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.
FII used to be known as "Munchausen's syndrome by proxy" (not to be confused with Munchausen's syndrome, where a person pretends to be ill or causes illness or injury to themselves).
Signs of fabricated or induced illness
Fabricated or induced illness (FII) covers a wide range of symptoms and behaviours involving parents or carers seeking healthcare for a child. This ranges from exaggerating or inventing symptoms, to deliberately making the child ill.
Behaviours in FII can include a parent or carer who:
- persuades healthcare professionals that their child is ill when they're healthy
- exaggerates or lies about their child's symptoms
- manipulates test results to suggest the child is ill, for example, by putting glucose in urine samples to suggest the child has diabetes
- deliberately induces symptoms of illness, for example, by poisoning their child with unnecessary medicine or other substances
Cases where the parent or carer wrongly reports symptoms are much more common than cases where they induce illness in the child.
Learn more about the signs of fabricated or induced illness.
Why fabricated or induced illness happens
The reasons why FII happens are not fully understood.
The parent or carer will have a need for their child to be treated as if they're ill, or as being more unwell than they really are. Their behaviour is intended to convince doctors that the child is ill.
This may be because the parent or carer gains something, such as attention, support or closeness to the child. Or it may be because they have anxiety or incorrect beliefs about their child's health, and they need these beliefs to be confirmed and acted upon.
The parent or carer is not always fully aware of the reasons for their own behaviour.
A large number of parents or carers involved in FII have borderline personality disorders characterised by emotional instability, impulsiveness and disturbed thinking.
Some parents or carers involved in FII have so-called "somatoform disorders", where they experience multiple, recurrent physical symptoms. A proportion of these parents or carers also have Munchausen's syndrome.
There have also been several reported cases where illness was fabricated or induced for financial reasons. For example, to claim disability benefits.
Read more about the possible causes of fabricated or induced illness.
What to do if you suspect a child is at risk
FII is a child safeguarding issue and cannot be managed by the NHS alone.
Medical professionals who suspect FII is happening should liaise with social services and the police, and must follow local child safeguarding procedures.
If your job involves working with children, for example, if you're a nursery worker or teacher, tell the person in your organisation who's responsible for child safeguarding issues. If you do not know who this is, your immediate supervisor or manager should be able to tell you.
If you suspect someone you know may be fabricating or inducing illness in their child, do not confront them directly. It's unlikely to make the person admit to wrongdoing, and it may give them the opportunity to dispose of any evidence of abuse.
You can contact your local social services department, or telephone the NSPCC's child protection helpline on 0808 800 5000. It's open from 8am to 10pm Monday to Friday, and 9am to 6pm on Saturday and Sunday.
Read more about what to do if you suspect fabricated or induced illness.
How a case is managed
The first priority is to protect the child, find out their true state of health and restore them to good health. Health professionals will create a health and education rehabilitation plan for the child.
The local authority children's social care team may also be involved. They may remove the child from the care of the person responsible. If the child is in hospital, the parent or carer may need to be removed from the ward.
The child may need help returning to a normal lifestyle, including going back to school. Younger children and babies who do not understand what was happening often make a good recovery after the abuse stops.
Older children, particularly those who've been abused for many years, may have more problems. For example, many affected children believe they're really ill. They need help and support to develop a more realistic understanding of their health.
It's common for older children to feel loyal to their parent or carer, and a sense of guilt if that person is removed from the family.
The parent or carer
Once the child is safe, it may be possible to treat the parent or carer's underlying psychological problems. This may include a combination of:
- intensive psychotherapy
- family therapy
The aim of psychotherapy is to uncover and resolve the issues that caused the person to fabricate or induce illness in the child.
Family therapy aims to resolve any tensions within the family, improve parenting skills and attempt to repair the relationship between the parent or carer and the child.
In more severe cases, the parent or carer may be compulsorily detained in a psychiatric ward under the Mental Health Act so their relationship with the child can be closely monitored.
Parents or carers involved in FII are difficult to treat because most do not admit their deceptions and refuse to recognise their abusive behaviour. In some cases, the child is permanently removed from their care.
The best results are achieved in cases where the parent or carer:
- understands and acknowledges the harm they've caused
- is able to communicate the underlying motivations and needs that led them to fabricate or cause illness
- is able to work together with healthcare and other professionals