Fabricated or Induced Illness

The fabrication or induction of illness in children by a caregiver is referred to by several different terms, most commonly Munchausen syndrome by proxy, factitious illness by proxy or illness induction syndrome. In the United States, the term pediatric condition falsification is being adopted by the American

Professional Society on the Abuse of Children. This terminology is also used by some as if it were a psychiatric diagnosis. The American Psychiatric Association's Diagnostic and Statistical Manual has proposed using the term factitious disorder by proxy for a psychiatric diagnosis applicable to the fabricator (40).

Fabricated or induced illness is a persistent fabrication of a child's illness either simulated or produced by the child's parent or caretaker. There are three main ways of the caregiver fabricating or inducing illness in a child:

• Fabrication of signs and symptoms. 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 include also falsification of letters and documents;.

• Induction of illness by numerous means.

This form of child abuse is uncommon but severe and carries a high mortality and morbidity. International research findings suggest that up to 10% of children die and approx 50% experience long-term morbidity. There is a high incidence of reabuse and harm to siblings, commonly requiring separation of the child from the abusing parent (41).

The perpetrator is more commonly the mother. The range of fabricated illness is wide and can be complicated further by multiple medical investigations. Among the most common presentations are fits, apnea, bleeding, diarrhea, vomiting, fever, and rash (42). Suffocation, poisoning, drug administration, and lying are mechanisms of fabricating illness. Emotional abuse is associated in almost all cases with considerable overlap with other forms of abuse. Diagnosis is difficult and often delayed. Management should follow the usual child protection procedures. Covert video surveillance can play an important role in detection, offering definitive evidence, but this approach must be a carefully coordinated, multiagency and multidisciplinary approach, with the surveillance undertaken by the police (40,43).

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