What To Do If Concerns Regarding FII Arise

FII is a clinical diagnosis. It is based on a full consideration of the clinical features, past medical and obstetric histories, examination findings and test results. The diagnosis is unlikely to be made on a single finding or consultation.

If you suspect FII:

• The safety of the child is paramount especially with regard to poisoning, suffocation or other physical induction of illness [2]
• Always discuss your concerns with senior colleagues. These include the paediatric registrar, the duty consultant, the named health professionals for child protection, senior nursing staff [1]
• Do not challenge the caregiver directly as they may break contact with medical staff and thus put the child at increased risk
• If immediate protection is required, i.e. you suspect the child to be at risk of harm, then local and national guidelines should be followed. This will include consideration of siblings
• Ensure thorough and accurate documentation of all consultations including the child’s account [1].This may include noting abnormal interaction between the child and carer or an unusual response by the carer to events
• A multi-agency strategy meeting will subsequently decide how best to investigate concerns and protect the child
• Subsequent diagnosis relies on a meticulous chronology of events. This includes a review of all available health records. Thus good inter-agency co-operation is vital
• Further investigations may include DNA sampling, toxicology or covert video surveillance. These are infrequently needed and should follow evidence based guidelines [2]

“Detailed accurate informative medical records are pivotal to the management of an FII case”