Table 1

Clinical features of the index child, siblings and father

CaseClinical presentation and cause1-151 SiblingsFather
 1Boy, living. Recurrent apnoea with near-miss death episodes from age 3 weeks to 3 months. False history
and smothering
One brother—died suddenly at age 6 months having had similar history of recurrent apnoeaMunchausen syndrome since age 19
 2Boy, living. Recurrent apnoea age 1 to 4 months. Unexplained haematemeses. Failure to thrive. False history and smothering One sister—died aged 16 months after 4 month history of recurrent apnoeaSomatising disorder—presented mainly to family and employers since age 17. Minor fraud and much fabrication
 3Boy. Died age 21 months following history of recurrent apnoea since age 2 weeks; also haematemeses, rectal bleeding, and ingestion of unusual foreign bodies.False history, smothering, and physical abuse Two elder siblings had fictitious epilepsy and were receiving inappropriate anticonvulsant treatmentMunchausen syndrome since age 14
 4Girl. Died age 6 months following 3 months history of recurrent apnoea. False illness and smothering NoneMunchausen syndrome since age 16
 5Newborn boy. Concerns about deaths of siblings. False history and smothering (of siblings) One sister died age 4 months following bouts of recurrent apnoea from age 5 weeks. One brother died age 4 months following history
of recurrent apnoea from day 4; also haematemeses
Somatising disorder since age 21
 6Boy, living. Recurrent apnoea age 4 to 7 months. Unexplained fractures of femur and ribs. False history, smothering, and physical abuse NoneFantastic story teller, but only a few unexplained illnesses
 7Boy, living. Recurrent apnoea age 2 weeks to 6 months. Haematemeses.False history and smothering NoneMild somatising disorder
 8Girl. Died age 6 months following one previous episode of apnoea. Failure to thrive. Unexplained fractures. False history, smothering, physical abuse and neglect NoneNo unusual medication or psychological features
 9Newborn girl. Concerns about deaths of three previous siblings. False history and smothering (of siblings) Unexplained deaths of two boys and one girl at ages 3 months, 5 months, and 16 months. The deaths were preceded by concerns about careRecord of criminal convictions. No unusual medical features
10Girl, living. Recurrent illnesses from 1 to 5 months, at which age she had marked hypernatraemia and high urine sodium. False history and salt (NaCl) poisoning NoneMild somatising disorder
11Boy, living. Recurrent unexplained illnesses age 1 week to 13 months when he had acute hepatic failure. Investigation revealed high blood levels of warfarin, paracetamol, and caffeine. False history and repetitive poisoning One sister age 6 years—wellMunchausen syndrome since age 22
12Boy, living, age 3 years. Pains, haematemesis, and haematuria. False history and fabrication of samples One healthy brotherMunchausen syndrome
13Girl, living, age 4 years. “Severe epilepsy” causing her to miss regular education. Girl adopting chronic illness role. False history One healthy brotherUnexceptional medical record. Since divorce 6 years before, father had been sole carer of the two children
14Boy, living, age 4 years. Marked behaviour disturbance. Being investigated and treated by his father for alleged bowel disorders, allergy, and anaemia. False history, disordered perception, and physical abuse One brother died age 10 years. One brother in custodySomatisation disorder and self injury
15Boy, living, age 9 years. “Uncontrollable epilepsy.” Previous genuine congenital bowel disorder and genuine seizures at time of viral meningitis at age 2. Father insisted that major seizures were still occurring and that the boy continued to need anticonvulsants. False story and disordered perception Five healthy siblings, but social services concerns about standards of care. Allegation of sexual abuseMild somatisation disorder leading to invalidity benefit
  • 1-151 Italicised statements represent final clinical conclusions.