Fabricated or Induced Illness by Carers (FII): A Practical Guide for Paediatricians (2009 Edn)
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Fabricated and Induced Illness was first described as Munchausen Syndrome by Proxy (MSbP) in the Lancet in 1977: "Here are described parents who, by falsification, caused their children innumerable harmful hospital procedures – a sort of Munchausen syndrome by proxy". This and other early reports on Munchausen Syndrome by Proxy focused mainly on severe cases where the implication was that the carer was deliberately fabricating or inducing illness in the child. Such reports explicitly defined this as a form of child abuse10-28.
These early descriptions reflect those cases where a carer actively promotes the sick role by exaggeration, non-treatment of real problems, fabrication (lying) or falsification of signs, and/or induction of illness. See Table 1 for more detail. In severe cases, some of the behaviours by a carer that may result in harm include:
- Deliberately inducing symptoms by administering medication or other substances (this includes non-accidental poisoning), or by intentional suffocation29
- Interfering with treatments by over-dosing, not administering medication, or interfering with medical equipment such as infusion lines;
- Claiming the child has symptoms which are unverifiable unless observed directly, such as pain, frequent passing of urine, vomiting, or fits, resulting in unnecessary investigations and treatments;
- Exaggerating symptoms, again resulting in unnecessary investigations and treatments;
- Falsifying test results and observation charts;
- Obtaining specialist treatments or equipment for children which are not required;
- Alleging unfounded psychological illness in a child
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