[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Forensic medicine](https://durgical.com/en/forensic-medicine/) › [Clinical forensic medicine](https://durgical.com/en/forensic-medicine/areas/clinical/) › Fabricated or induced illness in a child # Fabricated or induced illness in a child - Finding A carer invents, exaggerates or causes symptoms in a child, leading to needless tests and treatment; it is a form of abuse that can kill. Updated Nov 13, 2026 ## Key points - The carer invents, exaggerates or causes symptoms; the child improves when separated from them. - Ways of inducing illness: substances or medicines, salt, smothering, contaminating samples or intravenous lines. - The diagnosis centres on the harm to the child, not on the adult's motive. - Warning signs: symptoms nobody else witnesses, repeated negative tests, unnecessary procedures. - A chronological review of the whole medical record is the key diagnostic tool. ## What it is Fabricated or induced illness (formerly called Munchausen syndrome by proxy; in DSM-5-TR, factitious disorder imposed on another, when describing the carer) is abuse in which a carer, almost always someone close to the child, invents or exaggerates symptoms, tampers with samples or records, or causes illness, for example with substances, smothering or infections. Harm comes both from what the carer does and from the needless tests and treatments that follow. The diagnosis centres on the child (whether harm is done), not on the adult's motive. In forensic practice it appears in deaths from poisoning or smothering and in siblings with unexplained deaths. ## How to tell it apart - An anxious carer seeks help and accepts explanations; in fabricated illness there is active deception. - Genuine rare diseases must be ruled out sensibly, without endless testing. - Malingering seeks an external gain; in factitious disorder the motive is to take on the role of patient or carer. - Repeated apnoeas or arrests in an infant that occur only with the same carer present: consider smothering. ## How to recognise it - Symptoms that appear only when the carer is present and that nobody else sees. - Findings that fit no known disease, or impossible laboratory results. - Many visits, admissions and invasive procedures without a diagnosis. - The carer denies any role and the child improves when separated from them. - Contaminated or tampered samples, such as blood added to urine. ## How it forms - Fabrication: the carer reports symptoms that do not exist or alters records and samples. - Induction: the carer causes illness with substances (salt, medicines), smothering or introducing contaminated material. - Doctors who believe the account add tests, operations and treatments that also cause harm. ## Next step: what to do and document - Review and summarise in chronological order all visits, admissions and results, and compare the reported symptoms with those observed by staff. - Keep blood, urine and gastric content samples for toxicology, under chain of custody if you suspect induction. - Raise the concern with the institution's child protection team before talking to the carer. - Report to the ICBF and the competent authority: suspicion is enough to activate protection. - If a child with this history dies, inform the Fiscalía for a medico-legal autopsy and review the siblings' history. ## Common mistakes - Ordering more tests instead of reviewing the whole medical record in chronological order. - Confronting the carer before protecting the child, which may increase the risk. - Focusing on diagnosing the adult instead of documenting the harm to the child. - Not keeping samples for toxicology when symptoms are unexplained. ## Test yourself Think of the answer, then tap the question to see it. ## Which clinical finding strongly supports fabricated or induced illness? Symptoms that disappear when the child is separated from the suspected carer. ## What does DSM-5-TR call the disorder of a carer who fabricates illness in another person? Factitious disorder imposed on another. ## What distinguishes factitious disorder from malingering? Malingering seeks an external gain; in factitious disorder the deception aims at the role of patient or carer, without an obvious external gain. ## Which test is ordered when unexplained symptoms suggest induction with substances? Toxicology of blood, urine and gastric content, under chain of custody. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/forensic-medicine/fabricated-or-induced-illness-in-a-child/) ## Elsewhere in DurgiPedia - [Mandatory reporting: public health, violence and abuse](https://durgical.com/en/medical-ethics/mandatory-reporting-public-health-violence-and-abuse/) - [The limits of confidentiality: duty to warn and legal disclosure](https://durgical.com/en/medical-ethics/the-limits-of-confidentiality-duty-to-warn-and-legal-disclosure/) ## Connections ## Related 5 - [Fractures and visceral injuries in child abuse](https://durgical.com/en/forensic-medicine/fractures-and-visceral-injuries-in-child-abuse/) - [Child maltreatment: signs that should raise concern](https://durgical.com/en/forensic-medicine/child-maltreatment-signs-that-should-raise-concern/) - [Child homicide](https://durgical.com/en/forensic-medicine/child-homicide/) - [Smothering, gagging and choking](https://durgical.com/en/forensic-medicine/smothering-gagging-and-choking/) - [Forensic toxicology: which samples and how](https://durgical.com/en/forensic-medicine/forensic-toxicology-which-samples-and-how/) ## Related conditions 2 - [Factitious disorder and malingering](https://durgical.com/en/conditions/factitious-disorder-and-malingering/) - [Child maltreatment (physical abuse, abusive head trauma, neglect)](https://durgical.com/en/conditions/child-maltreatment/) [← All of forensic medicine](https://durgical.com/en/forensic-medicine/) Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority. Sources: [When Care Becomes Abuse: A Forensic-Medical Perspective on Munchausen Syndrome by Proxy](https://pmc.ncbi.nlm.nih.gov/articles/PMC12101293/) (Pediatric Reports (PMC), 2025); [Münchausen syndrome by proxy: a literary review and a reminder for every health care professional](https://pmc.ncbi.nlm.nih.gov/articles/PMC13218000/) (Italian Journal of Pediatrics (PMC), 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/forensic-medicine/fabricated-or-induced-illness-in-a-child/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/forensic-medicine/fabricated-or-induced-illness-in-a-child/