Fabricated or induced illness

Fabricated or induced illness (FII) is a rare form of child abuse. It occurs when a parent or carer, usually the child's biological mother, exaggerates or deliberately causes symptoms of illness in the child.

FII is also known as "Munchausen's syndrome by proxy" (not to be confused with Munchausen's syndrome, where a person pretends to be ill or causes illness or injury to themselves).

Signs of fabricated or induced illness

FII covers a wide range of symptoms and behaviours involving parents seeking healthcare for a child. This ranges from extreme neglect (failing to seek medical care) to induced illness.

Behaviours in FII include a mother or other carer who:

• persuades healthcare professionals that their child is ill when they're perfectly healthy
• exaggerates or lies about their child's symptoms
• manipulates test results to suggest the presence of illness – for example, by putting glucose in urine samples to suggest the child has diabetes
• deliberately induces symptoms of illness – for example, by poisoning her child with unnecessary medication or other substances

Learn more about the signs of fabricated or induced illness.

How common is FII?

It's difficult to estimate how widespread FII is because many cases may go unreported or undetected.

One study published in 2000 estimated 89 cases of FII in a population of 100,000 over a two-year period. However, it's likely that this figure underestimates the actual number of cases of FII.

FII can involve children of all ages, but the most severe cases are usually associated with children under five.

In more than 90% of reported cases of FII, the child's mother is responsible for the abuse. However, there have been cases where the father, foster parent, grandparent, guardian, or a healthcare or childcare professional was responsible.

Why does fabricated or induced illness occur?

The reasons why FII occurs aren't fully understood. In cases where the mother is responsible, it could be that she enjoys the attention of playing the role of a "caring mother".

A large number of mothers involved in FII have borderline personality disorders characterised by emotional instability, impulsiveness and disturbed thinking.

Some mothers involved in FII have so-called "somatoform disorders", where they experience multiple, recurrent physical symptoms. A proportion of these mothers also have Munchausen's syndrome.

Some carers have unresolved psychological and behavioural problems, such as a history of self-harming, or drug or alcohol misuse. Some have experienced the death of another child.

There have also been several reported cases where illness was fabricated or induced for financial reasons – for example, to claim disability benefits.

Read more about the possible causes of fabricated or induced illness.

What to do if you suspect a child is at risk

FII is a child safeguarding issue and can't be managed by the NHS alone.

Medical professionals who suspect FII is taking place should liaise with social services and the police, and must follow local child safeguarding procedures.

If your job involves working with children – for example, if you're a nursery worker or teacher, you should inform the person in your organisation who's responsible for child safeguarding issues. If you don't know who this is, your immediate supervisor or manager should be able to tell you.

If you suspect that someone you know may be fabricating or inducing illness in their child, you shouldn't confront them directly. It's unlikely to make the person admit to wrongdoing, and it may give them the opportunity to dispose of any evidence of abuse.

You can contact your local social services department or telephone the NSPCC's child protection helpline on 0808 800 5000. It's open 24 hours a day, seven days a week.

Read more about what to do if you suspect fabricated or induced illness.

How a case is managed

The child

The first priority is to protect the child and restore them to good health. This may involve removing the child from the care of the person responsible. If the child is in hospital, the parent or carer may need to be removed from the ward.

The child may need help returning to a normal lifestyle, including going back to school. Younger children and babies who don't understand they were victims of abuse often make a good recovery once the abuse stops.

Older children, particularly those who've been abused for many years, will have more complex problems. For example, many affected children believe they're really ill. They need help and support to develop a more realistic understanding of their health. They may also need to learn how to tell the difference between the impaired perception of their parent or carer and reality.

It's common for older children to feel loyal to their parent or carer, and a sense of guilt if that person is removed from the family.

The parent or carer

Once the child is safe, it may be possible to treat the parent or carer's underlying psychological problems. This may include a combination of:

• intensive psychotherapy
• family therapy 

The aim of psychotherapy is to uncover and resolve the issues that caused the person to fabricate or induce illness in their child.

Family therapy aims to resolve any tensions within the family, improve parenting skills and attempt to repair the relationship between the parent or carer and the child.

In more severe cases, the parent or carer may be compulsorily detained in a psychiatric ward under the Mental Health Act so their relationship with their child can be closely monitored.

Parents or carers involved in FII are difficult to treat because most don't admit their deceptions and refuse to recognise their abusive behaviour. Therefore, in many cases, the child is permanently removed from their care.

The best results occur in cases where the parent or carer:

• understands and acknowledges the harm they've caused
• is able to communicate the underlying motivations and needs that led them to fabricate or cause illness
• is able to work together with healthcare and other professionals

Media controversy

There has been controversy in the media regarding FII, with some commentators suggesting that it's not a real phenomenon.

However, a great deal of evidence exists to show that FII is real. The evidence of abuse includes hundreds of case files from more than 20 different countries, the confessions of mothers and other carers, the testimony of children, as well as video footage.