Safeguarding: Fabricated or Induced Illness

Fabricating or inducing illness in a child is a rare form of child abuse, which can be difficult to identify and prove. Parents or carers responsible often have complex histories and/or mental health issues.

If fabricated or induced illness is suspected, both the child and the parent/carer will require intervention, help and support.

What is fabricated or induced illness?

This is when a parent or carer deliberately causes harm to a child but presents the child’s symptoms as a medical condition. It is also known as Munchausen Syndrome By Proxy.

Research has shown that, in the majority of cases, the perpetrator is the child’s biological mother and more than 50% of the children involved will be under five years old.

How does the fabricated illness manifest itself?

The way that fabricated illness appears varies, but can include:

• the child is given something to make them ill or show symptoms such as a rash
• the parent reports symptoms that don’t exist
• the parent tampers with bodily fluid samples used to diagnose a child’s condition
• the parent fabricates the child’s medical history or tampers with medical documents
• the parent takes the child to many different doctors/hospitals
• the child has genuine symptoms that the parent exaggerates

How are fabricated illnesses identified?

It can be extremely difficult to separate genuine conditions from fabricated illness, but concerns usually arise when a child stops showing symptoms when the parent or carer is not in contact with them.

Other indicators can be:

• the child has symptoms that cannot be explained by a medical condition
• the child does not respond to treatment and there is no clear reason why
• the child keeps showing a wide range of symptoms over a period of time
• the child improves then the symptoms return or new symptoms appear

However, it’s important to note that other reasons can be behind any of the situations listed above and it doesn’t automatically mean that fabricated illness is the cause. Also, a parent’s behaviour can simply show natural anxiety about a child’s illness.

What leads a parent or carer to fabricate a child’s illness?

Although there is not one clear reason, parents and carers involved often have troubled histories themselves. This can include physical or emotional abuse in their own childhood, a history of medical conditions of their own and/or a history of mental health issues, including self-harm.

It can also include a history of experiencing bereavements, in particular a number of losses over a short time period. These may be adult deaths, child deaths or miscarriages.

Another indicator is that the parent is experiencing relationship problems, which can range from marriage breakdown to domestic violence.

What should happen when fabricated or induced illness is uncovered?

The first priority is the safety of the child. This can mean removing them from the parent responsible for causing them harm or from the family environment. In some cases it can be difficult for the other parent to accept that their partner is capable of harming their child.

A child is protected under the Children Act 1989 and investigations fall under the statutory framework of the government’s Working Together 2015 and its 2008 document: SafeguardingChildren in Whom Illness is Fabricated or Induced.

Assessing the parent

The parent or carer responsible should then be assessed to find out whether they have a psychiatric disorder and how it should be treated.

It’s important to remember that the perpetrator of this abuse may have suffered from abuse themselves, or suffered bereavements or other losses that have affected their mental well-being and led to this behaviour. They might also be at risk of harming themselves or attempting suicide after they have been found to be harming their child.

A hostile response to questioning should not be considered an automatic indicator of guilt, however, it is common for perpetrators to act defensively and deny the harm at first.

This may be in part because they are worried about how this will affect their relationship with their partner, other family members or friends. They might also not recognise how damaging their actions have been to their child’s health and well-being.

Treatment can only be successful, however, if the parent is able to acknowledge responsibility.

Conclusion

There remains controversy around identifying fabricated or induced illness since some high-profile cases of mothers convicted of harming or killing their children were overturned. While it’s considered rare and can be very hard to establish, those responsible for the welfare of the children and adults involved should be aware of the warning signs and prepared to take appropriate action if fabricated illness is suspected.

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CMS Vocational Training Ltd can be contacted on 01924 470 477.