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Contents1. IntroductionFabricated or Induced Illness is a rare, potentially lethal form of abuse. It has previously been referred to as
In order to keep the child's safety and welfare as the primary focus of all professional activity the government guidance: 'Safeguarding Children in Whom Illness is Fabricated or Induced' (2008) refers to "fabrication or induction of illness in a child by a carer" rather than using a particular term. This section outlines the procedures to follow when professionals are concerned that the health or development of a child is likely to be significantly impaired by the actions of a parent/carer/s having fabricated or induced illness. The procedures are derived from the government guidance issued in 2008 document Safeguarding Children in Whom Illness is Fabricated or Induced which provides further essential guidance. The Royal College of Paediatricians and Child Health 2009 guidance Fabricated or Induced Illness by Carers provides further guidance for medical clinicians. Professionals should also refer to the Appendix: Template for Warning signs of Fabricated or Induced Illness. 2. DefinitionA condition whereby a child suffers harm through the deliberate action of her/his main carer and which is attributed by the adult to another cause. There are three main ways of the carer fabricating or inducing illness in a child:
The above three methods are not mutually exclusive. Harm to the child may be caused through unnecessary or invasive medical treatment, which may be harmful and possibly dangerous, based on symptoms that are falsely described or deliberately manufactured by the carer, and lack independent corroboration. 3. RecognitionDoctors/paediatricians may be concerned at the possibility of a child suffering Significant Harm as a result of having illness fabricated or induced by their carer. These concerns may arise when:
Concerns may be raised by other professionals who are working with the child and/or parents/carers who may notice discrepancies between reported and observed medical conditions, such as the incidence of fits. Professionals working with the child’s parents may also note these concerns e.g. mental health professionals may identify a child being drawn into the parent’s illness. Further details regarding the warning signs given above are provided in Appendix: Template for Warning Signs of Fabricated or Induced Illness. 4. ResponseConcerns about a child’s health should be discussed with a health professional who is involved with the child such as the school nurse, GP or paediatrician. If any professional considers their concerns are not taken seriously or responded to appropriately, these should be discussed with the Designated Doctor or Designated Nurse (see also Surrey Health Service Contacts). If any concerns relate to a member of staff, these should be discussed with the relevant Named or Designated Professional and the Allegations Against Staff, Carers and Volunteers Procedureshould be followed. 5. Medical EvaluationAt no time should concerns about the reasons for the child’s signs and symptoms be shared with parents if this information would jeopardise the child’s safety and compromise any Section 47 Enquiry and or criminal investigation. The signs and symptoms require careful medical evaluation for a range of possible diagnoses. Where a reason cannot be found for the signs and symptoms, specialist advice and tests may be required. Normally, the doctor would tell the parent(s) that s/he has not found the explanation for the signs and symptoms and record the parental response. Parents should be kept informed of further medical assessments/ investigations/tests required and of the findings. Health professionals should consider using the Appendix: Template for Warning Signs of Fabricated or Induced Illness which can help to analyse any suspicions by categorising events and other available facts. However, the categories should be used as indicators and even if a case encompasses all the categories in the template it does not necessarily mean that the child is being abused. 6. ReferralWhen a possible explanation for the signs and symptoms is that they may have been fabricated or induced by a carer and as a consequence the child’s health or development is or is likely to be impaired, a referral should be made to the Surrey Children's Services in accordance with theContacts and Referrals Procedure. The referral may follow a medical evaluation or be the result of concern by professionals or members of the public. Whilst professionals should in general, discuss any concerns with the family and, where possible, seek agreement to making referrals to Surrey Children's Services, this should only be done where such discussion and agreement-seeking will not place a child at increased risk of significant harm. The Police Public Protection Investigation Unit (PPIU) must be informed at the earliest opportunity. Any suspected case of fabricated or induced illness may also involve the commission of a crime and the Police will take responsibility for deciding whether or not to initiate a criminal investigation. The referrer, Surrey Children's Services and PPIU should agree what the parents will be told, by whom and when. 7. Initial Consideration of ReferralAs with all other referrals, Surrey Children's Services should decide within one working day what response is necessary. Whilst Surrey Children's Services has lead responsibility for action to safeguard and promote the child’s welfare, the decision should be taken in consultation with the Consultant Paediatrician responsible for the child’s health care and the PPIU. This decision-making process must agree what action needs to be taken by whom and within what time-frame. All decisions about what information is shared with parents should be taken jointly, bearing in mind the safety of the child. The possible outcome of referrals is the same as for any other referrals (see the Contacts and Referrals Procedure). If emergency action is the required response, e.g. if a child’s life is in danger through poisoning or toxic substances being introduced into the child’s blood stream, an immediate Strategy Meetingshould take place, where possible, between Surrey Children's Services, Police, health and other agencies as appropriate. Decisions about possible immediate action to protect the child should be kept under constant review. 8. Assessment, Outcomes and Immediate ProtectionThe decision on the outcome should be made in consultation with the Paediatric Consultant and the police, with agreement reached regarding what the parents should be told. ‘Concerns should not be raised with a parent if it is judged that this action will jeopardise the child’s safety.’ (Safeguarding Children in Whom Illness is Fabricated or Induced paragraph 3.18). 9. Strategy MeetingIf there is reasonable cause to suspect the child is suffering, or likely to suffer significant harm, Surrey Children's Services should convene and chair a Strategy Meeting involving all the key professionals. The Strategy Meeting requires the involvement of key senior professionals responsible for the child’s welfare. At a minimum this must include Surrey Children's Services, the Police and the Paediatric Consultant responsible for the child’s health. Additionally the following should be invited as appropriate:
Wherever possible, prior to the Strategy Meeting, each agency should provide a written chronology of the contacts they have had with the child and family, to include all aspects of the family’s life, and a lead person should be identified to collate the chronologies in order to provide the best possible information for the decision-making process. When it is decided that there are grounds to initiate a Section 47 Enquiry, decisions should be made about how the Section 47 Enquiry as part of the Assessment will be carried out including:
It may be necessary to have more than one Strategy Meeting. This is likely where the child’s circumstances are very complex and a number of discussions are required to consider whether and, if relevant, when to initiate a Section 47 Enquiry and/or a Police investigation. Any evidence gathered by the Police should be available to other relevant professionals, to inform discussions about the child’s welfare and contribute to the Section 47 Enquiry and Assessment. 10. Outcome of Section 47 EnquiriesAs with all Section 47 Enquiries, the outcome may be that concerns are not substantiated - e.g. tests may identify a medical condition, which explains the signs and symptoms. It may be that no protective action is required, but the family should be provided with the opportunity to discuss what further help it may require. Concerns may be substantiated, but an assessment made that the child is not judged to be at continuing risk of harm. In this case, the decision not to proceed to a Child Protection Conferencemust be endorsed by a Surrey Children's Services Manager. Where concerns are substantiated and the child is judged to be suffering or at risk of sufferingSignificant Harm, an Initial Child Protection Conference must be convened. 11. Initial Child Protection ConferenceSee also Initial Child Protection Conference Procedure The Initial Child Protection Conference should be held within 15 working days from the last Strategy Meeting. Attendance at this conference should be as for other Initial Child Protection Conferences, with the additional experts invited as appropriate. 12. Pre-birth Child Protection ConferenceEvidence of illness having been fabricated in an older sibling or another child should be carefully considered during the pregnancy of a woman who is known to have abused a child in this way. A pregnant woman may have a history of fabricating illness in herself during a previous pregnancy. This could include the fabrication of medical problems while the baby is in the womb. A pre-birth child protection conference should be convened if, following a Section 47 Enquiry, either the unborn child’s health is considered to be at risk or the baby is likely to be at risk of harm following his or her birth. Appendix - Template for Warning Signs of Fabricated or Induced IllnessNote: ‘Symptoms’ are subjective experiences reported by the carer or the patient. ‘Signs’ are observable events reported by the carer or observed or elicited by professionals. We set out below some examples of behaviour to look out for.
Permission given by Cumbria ACPC to replicate this template as developed following their Serious Case Review, March 2004.
This page is correct as printed on Monday 12th of September 2022 06:52:38 AM please refer back to this website (http://surreyscb.procedures.org.uk) for updates. |