‘§3.41: Where primary care staff, including GPs, have concerns regarding possible FII they should ensure the child is referred to a paediatrician for a paediatric assessment. This should not delay referral to children’s social care when appropriate. §4.6: A full developmental history and an appropriate developmental assessment should be carried out. Consultation with peers, named or designated professionals or colleagues in other agencies will be an important part of the process of making sense of the underlying reason for these signs and symptoms. §4.9: Professionals should remain open to all possible explanations. §4.10: Where there are concerns about possible fabricated or induced illness the signs and symptoms require careful medical evaluation by a paediatrician(s). For children who are not already under the care of a paediatrician, the child’s GP should make a referral to a paediatrician, preferably one with expertise in the specialism which seems most appropriate to the reported signs and symptoms. §4.17: It is expected that the paediatric consultant responsible for the child’s healthcare is the lead health professional and therefore has lead responsibility for all decisions pertaining to the child’s healthcare (if a child is known to a GP but not to a paediatrician, it is important that a GP referral is made to a paediatrician and she or he assumes lead responsibility for the child’s health – see paragraph 4.10). §4.18: Sometimes it may be apparent that emergency action should be taken at this stage to safeguard a child (see paragraph 3.24 of Working Together). Such action may be necessary when a child’s life is in danger, for example, through poisoning or toxic substances being introduced into the child’s blood stream. §4.20: [The initial assessment under s.17 CA 1989] should be undertaken in collaboration with the lead paediatric consultant who is responsible for the child’s health care. §4.28: If at any point there is medical evidence to indicate that the child’s life is at risk or there is a likelihood of serious immediate harm, an agency with statutory child protection powers should act quickly to secure the immediate safety of the child.’
‘It is very rare for parents or carers to deliberately induce illness in a child by, for example, poisoning them or withholding treatment. Most cases are based on incorrect beliefs or misplaced anxiety which, unchecked, can cause children to undergo harms ranging from missing school and seeing friends, to undergoing unnecessary and painful or even harmful tests and treatments. Paediatricians, and other professionals, have a duty of care to the child but, in almost every case, their work will form part of a collaborative approach which involves the parent or carer as well as the child.’
‘The most important question to be considered is whether the child may be at immediate risk of serious harm, particularly by illness induction. This is most likely to occur when there is evidence of frank deception, interfering with specimens, unexplained results of investigations suggesting contamination or poisoning or actual illness induction, or concerns that an open discussion with the parent might lead them to harm the child.’
‘Concerns have been raised about FII. Harry’s main reported problems included: bleeding from rectum with possible rectal prolapse, cow’s milk protein intolerance, gluten intolerance and seizure disorder. Though several attendances were involved, this is likely to indicate parental anxiety or other issues with mother’s own mental health and reliability rather than fabrication. Harry’s investigations were appropriate for the history provided regarding the seizures. He may have epilepsy and due to this consideration, his neurologist has advised continuing treatment.’
‘A lot of parents blame gluten for their children's symptoms. This is a common feature nowadays and does not suggest fabrication. I accept that there are certain discrepancies in mother's version of events including family history of bowel disease, febrile seizures, breast cancer, possible intussusception, and Movicol prescriptions. I have also noted that mother has provided a history of dilated cardiomyopathy for herself which prompted cardiac investigations for Emma. These features do raise concerns about mother's truthfulness and borders on fabrication, but my overall view is, in relation to the children, it is probably an exaggeration or attention seeking behaviour on her part, rather than true fabricated or induced illness (FII). I would recommend a psychology review for the mother to explore these matters.’
‘[19] The local authority's actions on23 November 2004 in applying for and obtaining the EPO based on the social worker's uninformed opinion that this was a case of fabricated illness were described by counsel for the mother as 'outrageous' and 'inexcusable' leading, as it did, to 'the destruction of this family's ordinary life'; such descriptions do not, in my view, overstate the quality of what took place on that day. … [82] Given the work that has gone into preparing authoritative national and local guidance upon cases of induced or fabricated illness, the court is entitled to expect that when a social work team manager asserts in evidence that this is a case of 'Munchausen's syndrome by proxy' or 'factitious illness syndrome' (depending on which note of evidence is correct) the social work team has acted in accordance with the guidance and that the assertion being made is backed up by paediatric opinion. … [88] The hearing seemingly took place without the justices being referred to any of the relevant case-law about either EPO applications, or without notice applications. The local authority lawyer in such circumstances must consider him/herself under a duty not only to present the case for the applicant, but also to ensure that it is presented fairly and that the bench are fully aware of the legal context within which the application is made. … [101] (l) cases of fabricated or induced illness, where there is no medical evidence of immediate risk of direct physical harm to the child, will rarely warrant an EPO.’
‘As I have acknowledged, costs orders against local authorities are infrequently made, and for good reason. However, in this case I am satisfied that it is appropriate for me to order the local authority to make a contribution towards the parents' public funding costs. In arriving at that decision I have in mind all of the analysis set out above but in particular that the local authority: a) has abandoned all of the matters relied upon in its original threshold document on the basis of a belated acknowledgement that there is little or no material which is capable of satisfying the threshold criteria; (b) upon receipt of the reports Mrs G and Ms J, failed to convene a strategy discussion or otherwise take steps to obtain and evaluate information relating to the children's extensive involvement with health services in order to determine whether there is evidence that this is a case of FII and, if so, whether steps needed to be taken to safeguard the children; (c) in seeking to remove the children into foster care, fell below accepted standards of best practice in the decision-making process which led to its application to the court for interim care orders in August 2009; and (d) failed to raise with Dr M the shortcomings in his report, instead relying upon that report completely and uncritically in deciding to amend its threshold document to raise allegations of FII, in drafting those amendments and in proceeding with those allegations up to the 5th day of this fact-finding hearing.’