For debate: Forty years of fabricated or induced illness (FII): where next for paediatricians? Paper 2: Management of perplexing presentations including FII

• Published in: Archives of disease in childhood 2019-01, Vol.104 (1), p.7-11
• Main Authors: Glaser, Danya, Davis, Paul
• Format: Article
• Language: English
• Subjects: Caregivers; Child & adolescent mental health; Children; Children & youth; Families & family life; Food intake; Health services; Illnesses; Intervention; Intestine; Medical Evaluation; Medical referrals; Mental health; Mobility; Mood; Pain; Parent Child Relationship; Pediatrics; Physical Examinations; Physicians; Referral; Teenagers
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2016-311326

Correspondence to Dr Danya Glaser, Great Ormond Street Hospital For Children NHS Foundation Trust, London WC1N 3JH, UK; [e-mail] Introduction Perplexing medical presentations encompass many situations encountered by paediatricians, where a child is reported to have symptoms or disabilities that impact significantly on their everyday functioning, and yet thorough medical evaluation has not revealed an adequate and realistic medical explanation. A very useful way to proceed may be admitting the child (often for 2 weeks or over a period of time greater than the interval between reported episodes of concern, if they are not continuous) for close observation during which weight, intake of food and medication, bowel and bladder function, mobility, pain and other symptoms and hospital school attendance can be observed and monitored. Box 1 Approach to perplexing presentations Consult a colleague/named doctor Verify child’s current state of health Obtain history/observations from all carers (including father) Collate all current medical/health involvement and treatment Establish provenance of reported diagnoses Carry out further definitive, warranted investigations Inpatient admission for direct observation of child may be required Document child’s current functioning (school, mobility, aids) Seek parents’ views explanations, fears, hopes for child’s difficulties Seek child’s views—illness beliefs, anxieties, mood Explore family functioning and effect of child’s difficulties on Siblings, and their health Family life and interactions Professional consensus The first stage in the restorative process is to gain the agreement in a consensus meeting of all professionals concerned, including the general practitioner (GP), that this is the way to proceed. Hospital, GP and community health services—possibly including physiotherapy and occupational therapy, psychology, child and adolescent mental health and education professionals will need to work together.