Fabricated or induced illness in children

NEW guidance on perplexing presentations (PP) and fabricated or induced illness (FII) in children has been launched by the Royal College of Paediatrics and Child Health (RCPCH).

This updates the College’s 2009 guidance and aims to support paediatricians involved in these sometimes very difficult cases.

The RCPCH has produced the guidance to provide procedures for safeguarding children who present with PP or FII and best practice advice in the medical management of these cases to minimise harm to children.

A new and wider interpretation of FII now includes any clinical situation where the parent or carer’s actions are aimed at convincing doctors and other professionals that a child is more seriously ill than is the case. The guidance points out that in such cases the parent or carer may be acting on erroneous beliefs about the child’s state of health or, in some cases, deceiving professionals. This creates a risk that the child will be harmed directly by the behaviour of a parent or carer but also inadvertently by the medical team’s response.

Dr Alison Steele, Officer for Safeguarding at the RCPCH, said "It is very rare for parents or carers to deliberately induce illness in a child by, for example, poisoning them or withholding treatment. Most cases are based on incorrect beliefs or misplaced anxiety, which unchecked can cause children to undergo harms ranging from missing school and seeing friends, to undergoing unnecessary and painful or even harmful tests and treatments. Paediatricians, and other professionals, have a duty of care to the child but, in almost every case, their work will form part of a collaborative approach which involves the parent or carer as well as the child.

"This guidance is extremely important for paediatricians but we hope it will also be useful for those who work in the wider areas of child health, including GPs and others concerned with safeguarding of children, including social workers, police and education staff."

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