Fabricated or Induced Illness in Children: A Narrative Review of the Literature

Although child maltreatment due to abuse or neglect is pervasive within our society, less<br/>is known about fabricated or induced illness by carers (FII), which is considered to be a<br/>rare form of child abuse. FII occurs when a caregiver (in 93% of cases, the mother)<br/>misrepresents the child as ill either by fabricating, or much more rarely, producing<br/>symptoms and then presenting the child for medical care, disclaiming knowledge of the<br/>cause of the problem. The growing body of literature on FII reflects the lack of clarity<br/>amongst professionals as to what constitutes FII, the difficulties involved in diagnosis,<br/>and the lack of research into psychotherapeutic intervention with perpetrators. This lack<br/>of clarity further complicates the identification, management and treatment of children<br/>suffering from FII and may result in many cases going undetected, with potentially lifethreatening<br/>consequences for children. It has been suggested that there is a national<br/>under-reporting of fabricated or induced illness. In practice these cases are encountered<br/>more frequently due to the chronic nature of the presentations, the large number of<br/>professionals who may be involved and the broad spectrum including milder cases that<br/>may not all require a formal child protection response. Diagnosis of fabricated disease<br/>can be especially difficult, because the reported signs and symptoms cannot be confirmed<br/>(when they are being exaggerated or imagined) or may be inconsistent (when they are<br/>induced or fabricated). This paper highlights and discusses the controversies and<br/>complexities of this condition, the risks to the child and how it affects children; the<br/>paucity of systematic research regarding what motivates mothers to harm their children<br/>by means of illness falsification; how the condition should be managed and treated for<br/>both mother and child; and implications for policy and practice.