1. FABRICATED AND INDUCED ILLNESS (FII)

2. WHAT IS IT? FII occurs when a caregiver misrepresents the child as ill either by fabricating, or much more rarely, producing symptoms and then presenting the child for medical care, disclaiming knowledge of the cause of the problem. This can include physical, psychological and mental health symptoms

3. WHO DOES IT AFFECT? FII is seen in children of all ages. The reported severe or most dramatic events are usually seen in children under the age of 5 years. Older children may actively collude in the sick role with their parent and may eventually go on to somatise or simulate illness themselves and be diagnosed with hypochondria.

4. 4 POSSIBLE INDICATORS OF FII Repeated and unexplained illnesses or symptoms The carer may not appear as concerned about the child's well being as the health care professionals who are providing treatment; in contrast the carer may appear overly concerned The parent is keen for the child to undergo tests which most parents would only agree to if they were absolutely necessary. The carer will even encourage doctors to perform tests and procedures which may be painful for the child. However, the parent may not agree to the child being admitted for observation or investigation of the reported symptoms Supposed symptoms only occur when the carer is present Normal daily activities for the child are compromised more than would be expected for a particular medical activity (for example, confinement to a wheelchair) If carer’s views on what's wrong with the child are challenged, they become aggressive, confrontational, and may become abusive. An inexplicably poor response to treatment or medication. As soon as old symptoms are resolved, new ones appear. Documents or other sources indicate that the carer has changed doctors frequently, and/or has visited different hospitals for her child's treatment

5. 5 POSSIBLE INDICATORS OF FII Frequent and unexplained absences and from particular lessons/activities. Regular absences to keep a doctor’s or a hospital appointment, where no reason has been given Repeated claims by the parent/s that a child is frequently unwell and requires medical attention for symptoms which are vague, difficult to diagnose and which have not, of themselves ever been noticed by staff. Examples might be headaches, tummy aches, dizzy spells, frequent visits to opticians, dentists or referrals for second opinions. Refusal of permission for school medicals and/or other school based health related checks (e.g. hearing). Regular failures to keep medical and other health related appointments e.g. opticians, physiotherapists. The child may disclose ill treatment by carers to staff or complain about frequent doctor’s visits. Carers, siblings and the child may present conflicting stories about illnesses and deaths in the family Frequent illness, treatments or ailments not consistent, or considered to be excessive, in relation to a child’s disability.

6. IMPACT ON THE CHILD OF FII physical harm to their health emotional and behavioural difficulties difficulties in attention and concentration school non-attendance feeding disorders withdrawal or hyperactivity direct fabrication or exaggeration of their own physical symptoms by older children anxiety about their health and survival suicidal thoughts anger at the betrayal by their parent(s) lack of trust in those caring for them death non organic failure to thrive; speech, language or motor developmental delays; dislike of close physical contact; attachment disorders; low self esteem poor quality or no relationships with peers because social interactions are restricted; poor attendance at school and under- achievement

7. ACTION Staff should not advise parents/carers about the suspicion of fabricated illness as there is evidence that this can increase the harm and it may also damage evidence. The Designated Senior Person for Child Protection in school should discuss with Children’s Services what the parent/carers will be told, by whom and when.

8. CASE EXAMPLE Michael was treated for asthma as a baby almost exclusively on the basis of his mother’s report. When he was three and a half years old his mother described ‘absences’ to the family doctor and he was treated for epilepsy. There was never any conclusive proof of this epilepsy in spite of repeated consultations and investigations. School records suggested a number of absences were possibly observed but very few, if any, tonic/clonic seizures. Michael’s mother obtained quantities of the prescribed medication which were far in excess of his requirements. The prescribed medication was primarily administered by his mother or under her control and direction, and over a long period of time many drugs were tried but his ‘fits’ allegedly got worse. The toxic effects of the drugs caused chronic ill health for Michael. He was eventually unable even to attend school and had been fitted with a naso-gastric tube to administer food and drugs. The mother told a teacher and a relative that Michael had a terminal illness and that ‘they could do no more for Michael’. Mother rang the family doctor because Michael was having difficulty in breathing. The family doctor arranged an ambulance before visiting Michael, and after having examined him, instructed his mother not to give him any further medication before he was admitted. In spite of this advice, a further dose of medicine was given to Michael by his mother. Cumbria County Council http://www.cumbria.gov.uk/eLibrary/Content/Internet/327/3823713560.pdf