Skip to main content
SpringerLink
Log in

Fabricated and Induced Illness by Carers (FII)

  • Chapter
  • First Online:
Pediatric Forensic Evidence

  • 484 Accesses

Abstract

Medical neglect is when a carer fails to present a child for care when required. Fabricated or induced illness (FII) is when a carer seeks medical care unnecessarily or induces symptoms.

When a child is presented with symptoms, the clinician must make a diagnosis. In some cases a child may have a genuine medical problem diagnosed only at a later stage after initial concerns about FII have been raised. The term FII is child-centred, seeking to define the cause of a child’s reported or actual illness.

McClure et al. (1996) collected data nationally between 1992–94. Only cases discussed at a formal child protection case conference involving illness induction were included. There were 97 FII cases with incidences quoted as 0.5/100,000 under 16 years, 1.2/100,000 under 5 years and 2.9/100,000 under 1 year [1]. Watson et al. (2000) using broader inclusion criteria, estimated a prevalence rate for FII of 89/100,000 within a Health District in Manchester [2].

Flaherty et al. (2013) reviewing FII, reported that bleeding, seizures, central nervous system depression, apnoea, diarrhoea, vomiting, fever, and rash were the most commonly reported presentations and that illnesses could involve multiple organs with numerous specialists involved [3].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. McClure RJ, Davis PM, Meadow R, Sibert JR. Epidemiology of Munchausen syndrome by proxy, non-accidental poisoning and non-accidental suffocation. Arch Dis Child. 1996;75:57–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Watson S, Eminson DM, Coupe W. Quoted as personal communication. In: Eminson M, Postlethwaite RJ, editors. Munchausen syndrome by proxy abuse: a practical approach. Oxford: Butterworth Heinemann; 2000.

    Google Scholar 

  3. Flaherty EG, MacMillan HL, Committee On Child Abuse and Neglect. Caregiver-fabricated illness in a child: a manifestation of child maltreatment. Pediatrics. 2013;132:590.

    Article  PubMed  Google Scholar 

  4. Roesler T, Jenny C. Medical child abuse: beyond Munchausen syndrome by proxy. American Academy of Pediatrics; 2008.

    Google Scholar 

  5. Davis P. The Cardiff Leeds study of alleged Munchausen syndrome by proxy, non-accidental poisoning and non-accidental suffocation. Welsh Paediatr J. 2000;13:32–41.

    Google Scholar 

  6. Jureidini J. Obstetric factitious disorder and Munchausen syndrome by proxy. J Nerv Ment Dis. 1993;181(2):135–7.

    Article  CAS  PubMed  Google Scholar 

  7. Meadow R. Munchausen syndrome by proxy abuse perpetrated by men. Arch Dis Child. 1998;78:210–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Levin AV, Sheridan MS, editors. Munchausen syndrome by proxy: issues in diagnosis and treatment. New York: Lexington Books; 1995.

    Google Scholar 

  9. Rosenberg DA. Web of deceit: a literature review of Munchausen syndrome by proxy. Child Abuse Negl. 1987;11:547–63.

    Article  CAS  PubMed  Google Scholar 

  10. Sheridan MS. The deceit continues: an updated literature review of Munchausen syndrome by proxy. Child Abuse Negl. 2003;27(4):431–51.

    Article  PubMed  Google Scholar 

  11. Davis PM, McClure RJ, Rolfe K, Chessman N, Pearson S, Sibert JR, Meadow R. Procedures, placement and risks of further abuse after Munchausen syndrome by proxy, non-accidental poisoning and non-accidental suffocation. Arch Dis Child. 1998;78:217–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Mian M. A multidisciplinary approach. In: Levin AV, Sheridan MS, editors. Munchausen syndrome by proxy: issues in diagnosis and treatment. New York: Lexington Books; 1995. p. 271–86.

    Google Scholar 

  13. HM Government. Regulation of Investigatory Powers Act. 2000.

    Google Scholar 

  14. Shabde N, Craft AW. Covert video surveillance: an important investigative tool or a breach of trust? Archives of Disease in Childhood 1999;81(4):291–4.

    Google Scholar 

  15. Hall DE, Eubanks L, Meyyazhagan LS, Kenney RD, Johnson SC. Evaluation of covert video surveillance in the diagnosis of Munchausen syndrome by proxy: lessons from 41 cases. Pediatrics. 2000;105(6):1305–12.

    Article  CAS  PubMed  Google Scholar 

  16. General Medical Council. Protecting children and young people: the responsibilities of all doctors. 2012.

    Google Scholar 

  17. General Medical Council. 0–18 years: guidance for all doctors. 2007.

    Google Scholar 

  18. Bools C, Neale B, Meadow R. Munchausen syndrome by proxy: a study of psychopathology. Child Abuse Negl. 1994;18:773–88.

    Article  CAS  PubMed  Google Scholar 

  19. Bass C, David J. Psychopathology of perpetrators of fabricated or induced illness in children: case series. Br J Psychiatry. 2011;199(2):113–8.

    Article  PubMed  Google Scholar 

  20. McGuire TL, Feldman KW. Psychological morbidity of children subjected to Munchausen syndrome by proxy. Pediatrics. 1989;83:289–92.

    CAS  PubMed  Google Scholar 

  21. Makar AF, Squier PJ. Munchausen syndrome by proxy: father as a perpetrator. Pediatrics. 1990;85:370–3.

    CAS  PubMed  Google Scholar 

  22. Meadow R. Suffocation, recurrent apnea, and sudden infant death. J Pediatr. 1990;117:351–7.

    Article  CAS  PubMed  Google Scholar 

  23. Samuels MP, McClaughlin W, Jacobson RR, Poets CF, Southall DP. Fourteen cases of imposed upper airway obstruction. Arch Dis Child. 1992;67(2):162–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Rosen CL, Frost JD, Bricker T, Tarnow JD, Gillette PC, Dunlavy S. Two siblings with recurrent cardiorespiratory arrest: Munchausen syndrome by proxy or child abuse? Pediatrics. 1983;71:715–20.

    CAS  PubMed  Google Scholar 

  25. Southall DP, Stebbens VA, Rees SV, Lang MH, Warner JO, Shinebourne EA. Apnoeic episodes induced by smothering: two cases identified by covert video surveillance. Br Med J. 1987;294:1637–41.

    Article  CAS  Google Scholar 

  26. Becroft DM, Thompson JM, Mitchell EA. Nasal and intrapulmonary haemorrhage in sudden infant death syndrome. Arch Dis Child. 2001;85(2):116–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. McIntosh N, Mok JY, Margerison A. Epidemiology of oro-nasal hemorrhage in the first 2 years of life: implications for child protection. Pediatrics. 2007;120(5):1074–8.

    Article  PubMed  Google Scholar 

  28. McIntosh N, Mok JY, Margerison A, Armstrong L, Mathews A, Robertson AK, Street J, Sweeney S, Chalmers J. The epidemiology of oro-nasal haemorrhage and suffocation in infants admitted to hospital in Scotland over 10 years. J Arch Dis Child. 2010;95(10):810–6.

    Article  CAS  Google Scholar 

  29. Rees P, Kemp A, Carter B, Maguire S. A systematic review of the probability of asphyxia in children aged <2 years with unexplained epistaxis. J Pediatr. 2016;168:178–84.

    Article  PubMed  Google Scholar 

  30. Krous HF, Nadeau JM, Byard RW, Blackbourne BD. Oro-nasal blood in sudden infant death. Am J Forensic Med Pathol. 2001;22(4):346–51.

    Google Scholar 

  31. Krous HF, Chadwick AE, Haas EA, Stanley C. Pulmonary intra-alveolar hemorrhage in SIDS and suffocation. J Forensic Leg Med. 2007;14(8):461–70.

    Article  PubMed  Google Scholar 

  32. Semmekrot BA, van Sleuwen BE, Engelberts AC, Joosten KF, Mulder JC, Liem KD, Rodrigues Pereira R, Bijlmer RP, L’Hoir MP. Surveillance study of apparent life-threatening events (ALTE) in the Netherlands. Eur J Pediatr. 2010;169(2):229–36.

    Article  PubMed  Google Scholar 

  33. Wenzl TG, Schenke S, Peschgens T, Silny J, Heimann G, Skopnik H. Association of apnea and non-acid gastroesophageal reflux in infants: investigations with the intraluminal impedance technique. Pediatr Pulmonol. 2001;31(2):144–9.

    Article  CAS  PubMed  Google Scholar 

  34. Arad-Cohen N, Cohen A, Tirosh E. The relationship between gastroesophageal reflux and apnea in infants. J Pediatr. 2000;137(3):321–6.

    Article  CAS  PubMed  Google Scholar 

  35. Takahashi T, Yamada K, Kobayashi H, Hasegawa Y, Taketani T, Fukuda S, Yamaguchi S. Metabolic disease in10 patients with sudden unexpected death in infancy or acute life-threatening events. Pediatr Int. 2015;57(3):348–53.

    Article  PubMed  Google Scholar 

  36. Maguire SA, Hunter B, Hunter LM, Sibert JR, Mann MK, Kemp AM. Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries. Arch Dis Child. 2007;92(12):1113–7.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Morrison AL, Chute D, Radentz S, Golle M, Troncoso JC, Smialek JE. Air bag-associated injury to a child in the front passenger seat. Am J Forensic Med Pathol. 1998;19(3):218–22.

    Article  CAS  PubMed  Google Scholar 

  38. Lopez MR, Abd-Allah S, Deming DD, Piantini R, Young-Snodgrass A, Perkin R, Barcega B, Sheridan-Matney C. Oral, jaw, and neck injury in infants and children: from abusive trauma or intubation? Pediatr Emerg Care. 2014;30(5):305–10.

    Article  PubMed  Google Scholar 

  39. Bak-Romaniszyn L, Małecka-Panas E, Czkwianianc E, Płaneta-Małecka I. Mallory-Weiss syndrome in children. Dis Esophagus. 1999;12(1):65–7.

    Article  CAS  PubMed  Google Scholar 

  40. Paranjothy S, Fone D, Mann M, Dunstan F, Evans E, Tomkinson A, Sibert J, Kemp A. The incidence and aetiology of epistaxis in infants: a population-based study. Arch Dis Child. 2009;94(6):421–4.

    Article  CAS  PubMed  Google Scholar 

  41. Bools CN, Neale BA, Meadow R. Follow up of victims of fabricated illness (Munchausen syndrome by proxy). Arch Dis Child. 1993;69(6):625–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Berg B, Jones DP. Outcome of psychiatric intervention in factitious illness by proxy (Munchausen’s syndrome by proxy). Arch Dis Child. 1999;81(6):465–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Gray J, Bentovim A. Illness induction syndrome: paper I – a series of 41 children from 37 families identified at The Great Ormond Street Hospital for Children NHS Trust. Child Abuse Negl. 1996;20(8):655–73.

    Article  CAS  PubMed  Google Scholar 

Further Reading

  • Royal College of Paediatrics and Child Health. Fabricated or induced illness by carers (FII): a practical guide for Paediatricians. 2009 (Review date: October 2012).

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatrics, Queen’s University Hospital, Romford, Essex, UK

    David L. Robinson

Authors
  1. David L. Robinson
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Robinson, D.L. (2017). Fabricated and Induced Illness by Carers (FII). In: Pediatric Forensic Evidence. Springer, Cham. https://doi.org/10.1007/978-3-319-45337-8_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-45337-8_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-45335-4

  • Online ISBN: 978-3-319-45337-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation