FII should be dropped as a child protection category

Article in 'Community Care'

Andy Bilson and Taliah Dreyak

The article argues that Fabricated or Induced Illness (FII) should be dropped as a child protection category because its current framework is flawed, weakly evidenced, and causes catastrophic harm to families.

It argues:

• Weak Evidence Base: The FII label, which replaced the discredited Munchausen Syndrome by Proxy (MSbP) in 2002, lacks robust empirical evidence. The guidance relies on "alerting signs" that were never systematically evaluated, often leading to suspicion against parents who are simply advocating for children with rare or complex conditions.

• Inflated Risk Claims: Training and guidance frequently cite very high death rates (6-8%) linked to FII. The authors assert that these figures are based on flawed, non-epidemiological literature reviews of old case reports, not modern population data.

• Minimal Actual Harm: A review of UK serious case reviews and local child safeguarding practice reviews (2010-2025) found no child deaths caused by FII in England over 15 years, and only a handful of serious harm cases.

• Catastrophic Consequences: In contrast, investigations based on FII suspicion have led to severe harm, including children being removed from their families, denial of necessary medical treatment, and, in some cases, parental suicide.

The article concludes by supporting a campaign calling for the immediate withdrawal of the FII label and its associated guidance, advocating instead for evidence-based safeguarding frameworks that prioritize collaboration, disability awareness, and respect for families' rights.