Why are mothers pretending their children are ill?

AN ANXIOUS, middle-class mother notices a mysterious rash on her young son and, as one does, immediately turns to Dr Google. She comes across a medical website that tells her it’s a classic sign of a serious genetic condition – there’s a risk of seizures and sudden death.

In a panic, she rushes him to their GP. Tests show nothing but she’s not reassured.

She gets a specialist referral. Then another. Doctors conduct tests each time but find no problem. She begins to keeps her son off school, just to be safe.

Then she stops him playing with his friends. Years go by and, worried about her son’s strength, she begins to push him in a wheelchair. She continues to demand hundreds of invasive tests from doctors, some involving surgical procedures.

If you’re expecting, at some point, for some rare, hidden disease to be discovered, you might be in for a shock. Because, in reality, there is nothing wrong with the child.

Eventually, the woman’s doctors are forced to confront her. Social services step in. The child is taken away and makes a rapid, complete recovery. Bizarre and sinister as it may sound, cases such as these are on the rise.

We’re all familiar with the anxieties of the ‘worried well’ – those suffering health anxieties exacerbated by the rise of health websites. But this is something far darker.

Every year, paediatricians are faced with parents who dream up – or even induce – their child’s illness. Last week, a report published by The Royal College of Paediatrics and Child Health told of an increase in such cases, and new guidance has been issued to doctors to help them spot them.

‘These parents are often articulate and educated,’ says Dr Alison Steele, a paediatrician and specialist in child protection at Great Ormond Street Hospital. ‘They are already anxious about their own health, and then start reading into medical reports online about child health, which seems to trigger something.’

SOME may be familiar with the phenomenon of Munchausen syndrome – the psychological problem whereby people lie about being sick, or actively induce their own illness. In extreme cases, they poison themselves or endure unnecessary operations. But there is another type, Munthirds chausen syndrome by proxy. In this, a parent imagines their child is ill, or even harms them. The ultimate aim, in both cases, is the same: to gain attention. In the most extreme cases, the parents are eventually prosecuted for child abuse.

Previously, doctors estimated Munchausen syndrome by proxy affected 50 children a year. But now experts say most of the UK’s 3,200 paediatricians will see at least one more moderate case, as described above, every few years.

‘Previously, the guidance was geared towards the most extreme cases,’ says Dr Steele. ‘We were told to go to social services the moment we suspected anything.

‘But now we’re identifying these more everyday cases, where children aren’t immediately at risk. An open conversation with parents is more appropriate.’

Typically, parents complain that their children are suffering from vague symptoms such as confusion, shortness of breath, unusual rashes that come and go, or stomach Often parents claim their child is suffering from seizures, which is almost impossible to prove or disprove.

‘These aren’t just anxious parents,’ says Dr Danya Glaser, a child psychiatrist at Great Ormond Street Hospital and an expert in fabricated illness. ‘They are relentlessly persistent with doctors, insisting on tests after tests. Even when specialists have performed all the necessary tests, offered a second opinion and they conclude the child is healthy, some parents won’t accept it.’

It’s now believed patients aren’t always being deliberately deceitful. Many act on ‘erroneous beliefs’ causing them to exaggerate normal characteristics, according to the new guidance.

But Dr Glaser says the harm is real: ‘Parents stop their children going to school and living a normal life, and it poses a serious risk to their physical and emotional development.’

Doctors also say it’s not simply that they’re spotting more cases – the phenomenon is on the rise, linked to the proliferation of health advice online. Even more bafflingly, doctors insist Munchausen syndrome by proxy isn’t a mental illness. So what would possess a parent to do such a thing?

Studies suggest that roughly twoupsets.

of those who fabricate illness in children suffer anxiety about their own health – and this, say experts, is one way to spot a case.

‘Some were sick as a child, or a doctor failed to spot an illness in a loved-one,’ says Dr Glaser. ‘They project their fears of it happening again on to their child.’

Psychiatrists say it is a subconscious mechanism designed to get sympathy and support from others. Also common is a history of abandonment or neglect in earlier life.

On the whole, ‘these parents don’t lack human kindness,’ says Dr Glaser. ‘They care deeply about their children.’

It’s for this reason the new guidance urges doctors to avoid jumping to the worst conclusions.

‘All paediatricians must first say to parents, “OK, maybe you’re right,” and perform all the necessary tests,’ says Dr Glaser. ‘But if parents do not accept the careful investigations, and persist in believing their child is sick, parents must be told they are harming their child. And as much as they believe they have the right answers, sometimes they simply do not.’