FII - Fabricated or Induced Illness

Fabricated or induced illness (FII) is a rare form of child abuse. It occurs when someone who is caring for a child, usually the child’s biological mother, fakes or deliberately causes symptoms of illness in the child.
FII is also known as Munchausen syndrome by proxy. Munchausen's syndrome is a condition where a person pretends to be ill or causes illness or injury to themselves.
However, healthcare professionals in the UK prefer to use the term fabricated or induced illness because the term Munchausen's syndrome by proxy places the emphasis on the person carrying out the abuse, rather than the child who is the victim.
The term Munchausen syndrome by proxy is still widely used in other countries.
There has been some controversy in the media regarding FII, with some commentators suggesting it is not a real phenomenon. But there is a great deal of evidence to suggest that the condition does exist. The evidence of abuse includes hundreds of case files from more than 20 different countries, the confessions of mothers and other carers, the testimony of children and secret video footage.


Behaviours in FII

The term FII covers a wide range of cases and behaviours. These include:
a mother or other carer who convinces their child they are ill when in fact they are perfectly healthy
a mother or other carer who exaggerates or lies about their child’s symptoms
a mother or other carer who manipulates test results to suggest the presence of illness, for example by putting glucose in urine samples to suggest the child has diabetes
a mother or other carer who deliberately induces symptoms of illness, for example by poisoning her child with unnecessary medication or other substances


How common is fabricated or induced illness?

It is difficult to estimate how widespread FII is because many cases may go unreported or undetected.
The British Paediatric Surveillance Unit (BPSU), which is a specialist unit that assists researchers into rare childhood conditions, carried out a study of cases of FII. The study identified 97 cases of FII in the UK over a two-year period.
However, it is likely that this figure underestimates the true incidence of FII.
FII can involve children of all ages, but the most severe cases usually involve children under five.
In over 90% of reported cases of FII the child’s mother is responsible for the abuse. But cases have been reported in which the father, foster parent, grandparent, guardian, or a healthcare or childcare professional was responsible.

Motivation

It is not fully understood why FII occurs.
In cases where the mother is responsible, it could be that the mother enjoys the attention of playing the role of a ‘caring mother’.
A large number of mothers who have been involved in cases of FII have had a previous history of unresolved psychological and behavioural problems, such as a history of self harming or drug or alcohol misuse, or have experienced the death of another child.
In particular, a high proportion of mothers involved in FII have been found to have a type of mental health problem called borderline personality disorder, which is characterised by emotional instability and disturbed thinking. 
There have been several reported cases where illness was fabricated or induced for financial reasons, for example to claim disability benefits.

Child protection

FII is a child protection issue and cannot be treated by the NHS alone. Medical professionals who suspect FII is taking place should liaise with social services and the police, and must follow local child protection procedures.
If your job involves working with children, for example if you are a nursery worker or teacher, you should inform the person in your organisation who is responsible for child protection issues. If you do not know who this is, your immediate supervisor or manager should be able to tell you.
If you suspect that someone you know may be fabricating or inducing illness in their child, it is not recommended that you confront them directly. A direct confrontation is unlikely to make a 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, which is open 24 hours a day, seven days a week, on 0808 800 5000.

Treatment

In cases of FII, the first priority is to protect the child. This may involve removing the child from the care of the person responsible. If the child is in hospital, it may involve removing the responsible parent or carer from the ward.
Once the child is safe it may be possible to treat the the parent or carer's underlying psychological problems. However, parents or carers who are involved in FII are difficult to treat because most refuse to admit their abusive behaviour. Therefore, in many cases, the child is permanently removed from their care.

Outlook

Children who are affected by FII can experience long-term consequences for their physical health, as well as significant psychological and emotional trauma.
A BPSU study found that one in four victims of FII still had significant physical and/or psychological problems two years after the abuse had stopped.
In cases involving administering unnecessary medicines or other substances, it is estimated that around 1 in 16 will die as a result of this abuse. A further 1 in every 14 will experience long-term or permanent injury.