Fabricated or induced illness — recognition, safeguarding, and forensic role (MEQ)

(i) Terminology and continuum. Historical MSBP (Meadow) described caregiver fabrication/induction of child illness. RCPCH distinguishes perplexing presentations (concerning unexplained process) from confirmed FII. AAP prefers medical child abuse / caregiver-fabricated illness (child as victim in medical settings). DSM-5-TR FDIA diagnoses the caregiver who falsifies illness in another. Continuum: exaggeration → fabrication (false history/samples) → induction (poisoning, suffocation, withholding treatment). Describe behaviours before labels.[1][2][3][4][9]

(ii) Red flags and acute safety. Events only with one caregiver; normal observed investigations; multi-hospital doctor-shopping; healthcare-trained caregiver; sibling unexplained death; demands invasive tests; hostility to negative findings. Acute: stabilise child; restrict unsupervised access if authorised; multi-agency safeguarding notification on reasonable suspicion (local pathway—no invented statute numbers); protect siblings; senior single voice; document.[2][3][7]

(iii) Assessment / separation / video. Multi-source chronology (all hospitals, pharmacy, school, growth, sibling records); symptom–observer matrix; clarify treating vs forensic role. Separation observation may support environmental contribution but is not sole proof. Covert video only under lawful multi-agency authorised protocols—never freelance.[2][5][7]

(iv) Differential. Genuine evolving neurological disease; perplexing presentation without confirmed fabrication; anxious over-medicalising parenting without deception; malingering by proxy (external incentives); FDIA (factitious dynamics). Keep organic differential open in parallel.[2][6][9]

(v) Management and court limits. Child: stop unnecessary procedures, trauma-informed care, developmental support. Caregiver: treat comorbidity; specialised factitious-work engagement with guarded prognosis; structural protection trumps alliance alone. Family court: opine mental state, insight, treatability, recurrence risk for contact scenarios; multi-source; state limitations; do not replace court's findings or invent Act sections. Placement risk remains high if dynamics unchanged.[5][6][8]