Fabricated or induced illness by caregivers

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

FII happens when a parent or carer causes symptoms of illness in their child or exaggerates symptoms (says they are worse than they are).

The parent or carer does not necessarily plan to mislead doctors, but what they do and say is likely to harm the child. For example, the child may have treatment or tests they do not need or be made to believe they're ill.

The abuse that happens can be difficult to recognise, but there are warning signs to look out for.

Warning signs

A doctor may suspect FII if they examine a child or do tests and find no explanation for symptoms.

The doctor will look out for 1 or more of the following warning signs:

• the child only has symptoms when the parent or carer is present
• the only person who notices symptoms is the parent or carer
• the child does not get better after taking medicine or having other treatment
• if 1 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
• the child misses school or other activities because of the condition
• 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
• 1 parent has little or no involvement in the care of the child
• the parent or carer encourages healthcare professionals to do painful tests and procedures on the child

Patterns of abuse

Previous cases have found evidence of parents or carers:

• lying about the child's symptoms
• manipulating test results to suggest the child is ill, for example, by putting glucose in pee samples to suggest the child has diabetes
• poisoning the child with medicines they do not need
• infecting the child's wounds or injecting the child with dirt or poo
• suffocating the child to make them unconscious
• 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.

Healthcare professionals assume that a parent or carer will always act in the best interests of a child in their care.

This is unless there's strong evidence to suggest otherwise. They will also want to make sure they do not miss any genuine health conditions.

What to do if you notice signs of FII

If you suspect a child is at risk of FII, talk to a health care professional or the Child and Family Agency (TUSLA). They can advise you on the best course of action to take.

If a health care professional suspects FII, they will try to gather enough evidence to make a case to TUSLA.

TUSLA will:

• assess the child's risk
• take any necessary action to safeguard the child

They may recommend family supports if there is not enough evidence that the child is at 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 mental health difficulties.

Treatment 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 lie about or cause illness in the child.

Family therapy aims to:

• resolve any tensions within the family
• repair the relationship between the parent or carer and the child

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

The best results are when 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.

Some people may have had difficulties with their own parents that affect their parenting and relationship with their children. They may repeatedly see a doctor or other mental health professional to get attention for themselves and their child.

Several factors may increase the risk of developing FII.

These include:

• childhood trauma, such as emotional, physical or sexual abuse
• serious illness during childhood
• loss of a loved one through death, illness or abandonment
• low self-esteem
• personality disorders, such as borderline personality disorder
• depression
• they feel important when they have the attention of 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.

If you are worried about your own behaviour

If you are worried that you might be developing behaviours that are warning signs for FII, talk to your GP. They can refer you to a mental health professional.