Fabricated illness in children ‘much more common’ than previously thought

Fabricated illness in children is “more common” than people believe, experts have said.

“Doctor Google” and social media could be contributing to an increase in parents having misbeliefs about child illnesses, children’s doctors suggested.

It comes as the Royal College of Paediatrics and Child Health (RCPCH) launched new guidance about fabricated or induced illness (FII) in children – previously known as Munchausen’s syndrome by proxy.

Experts said that cases arise when parents either believe that their child has an illness when they do not, or in some rare instances cause the illness themselves – either by poisoning or other means.

Previous guidance on the issue focused on the rare, and more severe cases, where parents were actively causing harm to children.

But there are a number of cases where a parent’s misbelief that their child is being affected by an illness when they are not could inadvertently be causing them harm –  by causing them to miss school, become socially isolated or perhaps undergo unnecessary and potentially painful medical tests.

While experts do not have exact figures to show the scale of the problem, they said that most paediatricians will have had a case on their books in the last two years.

There are about 4,000 consultant paediatricians in the UK.

The old guidance on the issue was “outdated”, experts said, adding that the new version is more collaborative with parents and moves away from medics holding meetings in secret when they have concerns about FII and so-called “perplexing presentations” – deemed as such because they could indicate FII.

Dr Danya Glaser, visiting professor at UCL and honorary consultant child and adolescent psychiatrist at Great Ormond Street Hospital, said: “FII is a clinical situation in which a child is very likely to be harmed because the parents or the caregivers try, and sometimes succeed, to convince doctors that their child is unwell physically or psychologically.

“The particular child or children may have a genuine illness too but the parents are trying to convince doctors that there’s something more wrong with the child.

“And much more rarely, they actually use their hands in ways to make the child either look ill by interfering with investigations or actually make the child be ill by poisoning, or withdrawing treatment.

“Now, the parents and carers do this either because they have developed a mistaken belief and then misguided anxiety about their child, or they might actually deceive and gain something out of having an apparently sick child.

“These caregivers, or parents, are not actually intending to harm the child directly, but they’re, in a way, using the child.

“And the child is harmed by physical and emotional abuse or medical neglect, in a number of different ways – their life is not normal, they undergo repeated investigations or treatments, they are taken to different doctors, they don’t go to school, they might use aids which they don’t need, they become socially isolated, and they become either very worried about themselves, or the children begin to believe that they are really ill.”

Dr Glaser said that many parents are not “out to deceive” but have “erroneous wrong beliefs” that might have been “helped by the internet”.

“So all we can say is that this is much more common than the figures which are quoted in the literature,” she added.

Dr Alison Steele, officer for child protection and safeguarding at the RCPCH and consultant paediatrician at Great Ormond Street Hospital, added: “Certainly when you talk to designated doctors up and down the country they are dealing regularly with these sorts of issues and cases.”

“I think the clinician’s perception is that it has become a lot more common.

“I suspect in the past we weren’t as good at recognising it, I do think that probably has contributed.

“I do think that genuinely it has become more of an issue and I do think that part of the driver for that is doctor Google and social media.”

She added: “I think sometimes social media articles that are not from reputable sources can drive this.”

Consultant paediatrician Dr Emilia Wawrzkowicz, assistant officer for child protection at the RCPCH, said a poll of 216 paediatricians found that 92% reported that they were managing a case of perplexing presentations within the last 12 months and 30% were managing more than five cases.

She added: “I would say confidently that most of the paediatricians I supervise will have a case on their books either this year or in the past two years.”