Authored by Hayley Smith
Recently, the awareness of mental health issues in the news has been increasing in prominence, and rightly so. However, the full extent of how this may affect a child or young person regarding fabricated or induced illness by proxy, is still not understood.
Fabricated Induced Illness (FII) - formerly known as Munchausen’s syndrome - has been an identifying factor in previous serious case reviews and may have played a part in many other cases historically. It is therefore imperative that awareness is raised across professionals to reduce the risk of signals going unnoticed, and children not being safeguarded properly.
In October 2017, the National Institute for Health and Care Excellence (NICE) updated their guidelines regarding “Child maltreatment: when to suspect maltreatment in under 18s”. Within this, specific reference is made to fabricated or induced illness and how professionals need to be aware of recognising possible indicators. On many occasions, parental explanations for a child’s behaviour, demeanour or appearance, have been accepted or not challenged fully.
Excessive alcohol intake
Daniel Pelka died on 3rd March 2012, aged only four years and eight months. He had been suffering abuse and neglect for some time before his death. His mother, Ms Luczak, and her partner Mr Krezolek, were charged of his murder and both sentenced to thirty years imprisonment.
Daniel started school in 2011. He was lonely and spoke very little English, but would join in with activities and was considered well behaved. Unfortunately, Daniel’s poor language skills meant that professionals failed to keep a child central approach.
Ms Luczak came to the UK from Poland in 2005 and had three relationships over here; all of which involved excessive alcohol intake and domestic abuse. Police had been called out to the residential property twenty-seven times for reported incidences of domestic abuse. Mr Krezolek was residing in the property at the time, along with his son and a child he had with Ms Luczak.
Daniel’s attendance at school was poor and he would often appear with bruising and unexplained injuries, but the incidences were not recorded. He had been asked by one of the teaching assistants how two of the injuries were caused, but Daniel just looked down and did not say anything.
Scavenging for food
Daniel presented as very hungry in school and was often seen scavenging for food in bins. He would steal food from other children’s lunch boxes, and was reported to have eaten half a teacher’s birthday cake which was intended for the class. He would sometimes persuade other children to give him food which he would eat in the toilets.
School staff approached Ms Luczak about Daniel’s eating habits, who showed some concern but stated he must only eat what was in his lunch box. Daniel’s older sibling was told to reinforce Ms Luczak’s explanations by telling professionals Daniel was “retarded” and was always hungry.
Following school staff’s concern, the school nurse sought support from the GP and the community paediatrician, who saw Daniel in February 2012. His ravenous appetite and low weight centile were thought to be the result of a likely medical condition; yet the paediatrician was unaware of the physical injuries witnessed by the school, and so no consideration was given to abuse and neglect as a cause.
Total of 40 injuries
Following Daniel’s death, evidence was found on the family computer and within texts between Mr Krezolek and Ms Luczak, suggesting that both parties had beaten him. Mr Krezolek also admitted via text that he had made Daniel temporarily unconscious from nearly drowning him. Evidence also suggested he was often locked in the box room and illness was induced by forcing him to eat salt.
Daniel died on 3rd March 2012, three weeks after the paediatric assessment, from a fatal blow to the head. The coroner noted a total of forty injuries on Daniel’s body and very high sodium levels. The forensic pathologist concluded that these findings reflected longstanding abuse and neglect.
What can be learned?
A serious case review was subsequently undertaken which identified some key lessons:
- Domestic abuse is always a child protection issue and must be approached in this way by all professionals
- Parents’ explanations should not just be taken at face value and should be balanced with presenting factors and evidence. All conversations should be logged and any disparities professionally challenged
- The child should always be the centre focus of any investigation and the voice of the child should be taken into account
- Appropriate, accurate and timely records should always be kept and this information should be shared appropriately with other professionals to support decision-making
- Professionals must think the unthinkable and not be overly optimistic that things will get better on their own
In this particular case, although attempts were made to resolve Daniel’s behaviour and eating habits, there were too many missed opportunities to consider the possibility of abuse. As a result, assumptions were made that he had a medical condition.
In an attempt to cover up the abuse, his mother and her partner deliberately fabricated Daniel’s illness. They had tried to convince those around him that he had a medical condition which made him constantly hungry and even asked Daniel’s older sibling to reinforce this idea. It is also thought that illness was deliberately induced by force feeding him salt and suffocating him.
Recognising the signs
While it can be associated with children of all ages research has shown that FII is most likely to be presented in children under five according to the DfE 2006.
Though further research needs to be done, the following triggers have been identified in cases where the mother is responsible:
- Seeking attention for being a caring mother
- Borderline personality disorders
- Excessive drug/alcohol misuse
- Death of another child
- Fabricating illness to support benefit claims
Although Fabricated Induced Illness is relatively rare, it is important that all staff are trained to recognise the signs and indicators of this form of abuse. Of course, if any form of abuse or neglect is suspected, a referral must be made to social care or the police.
You can hear more on FII from expert Dr Juliet Court at our Safeguarding Conference on 2nd February 2018. If you have concerns around safeguarding, contact the One Education Safeguarding team by calling 0844 967 1111, or fill in our contact form.