Fabricated or Induced Illness in Children: Experience of a Tertiary Australian Children's Hospital.

Aims: Fabricated or Induced Illness in Children (FIIC) is a complex form of child abuse. Harm to the child is both iatrogenic and psychological, driven by caregivers. Our aim was to characterise the clinical features and outcomes of FIIC cases in a tertiary Australian child protection unit (CPU).

Methods: Retrospective review of cases referred for concerns of FIIC over a 15-year period from 1 January 2006 to 31 December 2020. Cases were excluded if they did not meet the Royal College of Paediatrics and Child Health (RCPCH) definition of FIIC or if there was inadequate information available.

Results: Twenty-two referrals fulfilled the criteria for diagnosis of FIIC, constituting 0.23% of all referrals for physical abuse and neglect. There was a 4-year duration between first presentation and first concern for FIIC being raised. Indirect evidence of FII was identified in 95% of cases, and only one case had direct evidence in the form of laboratory proof of poisoning. Additional child protection concerns were identified in 36% of cases. Statutory child protection reporting was made in most cases (77%). In 65% of the total cases, the child remained with the carer, who continued to seek excessive medical care-all were cases of indirect FIIC.

Conclusions: Children with indirect evidence of FIIC are at risk of further harm through unnecessary and extensive medical investigations. Statutory agency intervention is often required, and further research is needed to identify effective multi-agency management strategies.