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Fabricated or Induced illness (FII)/ Perplexing Presentations

Fabricated Induced Illness (FII) is one of the most time consuming and difficult conditions to identify and relies on the appropriate analysis of robust documentation of observations and assessments over time.  More often than not, there is a significant variability in the way the process is used by professionals. Safeguarding professionals have a degree of expertise in identifying this.

It was deemed that family members or caregivers should not be informed of consideration of FII owing to the risk of harm. Collection of evidence over years has resulted in the development of a guideline for health professionals which highlights three conditions, Medically Unexplained symptoms (MUS), Perplexing Presentations (PP) and Fabricated Induced Illness (FII).

The key message is that although the diagnosis is health led, the role of all agencies is vital in not only coming to a diagnosis but also in providing a robust HERP (Health and Education Rehabilitation Plan). Early involvement of carers and discussion with carers when unusual symptoms are identified is key, and the aim is to identify the risk of harm to children rather than labelling the presentation.  Social Care, Education, Mental Health Services, Universal, Specialist Health Services and Police are key partners who need to work together to identify, support and action these conditions as outlined in the new guidance. The key is to work with families acknowledging the difficulties yet providing challenge to identify the issues and support them in dealing with these, to ensure the child or young person is not harmed physically, mentally or emotionally.

It is recommended that all agencies familiarise themselves with the guidance below and use it in the recommended format, working together to ensure that every child matters and that every child is allowed to fulfil their potential by ensuring their health, physical, mental, social, and emotional needs are met and that they have the ability to function successfully in society.

Downloadable document: Perplexing Presentations (PP) / Fabricated or Induced Illness (FII) in Children RCPCH guidance

A summary of information and the full guidance can also be obtained from Royal College of Pediatrics and Child Health (RCPCH) website.

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