Caregiver-fabricated or induced illness — branching viva

Opening

Examiner: A two-year-old boy is on your ward for the fourth time this year with apnoea. No one on the team has witnessed an episode. His mother, a former enrolled nurse, is the most engaged parent on the ward and is pressing for a central line. Between her reports he feeds, plays, and grows normally. How do you frame this? ^[1]

Candidate: I would frame this as suspected caregiver-fabricated or induced illness — a form of child abuse in which the child is, or is very likely to be, harmed because of a caregiver's behaviour — while still excluding any genuine cause of apnoea. The cardinal finding is the gap between symptoms vividly reported by the mother but never witnessed by staff, that resolve when she is absent, that do not fit any recognised disease, and that accompany an inexplicably willing push for invasive intervention. My priority is to involve the designated safeguarding lead immediately, document that gap precisely, and never confront the mother alone. ^{[1] [2]}

Branch 1 — definition and why the label changed

Examiner: You said "fabricated or induced illness" rather than "Munchausen syndrome by proxy." Why does the terminology matter? ^[2]

Candidate: Because the label changes the clinical question. "Munchausen syndrome by proxy" centred on the perpetrator's psychopathology and asked the clinician to diagnose a mental disorder in the parent — something I cannot do and do not need to do. "Fabricated or induced illness," and the AAP's "medical child abuse," centre on the child's welfare and ask only whether the caregiver's behaviour is causing harm. Glaser's 2020 reframing is the hinge: the diagnosis is about harm to the child, not the parent's motivation. I can act to make the child safe without ever proving the caregiver has factitious disorder, somatisation, or any psychiatric label. ^[2]