Fabricated or induced illness perplexing presentation
Perplexing Presentation
In your work, you might come across situations where something just doesn’t feel right. A child or young person may show signs that raise concerns—maybe about their health, development, or behaviour—but there’s no clear diagnosis, and no immediate risk to their life or safety. This is what’s known as a perplexing presentation.
It’s a term used when there are early warning signs that something might be wrong—possibly even fabricated or induced illness (FII)—but things aren’t yet fully understood.
Fabricated or Induced Illness (FII)
Fabricated or induced illness (FII) a form of abuse where a parent or carer either makes up or causes health problems in a child. This can include:
- claiming the child is unwell when they’re not.
- exaggerating real symptoms.
- causing actual harm to make the child appear sick.
- pushing for unnecessary medical treatment.
Even if the parent or carer doesn’t mean to cause harm, their actions can have serious consequences. The child might:
- go through painful or unnecessary tests.
- miss out on school or social activities.
- start to believe they’re ill when they’re not.
- this behaviour used to be called Munchausen’s Syndrome by Proxy.
Possible signs and indicators:
- the child only seems unwell when the parent or carer is around.
- the symptoms don’t quite add up—for example, a child said to be very ill but still active and alert.
- the child doesn’t seem to get better with treatment.
- their daily life is more restricted than it should be (e.g. not allowed to go to school or play outside).
A Parent or Carer may:
- is the only one who reports the symptoms.
- won’t let professionals speak to the child alone.
- speaks for the child, or the child looks to them before answering.
- keeps changing doctors or hospitals.
- doesn’t accept medical advice and pushes for more tests or treatments.
- seems unusually keen for the child to have medical procedures.
Why it happens
The reasons behind FII are complex and not always fully understood. Some parents or carers may be seeking attention, emotional support, or a closer bond with the child. Others may have unresolved mental health issues, a history of trauma, or problems such as substance misuse. In some cases, there may be a financial motive, such as claiming disability benefits.
How do I respond well to abuse?
If you’re ever concerned that a child might be experiencing this kind of abuse, it’s important not to confront the parent or carer directly. Doing so could make the situation worse or lead to evidence being hidden. Instead, treat it as a safeguarding concern. Speak to your organisation’s Safeguarding Lead, or if that’s you, report the concern to your local Child Social Services team in England, the Health and Social Care Trust if you’re in Northern Ireland, the child’s Named Person or your local area’s child protection team if you’re in Scotland, or Children’s Social Care if you’re in Wales.
You don’t need to have all the answers—just raising the concern is enough. FII is a complex issue that requires a careful, coordinated response to make sure the child is safe and gets the right support.
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Page last updated: 11 November 2025