Fabricated or induced illness by caregivers

Fabricated or induced illness (FII) is a rare form of abuse towards children. It is also known as 'factitious disorder imposed on another.'

It happens when a parent or carer exaggerates or causes symptoms of illness in their child.

The parent or carer does not necessarily plan to deceive doctors, but their behaviour is likely to harm the child. For example, the child may have unnecessary treatment or tests or be made to believe they're ill.

The abuse that happens in 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 child's symptoms. If so, they may suspect FII.

The doctor will look out for one or more of the following warning signs:

• the symptoms only appear when the parent or carer is present
• the only person claiming to notice symptoms is the parent or carer
• the child does not respond well to medicine or other treatment
• if one health problem is solved, the parent or carer may begin reporting a new set of symptoms
• the child's symptoms do not seem believable
• 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 does not 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 healthcare professionals to perform painful tests and procedures on the child

Patterns and levels of abuse

The patterns of abuse usually fall into one of 6 categories.

These are ranked from least severe to most severe:

1. Exaggerating (saying something is worse than it is) or making up symptoms and manipulating test results
2. Not feeding the child or giving them the nutrition they need
3. Inducing symptoms by means other than poisoning or smothering, such as using chemicals to irritate their skin
4. Poisoning the child with a substance of low toxicity, for example, laxatives
5. Poisoning the child with a poison of high toxicity, for example, insulin
6. Smothering the child to induce unconsciousness

Previous cases have found evidence of parents or carers:

• lying about the child's symptoms
• contaminating or manipulating clinical tests to fake evidence of illness
• poisoning the child with unsuitable and non-prescribed medicine
• infecting the child's wounds or injecting the child with dirt or poo
• inducing unconsciousness by suffocating the child
• not treating or mistreating genuine conditions so they get worse
• not feeding the child

Diagnosis

It can be very difficult to confirm a suspected case of FII.

It is generally assumed that a parent or carer will always act in the best interests of a child. This is unless there's compelling evidence to suggest otherwise.

Protecting the child

If a health care professional suspects FII they will try to gather enough evidence to make a case to the Child and Family Agency (TUSLA). TUSLA will assess the child's risk.

Garda investigation

The Gardaí will investigate if there's enough evidence to bring criminal charges.

Treatment

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 the child.

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

Parents or carers involved in FII are difficult to treat because most do not admit their deceptions and refuse to recognise their abusive behaviour. In some cases, the child is permanently removed from their care.

The best results are achieved 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

Causes

We do not fully understand why some parents or carers fabricate or induce illness in their child. But a combination of psychological factors and stressful life experiences is often involved.

It is possible the parent or carer will have a history of previous traumatic experiences. In some cases, this might include physical or sexual abuse.

Some mothers may have experiences with their own mothers that affect their parenting and relationship with their children. They may repeatedly see a doctor to satisfy an emotional need to get attention for their child.

Risk factors

Several factors may increase the risk of developing FII.

These include:

• childhood trauma, such as emotional, physical or sexual abuse
• previous medical history, such as a serious illness during childhood
• loss of a loved one through death, illness or abandonment
• a poor sense of identity or self-esteem
• personality disorders, such as borderline personality disorder
• depression
• the desire to be associated with doctors or medical staff

Reducing the risk

There is currently no known way to prevent FII from happening. But early diagnosis and treatment can help to prevent further abuse from happening.