Types of abuse, exploitation and neglect

Fabricate injuries and illnesses (FII)

Fabricated or induced illness (FII) is a form of abuse. It typically occurs when a parent or carer, usually the child's biological mother, exaggerates or deliberately causes symptoms of illness in a child and sometimes this abuse can persist into adulthood.

FII is also known as "Munchausen's syndrome by proxy" (not to be confused with Munchausen's syndrome, where a person pretends to be ill or causes illness or injury to themselves).

Signs of fabricated or induced illness:

How common is FII?

It's difficult to estimate how widespread FII is because many cases may go unreported or undetected but it is thought to be very rare.

One study published in 2000 estimated 89 cases of FII in a population of 100,000 over a 2-year period. However, it's likely that this figure underestimates the actual number of cases of FII.

FII can involve children of all ages, but the most severe cases are usually associated with children under 5.

In around 85% of reported cases of FII, the child's mother is responsible for the abuse. However, there have been cases where the father, foster parent, grandparent, guardian, or a healthcare or childcare professional was responsible.

Why does fabricated or induced illness occur?

The reasons why FII occurs are not fully understood. In cases where the mother is responsible, it could be that she enjoys the attention of playing the role of a "caring mother".

A large number of mothers involved in FII have borderline personality disorders characterised by emotional instability, impulsiveness and disturbed thinking.

Some mothers involved in FII have so-called "somatoform disorders", where they experience multiple, recurrent physical symptoms. A proportion of these mothers also have Munchausen's syndrome.

Some carers have unresolved psychological and behavioural problems, such as a history of self-harming, or drug or alcohol misuse. Some have experienced the death of another child.

There have also been several reported cases where illness was fabricated or induced for financial reasons – for example, to claim disability benefits.

What to do if you suspect a child is at risk?

FII is a child safeguarding issue and cannot be managed by the NHS alone.

Medical professionals who suspect FII is taking place should liaise with social services and the police and must follow local child safeguarding procedures.

If your job involves working with children – for example, if you're a nursery worker or teacher, you should inform the person in your organisation who's responsible for child safeguarding issues. If you do not know who this is, your immediate supervisor or manager should be able to tell you.

If you suspect that someone you know may be fabricating or inducing illness in their child, you should not confront them directly. It's unlikely to make the person admit to wrongdoing, and it may give them the opportunity to dispose of any evidence of abuse.

Media controversy - There has been controversy in the media regarding FII, with some commentators suggesting that it's not a real phenomenon.

However, a great deal of evidence exists to show that FII is real. The evidence of abuse includes hundreds of case files from more than 20 different countries, the confessions of mothers and other carers, the testimony of children, as well as video footage.


NHS - https://www.nhs.uk/conditions/fabricated-or-induced-illness/symptoms/

RCPCH - https://www.rcpch.ac.uk/resources/fabricated-or-induced-illness-fii-carers-practical-guide-paediatricians