Fabricated or induced illness and perplexing presentations.
Every parent of a disabled child needs to be aware of this, especially if you are an autistic parent or have autistic children.
You would assume what FII/PP refers to is what was known as Munchausen's by proxy.
You would think that this is pretty self-explanatory.
You would assume that this is related to a type of child abuse that consists of a parent or carer "fabricating or inducing" illness in a child.
It's a lot scarier and broader than that.
Firstly FII/PP isn't an actual diagnosis rather than a list of "alerting signs"… There is very little evidence to support that FII/PP exists as a big problem that certain "professionals" claim it to be.
The royal college of peadiatrics and child health published guidance in March 2021 in which they even acknowledge the lack of evidence themselves.
"Literature in this field recognises that there is a gap within the existing evidence-base surrounding the incidence and prevalence of PP and FII."
Perplexing presentation in guidance is defined as "when the actual state of the child's physical, mental health and neurodevelopment is not yet clear." So basically, it means when the medics don't have an answer and the child's presentation is deemed "perplexing," but there are "alerting signs".
FII or PP is not a diagnosable condition. What this is is profiling based on what the RCPCH considers to be "alerting signs" with very limited evidence.
So let's look at some of these alerting signs.
In the child
• Reported physical, psychological or behavioural symptoms and signs not observed independently in their reported context
• Inexplicably poor response to prescribed treatment
• Unexplained impairment of child's daily life, including school attendance, aids, social isolation.
• Parents' insistence on continued investigations instead of focusing on symptom alleviation when reported symptoms and signs not explained by any known medical condition in the child
• Parents' insistence on continued investigations instead of focusing on symptom alleviation when results of examination and investigations have already not explained the reported symptoms or signs
• Repeated reporting of new symptoms
• Repeated presentations to and attendance at medical settings including Emergency Departments
• Inappropriately seeking multiple medical opinions
• Providing reports by doctors from abroad which are in conflict with UK medical practice
• Child repeatedly not brought to some appointments, often due to cancellations
• Not able to accept reassurance or recommended management, and insistence on more, clinically unwarranted, investigations, referrals, continuation of, or new treatments (sometimes based on internet searches)
• Objection to communication between professionals
• Frequent vexatious complaints about professionals.
• Not letting the child be seen on their own
• Talking for the child / child repeatedly referring or deferring to the parent
• Repeated or unexplained changes of school (including to homeschooling), of GP or of paediatrician / health team
• Factual discrepancies in statements that the parent makes to professionals or others about their child's illness
Suppose you are the parent of an autistic child that masks OR you know anything about rare conditions. In that case, you will see why all of the above is hugely problematic for parents worried about their child and trying to figure out what is happening.
And it gets worse.
Overly anxious parents ( how do you even define overly anxious?) are a risk factor, autistic parents, single parents. The NHS even state on their website that fii is "usually the child's biological mother".
So, if you are an autistic, single mother that home schools their children. You dare to challenge "professionals." You seek further assessment, complain about poor service or treatment… oh, not forgetting research on the web and talking about your experience on social media is also a risk factor.
We are practically sitting ducks.
Please don't make the mistake of thinking, "all of the above doesn't apply to me, so I'm ok."
You've probably seen my previous post on the history of parent (mother) blame. Statistics also tell us that 1in 5 Mum's of autistic children will be investigated by social service at some point.
And to think all of this can start with a simple "we don't see any of that in school."