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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.

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 affected 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 as a result of having 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 has good medical knowledge or a medical background
  • the parent or carer does not seem too worried about the child's health, despite being very attentive
  • the parent or carer develops close and friendly relationships with healthcare staff, but may become abusive or argumentative if their own views about what's wrong with the child are challenged
  • 1 parent (commonly the father) has little or no involvement in the care of the child
  • 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)

Previous case reports of FII have uncovered evidence of:

  • parents or carers lying about their child's symptoms
  • parents or carers deliberately contaminating or manipulating clinical tests to fake evidence of illness. For example, by adding blood or glucose to urine samples, placing their blood on the child's clothing to suggest unusual bleeding, or heating thermometers to suggest the presence of a fever
  • 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