Perplexing Presentations (PP)/Fabricated or Induced Illness (FII) in children – guidance

This guidance, published in March 2021, provides best practice advice for paediatricians in the medical management of PP and FII cases to obtain better outcomes for children.

Below provides a background and summary of what’s covered in the guidance. You can download the full guidance below.


Since the publication of the Royal College of Paediatrics and Child Health (RCPCH) guidance on Fabricated or Induced Illness by Carers (FII) in 2009, there have been significant developments in the field. The RCPCH Child Protection Companion 2013 extended the definition of FII in 2013 by introducing the term Perplexing Presentations with new suggestions for management.

This new guidance provides procedures for safeguarding children who present with perplexing presentations and FII and offers practical advice for paediatricians on when and how to recognise it, how to assess risk and how to manage these types of presentations in order to obtain better outcomes for children.

This guidance presents the current view and supersedes previous RCPCH guidance on this subject.

What is covered

  • Epidemiology and an outline of the current evidence base including findings from a survey of RCPCH members
  • Updated terminology and definitions for PP, FII and Medically Unexplained Symptoms (MUS)
  • Features of PP and FII including the relationships between parent, doctor and child, and alerting signs of possible FII
  • Response to alerting signs
  • Developing and implementing a Health and Education Rehabilitation Plan
  • When to refer to children’s social care
  • Points for record keeping
  • Signposting to training and providing supervision and support

Download the guidance below.

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