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4.12 Fabricated or Induced Illness


Contents

1. Introduction
2. Assessment
3. Additional Issues for Child Protection Procedures
  3.1 Referral
  3.2 Action to be Taken Following Referral
  3.3 Immediate Protection
  3.4 Strategy Meeting
  3.5 Outcome of Section 46 Enquiries
  Appendix 1: Flowchart for Dealing with Fabricated or Induced Illness


1. Introduction

1.1 Fabricated illness is when a child suffers harm caused by the action of a parent or other carer who deliberately fabricates symptoms or induces medical symptoms in a child which would not otherwise be present.
1.2 The use of terminology to describe the fabrication or induction of illness in a child has been the subject of considerable debate between professionals. This may have resulted in a loss of focus on the welfare of the child. The key issue is not what term is used to describe this type of abuse, but the impact on the child’s health and development and consideration of how best to safeguard the child’s welfare.
1.3

The following should alert professionals to the possibility of fabricated illness:

  • Reported symptoms and signs found on examination are not explained by any medical condition;
  • Physical examination and results of investigations do not explain reported symptoms and signs;
  • There is an inexplicably poor response to prescribed medication and treatment;
  • New symptoms are reported on resolution of previous ones;
  • Reported symptoms and found signs are not observed in the absence of the carer;
  • The child’s normal, daily life activities are being curtailed beyond that which might be expected from any known medical disorder from which the child is known to suffer.
1.4 The above may be noticed by doctors, nurses and other professionals working with the child as well as professionals who may be working with the child’s parents.
1.5 Where fabricated illness is suspected there should be discussion with the GP or Paediatrician responsible for the child’s health. If the person concerned feels their worries are not taken seriously or responded to appropriately they should discuss this with the Designated Professional.


2. Assessment

2.1 Where there are concerns about fabricated illness a full developmental history and appropriate developmental assessment should be carried out.
2.2

A medical evaluation should:

  • Explore the signs and symptoms for a range of possible diagnoses;
  • Carry out specialist tests or seek specialist advice where a reason cannot be found for the signs and symptoms;
  • Normally result in feedback being given to the parents where an explanation has not been found and the parental response to this information be noted;
  • Ensure that parents are kept informed of further assessments / investigations / tests and of the findings.
2.3 At no time should concerns about the reasons for the child’s signs and symptoms be shared with parents if this information would jeopardise the child’s safety. In these situations, convening a professionals’ meeting may be a useful first step.


3. Additional Issues for Child Protection Procedures

3.1

Referral

  3.1.1 In addition to usual child protection procedures (see Part 3, Managing Individual Cases where there are Concerns about a Child's Safety and Welfare), there are additional issues to be considered in relation to children where fabricated or induced illness is suspected. 
  3.1.2 The Significant Harm Threshold will have been met and a referral should always be made and child protection enquiries commenced when a possible explanation for the signs and symptoms is that they may have been fabricated or induced by the carer and, as a consequence, the child’s health or development is likely to be impaired.
  3.1.3

Where there are concerns about fabricated illness and it is decided to commence a Section 46 Enquiry, the Strategy Meeting should, in addition, agree:

  • Whether the child needs constant professional observation, and if so, whether the carer should be present;
  • The designation of a medical clinician to oversee and co-ordinate the medical treatment of the child and control the number of specialists and hospital staff the child may be seeing;
  • Who should be responsible for collating the medical records of all family members, including children who may have died or no longer live with the family;
  • How any required expert consultation will be obtained.

3.2

Action to be Taken Following Referral

  3.2.1 Following referral, Social Services should decide within one working day what response is necessary. Lead responsibility for action to safeguard and promote the child’s welfare lies with Social Services.
  3.2.2 All decisions about what information should be shared with parents, when and by whom should be taken jointly at the Strategy Meeting. The decision about when to share information with the parents will have a bearing on the Police investigations. While professionals should seek, in general, to discuss any concerns with the family and, where possible, seek their agreement to making referrals to Social Services, this should only be done where such agreement seeking does not place the child at increased risk of Significant Harm.
  3.2.3 Any case of fabricated or induced illness may also involve commission of a crime and therefore the Police should always be involved.
  3.2.4 The paediatric consultant has responsibility for the child’s health and decisions pertaining to it.

3.3

Immediate Protection

  3.3.1 If at any point there is medical or other evidence to indicate that a child’s life is at risk or there is likelihood of serious immediate harm, an agency with statutory child protection powers should act quickly to secure the immediate safety of the child.
  3.3.2 Emergency action may be necessary as soon as a referral is received or at any point in involvement with the child and family.  If this is necessary consideration, must be given as to whether it is necessary to safeguard other children in the household.

3.4

Strategy Meeting

  3.4.1 If there is reasonable cause to suspect a child is suffering or is likely to suffer Significant Harm as a result of possible induced/fabricated illness, Social Services should convene a Strategy Meeting. This is the most effective way to gather information in such complex situations.
  3.4.2 The Strategy Meeting will include Social Services, the Police, the medical consultant responsible for the child’s health and the Designated Professional.  Professionals involved with the child such as the GP, health visitor and staff from Education and nursery settings should be involved if appropriate.
  3.4.3 The advocate to the Department should also routinely be invited to the Strategy Meeting.
  3.4.4 Staff should be sufficiently senior to be able to contribute to the discussion of often complex information, and to make decisions on behalf of their agency.
  3.4.5

Where it is decided that there are grounds to initiate a Section 46 Enquiry decisions should be made about:

  • How the enquiry will be carried out and what information is required about the child and family and how it should be obtained and recorded;
  • Supplementary records to be kept in a secure place in order to safeguard the child;
  • Who will carry out what actions by when and for what purpose in particular the planning of further paediatric assessment;
  • The needs of siblings and other children with whom the alleged abuser has contact;
  • The needs of the parents or carer.
  3.4.6 There may need to be more than one Strategy Meeting/discussion in order to enable the best decision to be made about safeguarding the child’s welfare. If more than one Strategy Meeting is held as part of a series of discussions, the Initial Child Protection Conference should be held within 15 working days of the last Strategy Meeting/discussion.

3.5

Outcome of Section 46 Enquiries

  • Concerns not substantiated. Medical tests may reveal a medical condition which explains the child’s signs and symptoms and therefore no child protection action is necessary. The child’s health will require monitoring to see how it progresses;
  • Concerns substantiated but the child is not considered to be at continuing risk of Significant Harm. There may be substantiated harm but professionals involved may be able to agree a plan amongst agencies to ensure the child’s future safety and welfare without a Child Protection Plan;
  • Concerns substantiated and child is considered to be at continuing risk of Significant Harm. Social Services should convene a Child Protection Case Conference. This may include situations where the child’s life has not been placed in immediate danger, but continuation of the fabrication or induction of illness would have major consequences for the child’s long term health and development. 


Appendix 1: Flowchart for Dealing with Fabricated or Induced Illness

Click here to view 'Flowchart for Dealing with Fabricated or Induced Illness'.

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