It's a rare, insidious form of child abuse, and it often goes undetected.

But caregiver-fabricated illness in children (CFIC) is real, and healthcare providers need to know how to spot it, says Dr. Harriet MacMillan, a pediatrician and researcher at McMaster University.

'It's hard for people to actually conceive that caregivers would fabricate illness.'—Dr. Harriet MacMillan, McMaster University

She hopes a new report she's co-authored, appearing in the September issue of the medical journal Pediatrics, gives clinicians the tools to identify the hard-to-diagnose condition.

CFIC occurs when a caregiver — usually a parent — fakes or induces an illness in a child. This results in unnecessary visits to a healthcare provider and sometimes leads to harmful treatment.

The phenomenon is difficult to detect, MacMillan says. Physicians don't often suspect that an adult bringing a child into a clinic has invented the youngster's illness. 

"It's hard for people to actually conceive that caregivers would fabricate illness," said MacMillan. "If you think about it, people working with children are basically trained to trust the histories that are provided to them."

Red flags

But CFIC has its red flags. MacMillan's article, written with Northwestern University pediatrician Emalee Flaherty, details a laundry list of signs that an adult is causing, or trying to convince a healthcare professional of, a child's illness. Some of the most frequently reported ailments include rashes, allergic reactions, urinary tract infections and vomiting — all possible indicators of poisoning — as well as breathing and eating problems.

In other cases, a caregiver falsely reports that child has an emotional or behavioural problem, attention deficit/hyperactivity disorder or a learning disability. Some even claim that a child has suffered sexual abuse, even though they know the claim is false.

"I think what's important in this article that we really try to highlight is that it's not just symptoms of physical illness, but also psychiatric illness," MacMillan stresses.

Identifying a case of CFIC requires other detective skills. Questioning whether a child's symptoms match up with what a caregiver is reporting, taking a close look at medical records, even asking to interview the child one-on-one — all of these methods help clinicians make an informed diagnosis, MacMillan says.

"It's about looking at the whole clinical picture."

CFIC is relatively rare, occurring in approximately 0.5 to two out of every 100,000 children, studies suggest. However, the phenomenon is likely "underreported," MacMillan says.

Terminology

The condition is often to referred to as Munchausen Syndrome by proxy. But MacMillan and Flaherty discourage the use of that term, arguing it takes the focus away from the mistreatment of the victims.

"We are saying that we use this particularly terminology because it emphasizes the child's exposure to risk and harm rather than the motivation of the caregiver who is doing this," MacMillan said. "People working with children need to recognize this as a kind of child maltreatment."

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Dr. Harriet MacMillan is a professor in the department of psychology and behavioural neuroscience at McMaster University. (McMaster University)

Though the article doesn't establish the type of adult who fabricates a child's illness, MacMillan says perpetrators often have certain characteristics. They are typically mothers and often work in, or are very knowledgeable about, the healthcare field. Many yearn for the attention of doctors and nurses. Some have a history of feigning being ill themselves.

MacMillan says there is much work to be done on the long-term impacts of CFIC on the victims, and to oversee what treatments the children receive. She hopes monitoring programs will be established to combine information that healthcare providers gather on the CFIC cases they handle. This will help researchers better understand the phenomenon.

"What's key here, hopefully, for clinicians to take away from this is the need — in addition to their obligation to report to child protection services — to gather the comprehensive information from medical records. That's key generally, but it's also particularly important with this condition."