Fabricated or Induced Illness (FII) is perhaps, professionally, the most complex form of child abuse. Data on the prevalence and presentation of FII is sparse, making it difficult to scale the problem and resource the solutions, yet if managed poorly, could lead to death and serious injury to the child. A 2018 survey by the RCPCH showed 92% of the 216 surveyed paediatricians recalled seeing at least one perplexing presentation in the previous 12 months, 30% recalled seeing over five.¹ We have conducted an opportunistic and purposive National survey (3 UK Nations) of general paediatricians (and safeguarding specialists), paediatric gastroenterologists and AHPs.

Informed consent was obtained, along with ethical approval from University of Sheffield Ethics forum, to conduct a survey. This was constructed of 10 questions with mixed qualitative and quantitative data. The survey was promoted via national meetings and fora, and regional leads were approached to enhance participation.

A response was received from 28 individuals (10 gastroenterologists, 7 general paediatrics/safeguarding, 3 allied healthcare professionals, 8 undeclared):

1. How many suspected FII cases per year do you see? 64% 1–5 with median 2 cases, 21% 6–10 cases.

2. How many confirmed FII cases in last 5 years? 68% 1–5, median 2, 25%, 6–20 cases.

3. Is FII overrepresented in paediatric gastroenterology? 75% Yes, 4% no, 21% unsure.

4. Has FII in paediatric gastroenterology increased in last decade? 82% yes, 14% unchanged, 4% unsure.

5. Have you been trained in FII in paediatric gastroenterology or given adequate guidance? 89% yes, 11% no.

6. Who provided training? 54% RCPCH, 4% BSPGHAN, 21% NHS employer, 21% other.

7. Is that training adequate to enable you to manage PP/FII? 48% yes, 30% no, 22% unsure.

8. What would help with FII? Narrative responses focus on enhanced safeguarding support, acceptance by the general population that FII is a fact, approaches to second opinions.

Provisional data suggests a professional view of rising frequency of FII that is disproportionately higher frequency in paediatric gastro than other specialities.

Reference

1. RCPCH. Perplexing Presentations (PP)/Fabricated or Induced Illness (FII) in Children - RCPCH guidance: 2.2, p9. Published February 2021, Accessed 5 January 2023, at https://childprotection.rcpch.ac.uk/wp-content/uploads/sites/6/2021/03/Perplexing-Presentations-FII-Guidance.pdf.