Let’s Consign Fabricated or Induced Illness (FII) to the History Books

Guest Post By Dr Andy Bilson, Emeritus Professor at the University of Central Lancashire

Contents

We’ve written a number of times about Fabricated or Induced Illness, where parents of children with disabilities or illness have been accused of deliberately harming their child. It is most notable for occurring in SWAN children whose rare disease or syndrome doesn’t yet have a name or diagnosis.

Now new research by Professor Andy Bilson has shown the only thing the label has done is cause unnecessary trauma to families already facing extreme challenges trying to support their child. Prof. Bilson is on SNJ today to write about his findings…

New Research Reveals No Child Deaths from FII – Let’s Act Together by Prof. Andy Bilson

In 2002, a new term appeared in child protection guidance: Fabricated or Induced Illness (FII). It was introduced to replace the discredited “Munchausen’s Syndrome by Proxy,” a diagnosis that had led to major miscarriages of justice. FII was supposed to focus less on psychiatric labels and more on a pattern of parental behaviour thought to cause harm to children through deception, exaggeration, or unnecessary medical intervention.

But more than twenty years on, the label hasn’t made things clearer or safer. In fact, it’s caused enormous distress and disruption to many families—especially those of disabled and chronically ill children.

Now, new research I have undertaken with Alessandro Talia confirms what many families have long known: the harm being caused by FII investigations vastly outweighs the risks it was meant to prevent. You can access the full article via the British Journal of Social Work or if you are unable to access it there, a free version is available here.

The Evidence is In: No Child Deaths from FII in Over a Decade

A newly published academic review of all Serious Case Reviews (SCRs) in England from 2010 to 2021 reveals some shocking but important information:

There were no recorded child deaths due to FII during this 11-year period.
Just four cases involved serious harm that could be linked to FII—and even these were better explained by failures in medical care, not deliberate parental abuse.
No reliable evidence supports the widely cited figures that 6–9% of FII cases result in death or serious long-term harm.

These statistics directly contradict official guidance still in use today—including statements from the Royal College of Psychiatrists (RCPsych) and local child protection procedures like those from the West Yorkshire Consortium, both of which continue to claim that FII can lead to serious harm or death in a significant proportion of cases.

The Real Harm: What Happens to Families Accused of FII

While the evidence shows that FII-related deaths are extremely rare, the trauma experienced by wrongly accused families is anything but.

Parents—particularly mothers—of children with complex needs often find themselves under suspicion simply for doing what any good parent would do: advocating for their child, challenging dismissive medical views, or pursuing appropriate education and support.

Some families report being threatened with child removal. Others have had their children taken from them without clear evidence of harm. Still more have been pushed out of vital medical and social care services by professionals who view them with suspicion.

The damage is profound and wide-reaching:

Children lose access to trusted care and the stability of home.
Parents suffer mental health crises, reputational harm, and lasting distrust in public services.
Siblings and extended families are left traumatised by the upheaval.

All of this—based on a label that is not only inconsistently applied but also lacking in evidence.

Where Did FII Come From, and Why Is It Still Used?

FII evolved out of an attempt to address real but rare situations in which a parent deliberately harms a child by inducing or fabricating illness. But instead of being used only in clear-cut criminal cases, the concept has grown to encompass a vague spectrum of behaviours—such as “overanxious parenting,” “excessive health-seeking,” or “resistance to psychosomatic explanations.”

In practice, this has led to professionals mistaking parental persistence or disagreement for signs of abuse. And because the threshold for suspicion is so low—and the evidence required so weak—families often have little chance to defend themselves.

What began as a narrow concept for criminal behaviour has turned into a dragnet that captures countless innocent families.

Time for a Change: Let’s End the Use of FII

In the rare cases where someone deliberately induces harm, this is a crime that should be investigated by police, not managed through opaque safeguarding labels. The current approach does more to endanger families than to protect children.

It’s time to stop using a label that causes more harm than good. Let’s focus instead on improving communication between professionals and families, ensuring diagnostic accuracy, and strengthening systems to support, rather than punish, parents of children with complex needs.

Promoted

What You Can Do – Join the Call for Change

We believe that our research is a wake-up call – but it’s also an opportunity.

If you or someone you know has been wrongly accused of FII, your voice matters. Together, we can raise awareness and push for change in policy and practice.

Here’s how you can help:

Share Your Story (Confidentially)

I’m working with a journalist with a longstanding interest in child protection and the impact of safeguarding investigations on families. We’ve previously campaigned successfully on these issues, and we’re now gathering evidence on the consequences of FII accusations. If you feel able to share a short paragraph about your experience, please get in touch. All submissions will be treated confidentially, and we won’t share anything without your permission.

Contact the Royal College of Psychiatrists

Challenge the RCPsych to withdraw unsupported claims in their guidance. Ask for evidence—or an end to fear-based policy. Contact them here

Raise Awareness

Talk to others in your network—whether that’s parent forums, disability groups, or professional contacts. Share this article. Share the research. Encourage others to speak out.

The more we speak up, the harder it becomes for those in power to ignore us.

Together, we can protect families from unjust suspicion, rebuild trust in services, and ensure that children’s welfare is truly the focus—not parental blame without basis.

Let’s consign FII to the history books—where it belongs.

About Professor Andy Bilson

Andy Bilson is a white man with short dark hair, parted on ne side. He is middle-aged and is smiling

Dr Andy Bilson is Emeritus Professor at the University of Central Lancashire where he is associate director of The Centre for Children and Young People’s Participation. He continues to work as a researcher and consultant promoting children’s rights, parent advocacy and reform of child protection systems. He is committed to developing systems that support families and reduce institutionalisation and unnecessary removal of children from their families. His current research focuses on the overemphasis and exaggeration of risk in the child protection system and the increasing separation of children from parents through adoption and care. His research includes longitudinal studies of child protection in England, Scotland and Australia. https://bilson.org.uk/

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Special Needs Jungle was founded in 2008 as a personal SEN blog by Tania Tirraoro. It is now a multi-author, award-winning site covering special needs, disability, mental health and rare conditions in children & young people birth-25 years.

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