Expert calls for new official guidelines on identifying fabricated or induced illness for children

New guidelines on identifying fabricated or induced illness (FII) in children are needed after research has found previous guidance to be inaccurate and the cause of false accusations against parents.

Published today in The British Journal of Social Work, a study of serious case reviews (SCRs) in England, published between 2010—2021, found the rate of death caused by FII during this period was zero, despite guidance from a number of professional bodies suggesting high levels of mortality and morbidity caused by FII.

The term fabricated or induced illness (FII) has been used in England since 2002 to cover a situation in which a parent or caregiver exaggerates the child’s symptoms, or deliberately causes illness in their child, to convince medical professionals that their child is ill.

Based on research into FII’s discredited predecessor, Munchausen’s syndrome by proxy, the government’s statutory guidance, applicable in England between 2008 and 2022, suggested that FII involved high risk of mortality or serious harm to children, stating that up to 10% of children subjected to FII die, while about 50% suffer long-term morbidity.

Despite this guidance being officially withdrawn more than two years ago, many medical practitioners and social workers still adhere to similar guidelines and updated government guidelines haven’t been produced.

The SCR findings are published in a peer-reviewed research paper, written by Emeritus Professor of Social Work at the University of Central Lancashire Andy Bilson.

It used the NSPCC’s National Case Review Repository, which contained four SCRs where FII was associated with serious harm over this 12-year period. SCRs are required in all cases where a child has died where abuse or neglect is known or suspected or where a child has been seriously harmed and there is concern about the way in which staff have worked together to safeguard the child.

“In the SCRs analyzed in this research there wasn’t a single death reported caused by an illness being fabricated or induced. The literature review also found no deaths of children in the UK over this period due to FII. This suggests that deaths due to FII are, thankfully, extremely rare in England,” said Professor Andy Bilson.

“Much of the guidance available to medical practitioners and other professions on harm done by FII draws on publications about the controversial and now abandoned Munchausen’s syndrome by proxy. Save for a small number of case studies, FII does not have a research base.”

Professor Bilson argues that the widening of the definition of FII in 2013 to include what are referred to as “perplexing presentations” (PP), for cases with alerting signs of FII but with unclear medical explanations and then expanding the number of FII alerting signs from nine to 21 in 2021 alongside removing warnings around misidentification, has caused further confusion and distress.

“Several surveys of parents with disabled children show these changes have wrongly brought many families under suspicion of fabricating their child’s illness, causing severe and lasting trauma to innocent families. In some cases, this leads to families breaking up, children being unnecessarily taken into care and children missing out on needed treatment,” he said.

“The exaggeration of the likelihood of FII causing death and serious harm, along with wide and untested alerting signs means social workers and medical professionals are on heightened alert, misidentifying understandable parenting behaviors and concerns for FII.”

Taliah Drayak was wrongly accused of poisoning her daughter, who was removed from her care for a year as a result. She is now a parent advocate, helping families caught up in the child protection system.

“I have become a parent advocate helping families caught up in the child protection system since I was wrongly accused of fabricating or inducing my daughter’s serious illness,” she said.

“Professor Bilson’s research is really important because it challenges the exaggeration of mortality and harm to children from FII. This exaggeration is behind much of the over-reaction that leads to growing numbers of families falsely accused of harming their children with devastating effects.

“I see the trauma caused by these false allegations in families that I support as a parent advocate and in many online support groups. I am speaking out because I want to help build an understanding of the challenges families and professionals are facing and ultimately, to stop the needless harm that a false accusation causes to everyone involved.

“The harm caused to our family from being wrongly accused of FII has driven us from our home, has nearly killed me in my own health care, and has destroyed our children’s trust in professionals. This has to stop and I hope that Professor Bilson’s research will prevent other families going through the hell that was inflicted on our family.”‘

Professor Bilson added, “In the study of SCRs over a 12-year period, overmedicalization and/or medical errors were identified at an early stage in the four cases where serious harm was attributed to FII. The SCRs highlighted how the failure to follow standard medical practices led to missed opportunities to respond to medical errors, which played a central role in the harm faced by children.

“Better responses to overmedicalization and medical error rather than a focus on parental responsibility may have led to improved prevention of harm and identification of serious cases.

“The evidence in this paper clearly shows that new guidance on FII is needed in order for professionals to make informed decisions.”

New guidelines on identifying fabricated or induced illness (FII) in children are needed after research has found previous guidance to be inaccurate and the cause of false accusations against parents.

Published today in The British Journal of Social Work, a study of serious case reviews (SCRs) in England, published between 2010—2021, found the rate of death caused by FII during this period was zero, despite guidance from a number of professional bodies suggesting high levels of mortality and morbidity caused by FII.

The term fabricated or induced illness (FII) has been used in England since 2002 to cover a situation in which a parent or caregiver exaggerates the child’s symptoms, or deliberately causes illness in their child, to convince medical professionals that their child is ill.

Based on research into FII’s discredited predecessor, Munchausen’s syndrome by proxy, the government’s statutory guidance, applicable in England between 2008 and 2022, suggested that FII involved high risk of mortality or serious harm to children, stating that up to 10% of children subjected to FII die, while about 50% suffer long-term morbidity.

Despite this guidance being officially withdrawn more than two years ago, many medical practitioners and social workers still adhere to similar guidelines and updated government guidelines haven’t been produced.

The SCR findings are published in a peer-reviewed research paper, written by Emeritus Professor of Social Work at the University of Central Lancashire Andy Bilson.

It used the NSPCC’s National Case Review Repository, which contained four SCRs where FII was associated with serious harm over this 12-year period. SCRs are required in all cases where a child has died where abuse or neglect is known or suspected or where a child has been seriously harmed and there is concern about the way in which staff have worked together to safeguard the child.

“In the SCRs analyzed in this research there wasn’t a single death reported caused by an illness being fabricated or induced. The literature review also found no deaths of children in the UK over this period due to FII. This suggests that deaths due to FII are, thankfully, extremely rare in England,” said Professor Andy Bilson.

“Much of the guidance available to medical practitioners and other professions on harm done by FII draws on publications about the controversial and now abandoned Munchausen’s syndrome by proxy. Save for a small number of case studies, FII does not have a research base.”

Professor Bilson argues that the widening of the definition of FII in 2013 to include what are referred to as “perplexing presentations” (PP), for cases with alerting signs of FII but with unclear medical explanations and then expanding the number of FII alerting signs from nine to 21 in 2021 alongside removing warnings around misidentification, has caused further confusion and distress.

“Several surveys of parents with disabled children show these changes have wrongly brought many families under suspicion of fabricating their child’s illness, causing severe and lasting trauma to innocent families. In some cases, this leads to families breaking up, children being unnecessarily taken into care and children missing out on needed treatment,” he said.

“The exaggeration of the likelihood of FII causing death and serious harm, along with wide and untested alerting signs means social workers and medical professionals are on heightened alert, misidentifying understandable parenting behaviors and concerns for FII.”

Taliah Drayak was wrongly accused of poisoning her daughter, who was removed from her care for a year as a result. She is now a parent advocate, helping families caught up in the child protection system.

“I have become a parent advocate helping families caught up in the child protection system since I was wrongly accused of fabricating or inducing my daughter’s serious illness,” she said.

“Professor Bilson’s research is really important because it challenges the exaggeration of mortality and harm to children from FII. This exaggeration is behind much of the over-reaction that leads to growing numbers of families falsely accused of harming their children with devastating effects.

“I see the trauma caused by these false allegations in families that I support as a parent advocate and in many online support groups. I am speaking out because I want to help build an understanding of the challenges families and professionals are facing and ultimately, to stop the needless harm that a false accusation causes to everyone involved.

“The harm caused to our family from being wrongly accused of FII has driven us from our home, has nearly killed me in my own health care, and has destroyed our children’s trust in professionals. This has to stop and I hope that Professor Bilson’s research will prevent other families going through the hell that was inflicted on our family.”‘

Professor Bilson added, “In the study of SCRs over a 12-year period, overmedicalization and/or medical errors were identified at an early stage in the four cases where serious harm was attributed to FII. The SCRs highlighted how the failure to follow standard medical practices led to missed opportunities to respond to medical errors, which played a central role in the harm faced by children.

“Better responses to overmedicalization and medical error rather than a focus on parental responsibility may have led to improved prevention of harm and identification of serious cases.

“The evidence in this paper clearly shows that new guidance on FII is needed in order for professionals to make informed decisions.”