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40 years of fabricated or induced illness (FII): where next for paediatricians? Paper 1: epidemiology and definition of FII
  1. Paul Davis1,
  2. Una Murtagh2,
  3. Danya Glaser3
  1. 1Community Child Health Directorate, Cardiff and Vale University Health Board, Cardiff, CF11 9XB, UK
  2. 2Community Child Health Directorate, Cardiff and Vale University Health Board, Cardiff, UK
  3. 3Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
  1. Correspondence to Dr. Paul Davis, Community Child Health Directorate, Cardiff and Vale University Health Board, The Children’s Centre, St David’s Hospital, Cardiff CF11 9XB, UK; Paul.Davis{at}wales.nhs.uk

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Introduction

It is 40 years since the seminal description of ‘Munchausen Syndrome by Proxy’ (MSbP) by UK Paediatrician Professor Sir Roy Meadow.1 There have been a number of developments since, which include terminology, definition, prevalence and management. The Royal College of Paediatrics and Child Health (RCPCH) adopted the term ‘Fabricated or Induced Illness by Carers’ (FII) in 2002,2 and updated their guidance in 2009.3 The most recent version of the RCPCH Child Protection Companion extended FII to embrace perplexing presentations with suggestions for management.4 The important evolution in the UK has been towards earlier diagnosis and intervention without the need for proof of deliberate deception. In the USA terms such as ‘Pediatric Condition Falsification’, ‘Medical Child Abuse’ and ‘Caregiver-Fabricated Illness in a Child’ have been introduced although MSbP is still widely used and deception is still implicit.5–7 In adult psychiatry, The Diagnostic and Statistic Manual of Mental Disorders produced by the American Psychiatric Association (DSM-5) replaces Factitious Disorder by Proxy with Factitious Disorder Imposed on Another (FDIoA).8 However, as DSM-5 stipulates that the carer behaviour is associated with identified deception, this excludes many carers involved in paediatric FII. In this paper, FII will be the term used to encompass all of these terms.

Paediatricians in the UK have expressed significant concerns about FII, including when and how to recognise it, how to assess risk and how to manage these cases. Even in recent literature, most cases being reported still involve deliberate physical abuse by the carer. There are few descriptions of the earlier presentations and those involving erroneous reporting that form the majority of cases seen by paediatricians. While cases continue to be brought within the umbrella of FII and into the scope of national and local FII procedures for safeguarding children,9 there have …

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