The updated 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.

Updates in the 2021 guidance include:

  • Updated definitions of medically unexplained symptoms (MUS), PP and a wider view of FII.
  • Alerting signs are not evidence of FII but indicators of possible FII and, if associated with possible harm to the child, they amount to general safeguarding concerns.
  • The focus must be on the harm to the child rather than the perceived severity or type of caregiver motivations, actions and behaviours.
  • Unless there is risk of immediate, serious harm to the child’s health or life, caregivers can be informed (not seeking consent from) about the need for sharing information between different professionals involved in the child’s life.
  • Responsibility for the initial management, including collating of current health involvement, is with the responsible paediatric consultant. 
  • A Health and Education Rehabilitation Plan is an essential feature of management in all cases of FII, whether or not children’s social care are involved. 

Full details on the RCPCH Child Protection Portal

CPSIG is a special interest group of BACCH & RCPCH
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