Fabricated Illness

FII involves a well child being presented by a parent/carer as ill, or a disabled child being presented with more significant problems than he/she has in reality. This may result in extensive, unnecessary medical procedures and investigations being carried out in order to establish the underlying causes for the reported signs and symptoms. The child may also have treatments prescribed, investigations or operations which are unnecessary. These interventions can result in children spending long periods of time in hospital and some, by their nature, may also place the child at risk of suffering from harm (physical illness, disability or even death).

FII can also lead to emotional difficulties for the child and confusion over their own health status. Professionals need to focus on the impact of FII on the child’s health and development – this is crucial to ensure an appropriate safeguarding response.

Other terms are sometimes used to describe FII, some of which are out of date or used predominantly in other countries (e.g. Munchausen’s Syndrome by Proxy).

Detailed local CYSCB FII Guidance (PDF) and FII Chronology (Word document)

The Department of Health has issued guidance for the investigation and monitoring of suspected fabricated or induced illness as supplementary guidance to ‘Working Together to Safeguard Children’. These procedures will reflect that guidance.

These procedures are designed to ensure that an appropriate response to suspected fabricated or induced illness occurs across all agencies.


Fabrication of signs and systems – this may include fabrication of past medical history
Fabrication of signs and symptoms and falsification of hospital charts and records and specimens of bodily fluids. This may also include falsification of letters and documents



Concerns about fabricated or induced illness are likely to arise mainly as a result of information from professionals working with children, regarding a parent or carer who is over-presenting a child for medical attention or treatment, or where there is suspicion regarding the detail of certainty of the conditions of a child being presented to them by a parent or carer.

When a possible explanation for the signs and symptoms is that they may have been fabricated or induced by a parent/carer and, as a consequence, the child’s health or development is or is likely to be impaired, a referral should be made to Children's Social Care. Professionals must be clear that if they feel that fabricated or induced illness is a possible explanation for the child’s symptoms, they have a duty to refer, whether or not other colleagues agree with this explanation as a possibility.

It will be in the interests of the child that the parent/carer does not know at this stage of the concerns about fabricated or induced illness, as the ability to diagnose and intervene could be thwarted should they be informed before a Strategy Meeting is held. The decision not to inform the parents/carers must be recorded and justified.

Children's Social Care will decide within one working day what response is necessary.


Arrangements should be made by Children's Social Care to hold a Strategy meeting in cases where fabricated or induced illness is suspected, a Strategy meeting rather than a strategy discussion will be the most effective method of coming to an agreed understanding and decision, due to the complexity of such cases.

A Strategy Meeting should be held in all cases, including those where following initial checks at the start of the Initial Assessment there appears to be no further information to substantiate fabricated or induced illness. The discussion will ensure that a multi-agency decision will be made about whether fabricated or induced illness appears to be a feature of this case.

The following people should be invited to the Strategy Meeting:

  • Social Worker
  • Service manager
  • Police
  • Health Visitor/School Nurse
  • Named Nurse Child Protection
  • Paediatrician/Named Doctor for Child Protection
  • Psychiatrist – Adult and CAMHS (if involved)
  • Legal Services
  • General Practitioner
  • Education
  • Any other professional with relevant involvement with the family, or particular expertise.
  • The relevant Service Manager will chair the Strategy Meeting. This responsibility cannot be delegated.

The purpose of the meeting will be:

  • To bring together all key professionals to consider the information to date. It is particularly important to re-assess previous history of the child involved, siblings, parents and any others living within the household, including any presentations at other health agencies
  • To consider the immediate protection needs of the child
  • To decide whether there is sufficient information to determine the child is at risk of significant harm and whether the concerns warrant action under Section 47 of the Children Act 1989
  • To decide whether fabricated or induced illness is a feature in this case
  • To decide what further work is required, by whom, e.g contacting other Acute/Primary Care Health Trusts, contacting other agencies, drawing up of a detailed chronology, etc.
  • To consider whether it is necessary to keep supplementary medical/nursing records in a secure place to safeguard the child
  • To consider the needs of siblings and other children with whom the parents/carers have contact, this may also include consideration of any other vulnerable individuals in the care of the parents/carers
  • To consider the nature and timing of any police investigations, including the analysis of samples. This will be particularly pertinent if covert video surveillance is being considered, as this will be a task for which the police will have responsibility
  • To consider the needs of the parents/carers, including how and when parents should be informed
  • To set a date for a further Strategy Meeting, if required. It may be necessary to hold a series of Strategy meetings during the gathering of further information.

It is acknowledged that procedural timescales when dealing with concerns about fabricated or induced illness may be affected by not only the need for a full and extensive chronology, but also the need to determine when and how parents should be informed.


It may be necessary to seek expert advice to assist in diagnostic and practice matters, e.g from professionals allied to medicine – physiotherapists, etc., child psychologists, child and adolescent mental health, and adult mental health/forensic professionals, as well as considering how all the agencies will manage the work relating to a suspected case of fabricated or induced illness.

The need or nature of any further medical tests, if any, will depend upon the evidence available as to how the signs and symptoms may be being caused. It is important to acknowledge that any tests must be undertaken only in the child’s best interests. Unnecessary or over-investigation is, in itself, abusive.

It is important to assess the child’s understanding of their symptoms, and the nature of their relationship with each significant family member (including all care givers) each of the care givers’ relationships to the child, the parents’ relationship with each other and with the children of the family, as well as the family’s position in the community.

Careful and detailed note taken by all staff involved with the family will be very important for any subsequent police investigation or court action. Any significant or unusual events should be recorded in detail, and a distinction should be made between those events reported by the carer or others (stating who reported the event) and those actually directly witnessed by staff. Notes should be timed, dated, legible and signed. Most importantly, notes should be kept in a secure place so that they cannot be accessed by unathorised persons.


The nature and timing of any criminal investigation will depend upon medical and any other evidence. Any evidence gathered by the police should be made available to other relevant professionals, to inform decisions about the child’s welfare.

Where police obtain evidence that a criminal offence has been committed by the parent or carer, it is important that the suspect’s rights are protected by adherence to the Police and Criminal Evidence Act 1984. This would normally rule out, for example, the suspect being confronted with the evidence by a paediatrician or any other personnel from the statutory agencies, except for the police, which is the lead investigative agency.


The use of covert video surveillance (CVS) is governed by the Regulation of Investigatory Powers Act 2000. After a decision has been made at the Strategy Meeting to use CVS in a case of suspected fabricated or induced illness, the surveillance should be undertaken by the police. This is a decision which should not be taken lightly, and the purpose of CVS should be clearly defined and a clear plan of action made at multi-agency level. The operation should be controlled by the police and accountability for it held by a Police Manager.

CVS should be used if there is no alternative way of obtaining information which will explain the child’s signs and symptoms, and the Strategy Meeting considers that its use is justified based on the medical information available. It is likely to be used only in a minority of cases. When it has been decided to use CVS, all personnel, including nursing staff who will be involved in its use, should have received specialist training in this area.

The medical consultant responsible for the child’s care should ensure that this matter is discussed at the highest level in the Trust, to ensure that the necessary medical and nursing staff are available to support the police during this operation. Discussion should involve the responsible consultant, the Named Professionals for Child Protection, the Chief Executive of the Trust, the Trust’s legal advisers and representative of Trust Ethics Committee, in conjunction with the responsible Police Manager. These discussions should take place within 72 hours of the Strategy Meeting. The role of all professionals involved should be clearly defined and the level and nature of health involvement during the period of the CVS should be agreed. All relevant staff should be briefed on the arrangements for the child’s health care. All decisions to undertake CVS should be recorded in the child’s notes and signed by the responsible consultant and the Chief Executive of the Trust.

At no point will the gathering of evidence be placed before the child’s need for health or medical care.