How did a mother convince doctors to operate on her children unnecessarily?

A woman from south London has been jailed for fraud and child abuse after causing her children to undergo surgery for fictitious medical problems. How did a mother convince experienced doctors to operate on her children unnecessarily?

Croydon Crown Court heard the mother of six, who cannot be named for legal reasons, displayed tendencies towards Fabricated or Induced Illness (FII), which used to be known as Munchausen by proxy syndrome where people invent or cause symptoms of illness in others.

She persuaded doctors to prescribe copious medication and provide equipment for her children worth more than £145,000, which - as they did not require it - was potentially dangerous for them, the prosecution said.

She also convinced them to perform invasive operations and insert feeding tubes into her son and daughter's stomachs.

Part of the problem was the number of health referrals that reduced the chance of any single medic's suspicions being raised.

Dr Eveline Knight-Jones, who prepared the paediatric overview for the court case, said: "In London it is all too easy for fabricated illness cases to attend several different hospitals some distance from their local hospital, because there are so many hospitals, particularly specialist hospitals."

Most of the health professionals her children saw took what the mother said about them "at face value," the Crown said.

The defence claimed the mother suffered from a severe anxiety disorder herself, which caused her to "catastrophise" and overstate her children's medical symptoms.

Management of their health condition was heavily based on the mother's description of their symptoms, which "appeared believable and persuasive", although the children were rarely seen to be unwell at the clinics, the Crown added.

The mother was also "resistant" to any attempts to investigate the causes of the alleged symptoms. For example she refused to allow one child to be admitted to hospital for a two-week review, the prosecution said.

"There are certain conditions that can leave a child coping very well in between episodes, and unless they happen to feel unwell at the time they are presented to you, there is no way of reproducing that condition, which makes it very hard to prove or disprove either way," consultant paediatrician Dr Paul Davis told BBC News.

He was the last person to carry out a major study of FII in the UK in the early 1990s and at the time had identified about 50 cases per year.

He said: "One thing you might do if you had suspicions of that nature is try to get the child admitted to hospital for a longer period of observation. But even then, without someone constantly watching that patient, you can't rule out that a parent at their bedside might be interfering with their results."

Dr Knight-Jones said what made this case particularly difficult was that the children, in her opinion, had real illnesses at the start, but nothing that would cause them permanent ill-health.

One of the children was diagnosed with coeliac disease, an auto-immune disease triggered by a reaction to gluten. Placing him on a gluten-free diet would likely have cleared up his symptoms, the Crown said. Later tests revealed no presence of the disease and the Crown suggests he may have been misdiagnosed originally.

Another child was found to have had an inflammatory gut disease that later tests showed had cleared up before a feeding tube was surgically fitted.

Police said as a result of her children's fabricated illnesses the mother received about £87,000 in disability living allowance, between 2003 and 2014. She also falsely claimed income support benefit.

The total amount of falsely claimed benefit was £375,200.

Following the trial, Det Sgt Stuart Parsons, from the Met Police's Sexual Offences, Exploitation and Child Abuse Command said: "It is staggering to think that the mother's wilful actions resulted in the children undergoing unnecessary surgical and medical interventions.

"She lied at every opportunity, presenting herself as a lone parent coping with ill and vulnerable children. The reality was that she resided with her partner and fabricated her children's conditions for personal financial gain."