Features where fabricated or induced illness (child maltreatment) should be considered

• features where fabricated or induced illness should be considered - to consider child maltreatreatment means that one possible explanation for the alerting feature or is included in the differential diagnosis
  
  
  • consider fabricated or induced illness if a child's history, physical or psychological presentations or findings of assessments, examinations or investigations leads to a discrepancy with a recognised clinical picture. Fabricated or induced illness is a possible explanation even if the child has a past or concurrent physical or psychological condition
    
    
• features where fabricated or induced should be suspected - to suspect child maltreatment means a serious level of concern about the possibility of child maltreatment but is not proof of it
  
  
  • suspect fabricated or induced illness if a child's history, physical or psychological presentations or findings of assessments, examinations or investigations leads to a discrepancy with a recognised clinical picture and one or more of the following is present:
    
    
    • reported symptoms and signs only appear or reappear when the parent or carer is present
      
      
    • reported symptoms are only observed by the parent or carer
      
      
    • an inexplicably poor response to prescribed medication or other treatment
      
      
    • new symptoms are reported as soon as previous ones have resolved
      
      
    • there is a history of events that is biologically unlikely (for example, infants with a history of very large blood losses who do not become unwell or anaemic)
      
      
    • despite a definitive clinical opinion being reached, multiple opinions from both primary and secondary care are sought and disputed by the parent or carer and the child continues to be presented for investigation and treatment with a range of signs and symptoms
      
      
    • the child's normal daily activities (for example, school attendance) are being compromised, or the child is using aids to daily living (for example, wheelchairs) more than would be expected for any medical condition that the child has. Fabricated or induced illness is a likely explanation even if the child has a past or concurrent physical or psychological condition.

Reference:

• 1. NICE (July 2009). When to suspect child maltreatment