Fabricated or Induced Illness (FII) - ED perspective
Fabricated or Induced Illness (FII) describes caregiver behaviours that fabricate, falsify or deliberately induce illness in a child. The child is the primary victim and the clinician’s priorities are: provide urgent medical care, recognise patterns suggestive of FII, document objectively, and initiate timely multi‑agency safeguarding (NICE CG89; NG76; Working Together).
This section covers recognition, typical presentations, immediate ED actions, documentation, common clinical examples, diagnostic pitfalls and the statutory escalation pathway.
Why this matters in the ED
- FII causes direct harm (poisoning, suffocation, infection, unnecessary invasive procedures) and may be life‑threatening.
- ED staff are often first to see affected children and must balance clinical investigation with safeguarding responsibilities.
- Use NICE wording to grade concern: “consider” when suspicious features warrant further assessment; “suspect” when evidence is stronger and urgent referral is needed (NICE CG89).
Spectrum of behaviours
- Fabrication: caregiver invents symptoms or signs without physical evidence.
- Fabrication with false evidence: falsified records or planted specimens that support a false history.
- Induction: deliberate causation (poisoning, smothering, device misuse, excessive medication).
- Obstetric fabrication/induction: false reports or actions in pregnancy affecting the fetus.
- FII with chronic illness: genuine disease may be exaggerated or manipulated; coexistence is common and complicates assessment.