The abuse that happens in fabricated or induced illness (FII) takes a range of forms and can be difficult to recognise, but there are warning signs to look out for.

Warning signs

A clinician may suspect fabricated or induced illness if, after carrying out examinations and tests, there appears to be no explanation for the child's symptoms. For more information, you can read the NICE guidance about when to suspect child maltreatment in under 18s.

They should also look out for 1 or more of the following warning signs:

symptoms only appear when the parent or carer is present
the only person claiming to notice symptoms is the parent or carer
the parent or carer does not let healthcare professionals see the child on their own
the parent or carer talks for the child, or the child refers to the parent or carer rather than speaking for themselves
the child has an inexplicably poor response to medicine or other treatment
if 1 particular health problem is resolved, the parent or carer may then begin reporting a new set of symptoms
the child's alleged symptoms do not seem plausible – for example, a child who has supposedly lost a lot of blood but does not become unwell
the parent or carer has a history of frequently changing GPs or visiting different hospitals for treatment, particularly if their views about the child's treatment are challenged by medical staff
the child's daily activities are being limited far beyond what you would usually expect for a certain condition – for example, they never go to school or have to wear leg braces even though they can walk properly
the parent or carer does not accept reassurance or recommended treatment, and insists on continued investigations or new treatments
the parent or carer encourages medical staff to perform often painful tests and procedures on the child (tests that most parents would only agree to if they were persuaded that it was absolutely necessary)

Types of abuse in FII

Previous case reports of FII have uncovered evidence of parents or carers:

exaggerating, distorting or lying about their child's symptoms, medical history, tests or diagnoses
falsifying documents
deliberately contaminating or manipulating clinical tests to fake evidence of illness, for example, by adding blood or sugar to urine samples
poisoning their child with unsuitable and non-prescribed medicine
infecting their child's wounds or injecting the child with dirt or poo
inducing unconsciousness by suffocating their child
not treating or mistreating genuine conditions so they get worse
withholding food, resulting in the child failing to develop physically and mentally at the expected rate