Child Protection Guidance 2021

Part 4: Specific support needs and concerns 205 National Guidance for Child Protection in Scotland 2021 Version 1.0 September 2021 Fabricated or induced illness 4.439 Definition. Fabricated or induced illness refers to a process in which a parent or caregiver induces illness or a sick role in a child by exaggeration, deliberate non-treatment, fabrication or falsification of signs of illness. The process can include maladministration of medication or other substances causing symptoms of illness, and interference with equipment, observation charts or other documents relevant to the child’s health. The caregiver may or may not genuinely believe the child to be ill. 4.440 Impact on the child can include actual physical harm, potential trauma, anxiety and confusion during multiple and sometimes invasive treatments and investigations, as well as social and emotional impairment of a child’s development, identity and relationships. 4.441 Occurrence. Proven incidence is rare. It is more frequent in young children. A common feature is that the caregiver reports symptoms or signs, and health assessments cannot account for these signs. It can be a feature that symptoms are not seen by anyone other than the caregiver, that new symptoms are reported by the caregiver when one form of concern is resolved, or that multiple medical opinions are sought inappropriately. 4.442 Response. Where concerns do exist about the fabrication or induction of illness in a child, practitioners must work together in co‑ordination, considering all the available evidence, in order to reach an understanding of the most probable reasons for the child’s signs and symptoms of illnesses. Careful medical evaluation is always required to consider a range of possible diagnoses, including the possibility that some older children may present with fabricated symptoms, again requiring careful assessment, understanding and supportive response in relation to whatever the causes may be. 4.443 An inter-agency referral discussion will be necessary when risk of significant harm from abuse or neglect is identified as described in Part 3 of this Guidance. An IRD should be held in order to consider timing and responsibilities when co‑ordinated investigation, planning and action are required, step by step, to ensure the child’s physical and emotional safety and support. A chronology will be an essential feature within such a multi-agency assessment. 4.444 All agencies and practitioners should be aware of the potential indicators of illness being fabricated or induced in a child, and be alert to the risk of harm that individual abusers, or potential abusers, may pose to children in whom illness is being fabricated or induced. Practitioners must work together to form a multi-agency assessment and plan. Work should be in collaboration with parents/caregivers unless to do so would place the child at increased risk of harm. In any criminal or civil proceedings, practitioners must be prepared to give evidence as required. 4.445 Note: guidance for paediatricians in relation to the medical management of these forms of concern has recently been published (Royal College of Paediatrics and Child Health (March 2021). Perplexing Presentations (PP)/Fabricated or Induced Illness (FII) in Children Guidance). The implications for multi-agency child protection in Scotland are under review. This subsection will then be revised as necessary. Resources and References – Fabricated and induced illness