Guideline review: RCPCH perplexing presentations, fabricated or induced illness in children guidance 2021.

In the 40 years since Professor Roy Meadow first described ‘Munchausen Syndrome by Proxy’, there have been a number of significant developments, including terminology, definition, prevalence and management. The Royal College of Paediatrics and Child Health (RCPCH) guidance on Perplexing Presentations (PP)/Fabricated or Induced Illness (FII) in Children outlines procedures in order to safeguard children who present with perplexing presentations and fabricated or induced illness. It offers practical advice on how to recognise it, how to manage risk and how to manage these presentations. This guideline was commissioned and developed by the RCPCH. There was input from a wide range of paediatric generalists and subspecialists, as well as social work practitioners and several organisations and commissioning groups. Although written primarily for paediatricians, it is of direct relevance to general practitioners (GPs), other specialists, social care and education. See box 1 for a link to the full guideline and other related resources. Box 1 ### Resources While this guidance supersedes the 2009 RCPCH guideline entitled Fabricated or induced illness by carers: a practical guide for paediatricians, it does not fully replace it or render it obsolete. For the ‘high risk’ or physically injurious FII cases, the detailed management guidance in the 2009 document is still applicable. The RCPCH Child Protection Companion 2013 extended the definition of FII by introducing the term Perplexing Presentations with new suggestions for their management. This guideline supports a cultural …