Fabricated or induced illness (FII) is a little-known form of child abuse. However, one of its strongest indicators is that of frequent and unexplained absences. In this article, Suzanne O’Connell explains what it is and how it might be recognised.
- FII is a type of child abuse that school staff should be aware of.
- In cases of FII, there may be frequent absences and medical appointments with explanations that seem implausible.
- Suspected cases of FII should be referred to social care and a multi-agency response is needed.
Fabricated or induced illness (FII), previously often referred to as ‘Munchausen’s syndrome by proxy’ is when a parent or carer exaggerates or deliberately causes symptoms of illness in their child. It is often the mother figure who is involved in trying to persuade professionals that her child is ill when they are healthy.
It is a type of abuse that is both difficult to identify and hard to understand. Although not widespread, it is likely that the number of those affected is under-reported. There are three main ways in which a carer may fabricate or induce illness:
- Fabrication of signs and symptoms, including the possible fabrication of medical history.
- Falsification of records and specimens of bodily fluids.
- Induction of illness.
Why it happens is unclear. However, the need to continue in a caring role is one possible motive, along with mental health difficulties and even, very occasionally, financial gain from fundraising. The family’s history is likely to have been troubled and parents may themselves have experienced childhood abuse. There may be a history of medical and psychiatric difficulties and there could be a personality disorder.
FII is a form of child abuse that can lead to immediate and long-term implications. Carers might administer medication or other substances to cause physical signs. They might interfere with medical treatments either by not administering them or altering the dosage. Children can suffer from unnecessary investigations, including invasive treatments that are harmful to them.
It is important that staff are aware of it and the possible signs that indicate that it might be taking place. These signs can also be the result of other types of abuse and the identification of FII will require a multi-agency response.
How to recognise it
The attendance officer is in a particularly good position to be aware of the possibility of FII, given that children who are affected may frequently be absent from school and the subject of attendance issues. Children experiencing it may have a poor attendance record and be regularly kept at home. In particular you should look out for:
- frequent and unexplained absences
- regular absences because of medical appointments
- regular claims by the parent that the child is ill when teachers have not noticed anything themselves.
It might be that the only person noticing the symptoms is the parent and that sometimes the symptoms might not be plausible; for example, the parent may claim that the child has lost a lot of blood but they don’t appear to be unwell. There might be changes to the GP as the parent moves on if they feel that the health professional suspects them. In some cases, the parent may not seem too worried by the illness in spite of being very attentive.
In some instances, the illnesses which the child is apparently suffering from are often vague and difficult to prove or disprove; for example, headaches, tummy aches and dizzy spells. The problems may not just be referred to the GP but might also involve a dentist or an optician, for example. Although often it’s a young child who is involved, older children can sometimes collude with the parent.
There is a word of warning here. Although school staff should be aware of the signs and symptoms of FII, this possibility should also be carefully balanced with the need to listen to pupils and their parents. For example, it has been claimed that families with children suffering from ME (Myalgic Encephalomyelitis) sometimes known as chronic fatigue syndrome, are being unfairly suspected of FII.
The vast majority of those with numerous medical appointments and those who are off school because of illness, including those illnesses listed above, are entirely justified in their absences. School staff should be made aware of the existence of FII but apply it cautiously as a possibility and in conjunction with social care.
What should you do?
Any concerns should first be reported to the designated safeguarding lead (DSL) who should then contact social care about the suspicion. The parent should not be approached directly at this stage. If they become suspicious that FII is suspected, this might provide time for them to remove or disguise evidence. It will be the role of social care to investigate the case further.
However, practical actions can be taken. As attendance officer you should keep a careful record of any absences and the reasons given. You might involve the school’s health representative in the discussion but the parent should not be approached. If there are siblings in another local school, it can be useful to contact the school for evidence of similar behaviour. Social services will coordinate any necessary actions that could include the involvement of the police.
Many children will suffer from long-term consequences of FII, including emotional and behavioural disorders and confusion about their state of health. They may develop anxieties about their health and may even express suicidal thoughts. The school’s pastoral system will need to help support them with these insecurities and work with outside agencies to address any mental health issues.
For more detailed information about FII, you can read ‘Safeguarding children in whom illness is fabricated or induced’, a document which was published in 2008 and hasn’t been updated since. FII is a complex issue that requires a co-ordinated approach from different agencies. It is important that staff are made aware, but that a considered approach is taken to any possible case that’s suspected.
- ‘Safeguarding children in whom illness is fabricated or induced’, Department for Children, Schools and Families, 2008: https://bit.ly/2IC0glT
Use the following item in the Toolkit to help you put the ideas in this article into practice: