Perplexing Presentations & Fabricated or Induced Illness - PowerPoint Presentation

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Perplexing Presentations & Fabricated or Induced Illness7 MINUTE BRIEFING

Introduction Fabricated or Induced Illness is the most commonly used term for falsification of an illness by carers. It has replaced previous terms such as Munchausen Syndrome by proxyThere are three main ways a carer may attempt to deliberately deceive medical services:fabrication of signs and symptoms including past medical historyfabrication of signs and symptoms along with falsification of specimens, charts and medical records

Induction of an actual illness. For example poisoning with salt or

non-prescribed

medication, or withholding prescribed

medication

Presence

of an existing chronic medical condition does not exclude

FII

In

investigating FII, the needs of the child are paramount

What are Perplexing Presentations?A more common presentation than true FII is that of “Perplexing Presentations” (PP) These often involve verbal accounts and descriptions by a carer that are not aimed at deliberate deception, or the carer may simply exaggerate genuine symptoms and signsThe term PP is used to describe the commonly encountered situation when there are alerting signs of possible FII (not yet amounting to likely or actual significant

harm)

Children

with PP often have a degree of underlying illness, and

exaggeration health

professionals to manage

and treat

the child

appropriately

PP

may need to be considered within the spectrum of FII

Common Indicators of FII/PPcarer reporting symptoms that are not explained by known medical conditionsphysical examination and investigations do not explain symptoms and signschild has inexplicably poor response to prescribed medication or treatmentif presenting problems are resolved carer will often report new symptoms or symptoms in other children in familychild’s daily life is disrupted beyond what would normally be expected, for example kept off school, use of a wheelchair when not necessary etc.carers seeks multiple opinions

symptoms contradicted by medical tests

deliberately inducing or exaggerating symptoms

Managing ConcernsFII/PP are difficult to establish, especially during initial presentations, therefore it is important all evidence is recorded in detailed recordsMaintain a focus on the safeguarding and the welfare of the child at all timesAny alerting signs should be immediately discussed with line managers/ safeguarding leadsIt is important to establish facts by using a detailed chronology and to look for any emerging patternsIn most cases, particularly those of PP it is advisable to discuss concerns with parents as soon as possible, but not in suspected FII cases if doing so may put the child in

danger

If in doubt consult and refer

to Wales Safeguarding Procedures/

guidance

Action in true FII casesIn these cases child will be suffering or at risk of suffering significant harmRefer to the Local Authority Children’s Social Care immediately, and police if immediate protection requiredDo not share the reason for the referral with the carer if this may compromise the safety of the childSecure any potential evidenceOnce referral has been accepted Children’s Social Care will lead further assessment in conjunction with health colleagues and other agencies. This may include collection of chronologies from partnersA multi-agency strategy meeting

will be

convened

by

CSC in line with the Wales Safeguarding Procedures

Action in Cases of PPSafeguarding leads in each involved agency must be aware of case, including a PaediatricianIf no underlying cause of illness is identified following tests/observations this should be discussed with the carer (and child if old enough). It is helpful to use the term perplexing presentations at this stageA health professionals meeting may need to be convened (with other partners attending) to share information and inform future careThe meetings will determine whether the case is PP or FII, and the level of risk to the child

Referral to

LA CSC

, Early Help or another agency may follow

For Further InformationPlease refer to the Wales Safeguarding Procedures