Introduction
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 actually causes the symptoms of illness.
The term mother will be used throughout this article to describe the perpetrator of FII. However, it should be made clear that a small number of cases of FII have involved the father, foster parent, grandparent, guardian, or a healthcare or childcare professional.
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. See the Health A-Z topic about Munchausen's syndrome for more information about this condition.
The term Munchausen syndrome by proxy is sometimes used to describe when someone fabricates or causes illness or injury to others. However, healthcare professionals in the UK prefer to use the term fabricated or induced illness for the two main reasons below.
- Munchausen syndrome by proxy places the emphasis on the person carrying out the abuse rather than the child who is the victim of abuse.
- The term Munchausen syndrome by proxy has been misinterpreted as a psychiatric diagnosis when, in fact, it was designed to describe a particular pattern of abuse.
The term Munchausen syndrome by proxy is still widely used in other countries.
Range of cases
The term FII covers a wide range of cases and behaviours ranging from moderate to severe. For example, these might be:
- a mother who convinces her child they are ill when in fact they are perfectly healthy
- a mother who exaggerates or lies about her child s symptoms
- a mother 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 who deliberately induces symptoms of illness, for example by poisoning her child with inappropriate medication
How common is fabricated or induced illness?
It is difficult to estimate exactly how widespread FII is because many perpetrators of abuse are very good at disguising their actions.
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. This equates to one child in every 5,000 being affected by FII.
However, it is highly likely that this figure underestimates the true scale of the problem. Another expert study estimates that the number of children affected by FII could be as high as one in every 1,100.
Most cases of FII involve young children, with 20 months being the average age at diagnosis. In 90% of reported cases of FII the child s mother is responsible for the abuse.
Motivation
It is not fully understood why FII occurs, but a number of theories have been suggested. 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.
There have been several reported cases where illness was fabricated or induced for financial reasons, for example to claim disability benefits. However, it is not known exactly how widespread this practice is because, unlike in the classic pattern of FII, mothers who are involved in this type of deception tend to avoid visiting doctors to prevent their deception being discovered.
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.
The first priority is to protect the child. This may involve removing the child from their mother s care or, if the child is in hospital, removing the carer from the ward.
Once the child is safe it may be possible to treat the mother s underlying psychological problems. However, women who are involved in FII are notoriously 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 often experience significant trauma and are often subjected to significant levels of abuse. The 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.
It is estimated that 1 child in every 16 will die as a result of the abuse that they receive. A further 1 in every 14 will experience long-term or permanent injury.
Controversy about fabricated and induced illness
There has been some controversy in the media regarding FII. A number of women who were convicted of murdering their children were later found not guilty and freed by the Court of Appeal.
An expert witness for the prosecution in these cases was a paediatrician (an expert in treating children) called Professor Roy Meadows. Professor Meadows is also a leading expert in cases of FII and was the first to use the term Munchausen syndrome by proxy .
Even though neither the court cases nor the expert advice given by Professor Meadows was related to FII, the fact the cases were overturned led some media commentators to claim that the concept of FII was also unsound and not a real phenomenon.
This article is not designed to comment on individual cases of FII, 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, the testimony of children and secret video footage.
