Fabricated or induced illness (FII) is a rare form of child abuse. A carer, usually the biological mother, fakes or actually causes the symptoms of illness in a child who is under their care.

The term 'mother' will be used in the rest of this article to describe the perpetrator of FII, although it should be made clear that a small number of cases of FII have involved the father, foster parent, other guardian, or a healthcare or childcare professional.

FII is also known as Munchausen Syndrome by Proxy. Munchausen Syndrome is a condition in which a person pretends to be ill, or actually causes illness or injury to themselves. The term Munchausen Syndrome by Proxy can be used to describe when somebody fabricates or causes illness or injury to others.

However, healthcare professionals in the UK now prefer to use the term fabricated or induced illness, as it was thought that Munchausen Syndrome by Proxy did not properly describe the full range of behaviour and parental motives that can occur in FII. The term Munchausen Syndrome by Proxy is still widely used in other countries.

Cases of FII can range from moderate to severe. Previous case reports of FII have uncovered evidence of:

• Mothers lying about their child's symptoms.
• Mothers deliberately contaminating or manipulating clinical tests to fake evidence of illness, such as adding blood to urine samples or heating thermometers to suggest the presence of fever.
• Poisoning their child with unsuitable medicine.
• Infecting their child's wounds with dirt or faeces.
• Inducing unconsciousness by suffocating their child.

It is estimated that 6% of all children involved in cases of FII will die as a result of their abuse.

How common is FII?

Cases of FII are extremely rare. One study estimated that only 50 new cases of FII occur in the UK every year.

Most cases of FII involve children under the age of five, with the average age being 20 months. In around 85% of the cases, the abuse was carried out by the child's biological mother. Usually only one child in a family is affected.

Why do mothers want to hurt their child?

It is not fully understood why FII occurs, but a number of theories have been suggested. It could be that the mother enjoys the attention involved in playing the role of the 'caring mother'.

A large number of mothers who have been involved in cases of FII have had a previous history of often unresolved psychological and behavioural problems, such as a history of self harming, drug or alcohol abuse, or having experienced the death of another child.

Protecting the child

FII is a child protection issue and cannot be treated by the NHS alone. Medical professionals who suspect FII is taking place will liase with social services and the police.

The first priority is to protect the child. This may involve removing them from their mother's care. Once the child is safe, it is sometimes possible to treat the underlying psychological problems of the mother, and if they successfully respond to treatment, then place the child back into their care.

Controversies surrounding FII

There have been some recent controversies surrounding the issue of FII. This is due to a number of women who were convicted of murdering their children being exonerated and freed by the Court of Appeal. The Court of Appeal judged that the medical evidence given by the expert witness in these cases, Professor Roy Meadows, was unsafe and misleading.

As Professor Meadows was the doctor who first coined the term Munchausen Syndrome by Proxy, and became a leading expert in cases of FII, this led many media commentators to conclude that FII was not a real phenomenon.