual blood
Patterns and levels of abuse
The patterns of abuse found in cases of FII usually fall into one of six categories. These are ranked below from least severe to most severe.
In the more severe cases of FII, the parent or carer may carry out behaviour from several or all categories.
The categories are:
- fabricating symptoms and manipulating test results to suggest the presence of illness
- intentionally withholding nutrients from the child or interfering with nutritional intake
- inducing symptoms by means other than poisoning or smothering, such as using chemicals to irritate their skin
- poisoning the child with a poison of low toxicity, for example, using a laxative to induce diarrhoea
- poisoning the child with a poison of high toxicity, for example, using insulin to lower a child’s blood sugar level
- deliberately smothering the child to induce unconsciousness
Previous case reports of FII have uncovered evidence of:
- parents or carers lying about their child’s symptoms
- parents or carers deliberately contaminating or manipulating clinical tests to fake evidence of illness, for example by adding blood or glucose to urine samples, placing their blood on the child’s clothing to suggest unusual bleeding, or heating thermometers to suggest the presence of a fever
- poisoning their child with unsuitable and non-prescribed medicine
- infecting their child’s wounds or injecting the child with dirt or faeces (stools)
- inducing unconsciousness by suffocating their child
- not treating or mistreating genuine conditions so they will get worse
- withholding food, which results in the child failing to develop physically and mentally at the expected rate
Reported symptoms
Parents or carers involved in fabricating or inducing illnesses usually allege symptoms that only happen at certain times, such as seizures (fits) and vomiting.
The most commonly reported symptoms in cases of FII are listed below, in order of most to least common:
- seizures (fits)
- apparently life-threatening events, for example, a mother may claim that her baby suddenly stopped breathing for a few minutes
- being unusually drowsy
- vomiting blood or passing blood in their stools
- feeding difficulties
- bowel disturbances, such as constipation and diarrhoea
- asthma
- vomiting
- heartburn
- spitting or coughing up blood
- skin rashes, wounds or other types of skin injury
- fabricated disability, for example, pretending that a young child has hearing difficulties
- false allegations that other people have abused the child
- blood in the child’s urine
- falsely claiming that the child has taken an accidental overdose
