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Fabricated or induced illness

Fabricated or induced illness (FII) is a rare form of child abuse.

It happens when a parent or carer exaggerates or causes symptoms of illness in the child. This is usually the mother.

FII is also known as "Munchausen's syndrome by proxy."

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

Warning signs

A doctor may carry out examinations and tests and find no explanation for the symptoms. If so, they may suspect FII.

The doctor will look out for one 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 child doesn't respond well to medication or other treatment
  • if one health problem is solved, the parent or carer may then begin reporting a new set of symptoms
  • the child's symptoms don't seem plausible
  • a history of changing GPs or visiting different hospitals for treatment
  • limited activities as a result of having a condition – for example, missing a lot of school
  • the parent or carer has a good medical knowledge or a medical background
  • the parent or carer doesn't seem worried about the child's health, despite being very attentive
  • the parent or carer develops close relationships with healthcare staff, but becomes argumentative if their views are challenged
  • one parent - usually the father - has little or no involvement in the care of the child
  • the parent or carer encourages staff to perform painful tests and procedures on the child

Patterns and levels of abuse

The patterns of abuse usually fall into one of six categories.

These are ranked from least severe to most severe:

  • exaggerating or making up symptoms and manipulating test results
  • withholding nutrients from the child or interfering with nutritional intake
  • inducing symptoms by means other than poisoning or smothering, such as using chemicals to irritate their skin
  • poisoning the child with a substance of low toxicity, for example, laxatives
  • poisoning the child with a poison of high toxicity, for example, insulin
  • smothering the child to induce unconsciousness

Previous cases have found evidence of:

  • parents or carers lying about their child's symptoms
  • parents or carers contaminating or manipulating clinical tests to fake evidence of illness
  • 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

Content supplied by the NHS and adapted for Ireland by the HSE.

page last reviewed: 31/10/2018
next review due: 31/10/2021

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