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Fabricated or Induced Illness in Children: Experience of a Tertiary Australian Children's Hospital
Sandra Hanna1, Ben W R Balzer1,2, Lydia J Garside1,2
1Child Protection Unit, Sydney Children's Hospital, Randwick, New South Wales, Australia.
Insights
Fabricated or Induced Illness in Children (FIIC) poses significant risks, with most cases showing indirect evidence and prolonged diagnostic delays. Children with indirect FIIC evidence face harm from unnecessary medical interventions, necessitating multi-agency strategies.
Area of Science:
- Pediatrics
- Child Protection
- Forensic Medicine
Background:
- Fabricated or Induced Illness in Children (FIIC) is a complex form of child abuse involving iatrogenic and psychological harm.
- Caregiver-driven actions in FIIC necessitate specialized clinical characterization and outcome analysis.
Purpose of the Study:
- To characterize the clinical features and outcomes of Fabricated or Induced Illness in Children (FIIC) cases.
- To analyze data from a tertiary Australian child protection unit (CPU) over a 15-year period.
Main Methods:
- Retrospective review of cases with suspected FIIC from January 2006 to December 2020.
- Exclusion criteria included not meeting the Royal College of Paediatrics and Child Health (RCPCH) definition or inadequate information.
- Analysis focused on clinical presentation, diagnostic timelines, evidence types, and child protection interventions.
Main Results:
- Twenty-two cases met FIIC criteria, representing 0.23% of physical abuse/neglect referrals.
- A median 4-year delay occurred between first presentation and FIIC concern.
- Indirect evidence was present in 95% of cases; only one had direct proof (poisoning).
- 36% had additional child protection concerns; 77% involved statutory reporting.
- In 65% of indirect FIIC cases, children remained with caregivers seeking excessive medical care.
Conclusions:
- Children with indirect FIIC evidence are vulnerable to harm from excessive medical investigations.
- Statutory agency intervention is frequently required for managing FIIC.
- Further research into effective multi-agency management strategies for FIIC is essential.
Aims:
Fabricated or Induced Illness in Children (FIIC) is a complex form of child abuse. Harm to the child is both iatrogenic and psychological, driven by caregivers. Our aim was to characterise the clinical features and outcomes of FIIC cases in a tertiary Australian child protection unit (CPU).
Methods:
Retrospective review of cases referred for concerns of FIIC over a 15-year period from 1 January 2006 to 31 December 2020. Cases were excluded if they did not meet the Royal College of Paediatrics and Child Health (RCPCH) definition of FIIC or if there was inadequate information available.
Results:
Twenty-two referrals fulfilled the criteria for diagnosis of FIIC, constituting 0.23% of all referrals for physical abuse and neglect. There was a 4-year duration between first presentation and first concern for FIIC being raised. Indirect evidence of FII was identified in 95% of cases, and only one case had direct evidence in the form of laboratory proof of poisoning. Additional child protection concerns were identified in 36% of cases. Statutory child protection reporting was made in most cases (77%). In 65% of the total cases, the child remained with the carer, who continued to seek excessive medical care-all were cases of indirect FIIC.
Conclusions:
Children with indirect evidence of FIIC are at risk of further harm through unnecessary and extensive medical investigations. Statutory agency intervention is often required, and further research is needed to identify effective multi-agency management strategies.
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