The Fabrication or Induction of Illness in Children with Complex Needs: Views from Practice

Abstract

Consideration of the abuse of disabled children has been described as thinking the unthinkable. Realising that a disabled child's condition could itself be the result of physical abuse or neglect takes this thinking one step further. Even more disturbing is the possibility that a parent may deliberately exacerbate the effects of their disabled child's existing impairment by falsely describing symptoms, seeking unnecessary treatment or inappropriate use of medication, thus causing the child's condition to deteriorate. Despite the current controversy in the UK (Community Care 4 February 2004) regarding medical opinions in cases where parents have been prosecuted or had their children removed because of concern about Fabricated or Induced Illness (formerly known as Munchausen Syndrome by Proxy) the practice experience of the authors is that some parents do behave in this way towards their children, but that detecting such behaviour is very difficult. We are very aware of the sensitive nature of this subject matter and have taken care to ensure that the circumstances used in the case examples are anonymised while still preserving their clinical significance. In this paper we consider the possibility that recognition of Fabricated or Induced Illness (FII) in disabled children is particularly challenging. It is our contention that some of the benign behaviour patterns of families who have a disabled child can be similar to some of the dynamics associated with FII. Our concern is that child welfare professionals may miss indicators of FII in disabled children because of the assumption that these behaviours are ‘typical’ of families with a disabled child and seek no further explanation. In this paper we look at such matters as how parents of disabled children may use professional networks, manage complex treatment and medication regimes and seek second opinions on their child's condition. We suggest that in most cases these activities are undertaken to benefit the child but warn that professionals must also be aware that some parents may exploit their child's circumstances, resulting in effects on the child that range from a compromise to the welfare of the child to serious harm or even death.