Recognition Of FII

The diagnosis of FII can be extremely difficult. Health Professionals evaluating children should be aware of the possible presenting features and include FII in the differential diagnosis along with other acute medical conditions.

Behaviours that should raise concern include [2]:

  • Reported symptoms and signs not explained by any medical condition [2]
  • Physical examination and investigations that do not explain reported symptoms [2], e.g. normal peak flow and minimal wheeze despite reported severe asthma attacks
  • Inexplicably poor response to prescribed medication [2], e.g. persistent seizures despite anti-epilepsy medication
  • Acute symptoms observed in the presence of the carer that are not seen in their absence [2], e.g. seizures seen at home but not at school or in hospital
  • Limitation in the child’s activities in excess of what might be expected for their condition [2], e.g. partial or no school attendance; special aids e.g. wheelchairs for ambulant children
  • Further objective evidence of fabrication, e.g. different histories from child and mother or biologically implausible symptoms, e.g. reports of massive fluid losses without any weight loss [2]
  • Disclosure from the child or another relative that the caregiver may be responsible for the child’s illness
  • Caregivers who seek multiple opinions inappropriately. The child may have seen many different health professionals in different settings and varied geographical locations [2]
  • Common presenting complaints include [4]: Seizures, BRUE, drowsiness, GI bleeds, and feeding difficulties. However FII can present with any symptom
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