Collusion

Children may adopt parents’ perception of the illness and comply with bogus symptoms. [3] Thus they may acquiesce or even collude in the falsification. [1] Despite this it remains important that the child is asked for their account. [3] This may result in a disclosure or an account at variance with the carer’s.

The range of collusive behaviours includes [2]:

• Unawareness: the child has no knowledge of what is happening. e.g. infants, poisoning
• Passive acceptance: the child is aware what is happening but does not resist
• Active participation: the child participates in creating the false story or signs
• Self harm: adolescents may proceed to somatising behaviour [2] and self harm

Collusion occurs for many reasons, e.g. naivety, fear of abandonment, re-enforcing of the relationship with their caregiver when the sick role is adopted. [3]

These are complex interactions which are likely to require a full family assessment.