Update to Perplexing Presentations or Fabricated or Induced Illness in Children Guidance
I am pleased to let you know about the publication of the Royal College of Paediatrics and Child Health Perplexing Presentations (PP)/Fabricated or Induced Illness (FII) in Children guidance.
This is an update of the 2009 RCPCH guidance, which aims to better support paediatricians when involved with PP or FII. It provides procedures for safeguarding children who present with PP or FII and best practice advice in the medical management of these cases to minimise harm to children. While written primarily for paediatricians, this guidance is also of relevance to social care workers, GPs and other health care specialists.
Updates in the 2021 guidance include:
- Updated definitions of medically unexplained symptoms (MUS), PP and a wider view of FII.
- Alerting signs are not evidence of FII but indicators of possible FII and, if associated with possible harm to the child, they amount to general safeguarding concerns.
- The focus must be on the harm to the child rather than the perceived severity or type of caregiver motivations, actions and behaviours.
- Unless there is risk of immediate, serious harm to the child’s health or life, caregivers can be informed (not seeking consent from) about the need for sharing information between different professionals involved in the child’s life.
- Responsibility for the initial management, including collating of current health involvement, is with the responsible paediatric consultant.
- A Health and Education Rehabilitation Plan is an essential feature of management in all cases of FII, whether or not children’s social care are involved.
This guidance presents the current view and supersedes previous RCPCH guidance on the subject.