• The child has repeated, unexplained and sometimes multiple illnesses.
• The child's symptoms do not correspond with the results of clinical tests.
• The child's reported symptoms only occur in the mother's presence.
• The mother often has a good medical knowledge or medical background.
• The mother is very attentive to the child and stays with them constantly in hospital, yet appears less worried about their child's health than the doctors who are treating the child.
• The mother often tries to maintain a close and friendly relationship with medical staff, yet can quickly become abusive or argumentative if her own views on what is wrong with the child are challenged.
  The father has little or no involvement in the care of the child.
• The mother encourages medical staff to perform often painful tests and procedures on the child (tests that most parents would only agree to if they were persuaded that it was absolutely necessary).
  The mother has a history of frequently changing GPs, or visiting different hospitals for treatment, especially if her own views on her child's treatment are challenged by medical staff.

Patterns of abuse

The patterns of abuse found in cases of FII usually fall into one of six categories, which are ranked below from least severe to most severe. However, in the more severe cases of FII, the mother may carry out behaviour from several, or possibly all, categories.

The categories are:

• fabricating symptoms and manipulating test results to suggest the presence of illness,
• withholding nutrients from the child,
• inducing symptoms by means other than poisoning or smothering, such as using chemicals to irritate their skin,
• poisoning the child with a poison of low toxicity, such as using a laxative to induce diarrhoea,
• poisoning the child with a poison of high toxicity, such as using insulin to lower a child's blood sugar level (causing hypoglycaemia),
• deliberately smothering the child to induce unconsciousness.

Commonly reported fabricated symptoms

The most commonly reported fabricated symptoms in cases of FII are:

• seizures,
• fainting,
• vomiting,
• diarrhoea,
• allergies,
• asthma,
• episodes of breathlessness (apnoea), and
• psychological symptoms, such as hyperactivity or learning difficulties.

Older children will often take part in their mother's deception, and confirm their mother's claims about symptoms. This can be due to a desire to please their mother, or a fear that their mother will leave them if they do not back up her claims, or because they actually become convinced that there is something wrong with them.

What to do if you suspect a case of FII

If you suspect that somebody you know may be fabricating or inducing illness in their child, it is not recommended that you confront them directly. A direct confrontation is not likely to make a person admit to doing anything wrong, and it may give them the opportunity to dispose of any evidence of abuse.

If your job involves working with children, such as a nursery worker or teacher, you should inform the nominated person in your organisation responsible for child protection issues. If you do not know who this is, your immediate supervisor or manager should be able to tell you.