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Fits, faints, or fatal fantasy? Fabricated seizures and child abuse
  1. M A Barber1,
  2. P M Davis2
  1. 1Department of Child Health, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK
  2. 2Clinical Director of Child Health, Cardiff and Vale NHS Trust, Lansdowne Hospital, Cardiff CF1 8UL, UK
  1. Correspondence to:
    Dr P M Davis, Clinical Director of Child Health, Cardiff and Vale NHS Trust, Lansdowne Hospital, Cardiff CF1 8UL, UK;

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Munchausen syndrome by proxy (MSbP) is now an established form of child abuse.1 It carries the risk of significant harm to the dependent child and siblings, with long term physical and emotional consequences for many.2–4 It is known from retrospective studies that many cases go unrecognised for long periods and that the long term outcomes may be poor.5–7 In many cases there have been previous sibling deaths, likely to be due to abuse.2, 3 The high degree of certainty that paediatricians often require before intervening has been highlighted.2

Seizures have been reported to be the most common presentation of fabricated illness. The authors' experience, mirrored by many case reports in the literature, suggests that the current threshold for the diagnosis of fabricated seizures remains too high and that abuse may continue for years before the diagnosis is made. There is a need to move towards earlier diagnosis of child abuse in these cases.


Four modified criteria for MSbP have been proposed4:

  1. A parent or someone in loco parentis fabricates illness in a child.

  2. The child is presented for medical care (usually persistently).

  3. The perpetrator denies the aetiology of the child's illness.

  4. Symptoms and signs of illness cease when the child is separated from the perpetrator.

The essential feature is that the child's illness has been deliberately fabricated or induced by the carer and the child has suffered harm as a result.


Various terms have been employed in the literature in an attempt to be more descriptive—illness induction syndrome, factitious illness syndrome, and fabricated illness spectrum. These terms are often used loosely without a clear distinction between them. Dictionary definitions may be illuminating:

Factitious: “specially contrived, not genuine, artificial” (could apply to …

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