Detecting fabricated or induced illness in children

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7525.1144 (Published 10 November 2005) Cite this as: BMJ 2005;331:1144

Are we ready for covert video surveillance?

  1. Prathap Chandra (prathap_c{at}yahoo.com), specialist registrar in paediatrics,
  2. Anandagiri M Shankar, honorary fellow
  1. Sandwell General Hospital, West Bromich, West Midlands B71 4HJ
  2. Department of Public Health, Walsall Teaching Primary Care Trust, Walsall WS1 1TE

    EDITOR—Foreman identifies covert video surveillance (CVS) as a potential tool for detecting fabricated or induced illness in children, despite several constraints to its effective use.1 Of various methods of inducing illness, suffocation may seem the only one that could be averted using it.

    The Regulation of Investigatory Powers Act 2000 does not clearly help the cause of CVS. Courts are also not in favour of its use. Indeed, healthcare providers might even contribute to Munchausen syndrome by proxy.2

    Little information exists about episodes of inducing illness in children by carers while in a hospital. Only one study, in Atlanta, Georgia, of 41 children with suspicion of Munchausen's syndrome by proxy, showed that CVS helped confirm diagnosis in 13 out of 23 cases. Of these 13 cases, only two of induction were picked up by such surveillance: the rest were fabricated. The authors highlight the ethical and privacy related issues of using CVS, indicating the need for specific training and raising concerns about the timing of intervention after detection of any abnormality.3

    The large cost-benefit implications of CVS have to be considered. Instead, resources could be directed towards primary prevention with a multidisciplinary approach of public health, education departments, and social services.


    • Competing interests None declared.


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