Although child maltreatment due to abuse or neglect is pervasive within our society, less is known about fabricated or induced illness by carers (FII), which is considered to be a rare form of child abuse. FII occurs when a caregiver (in 93% of cases, the mother) misrepresents the child as ill either by fabricating, or much more rarely, producing symptoms and then presenting the child for medical care, disclaiming knowledge of the cause of the problem. The growing body of literature on FII reflects the lack of clarity amongst professionals as to what constitutes FII, the difficulties involved in diagnosis, and the lack of research into psychotherapeutic intervention with perpetrators. This lack of clarity further complicates the identification, management and treatment of children suffering from FII and may result in many cases going undetected, with potentially life-threatening consequences for children. It has been suggested that there is a national under-reporting of fabricated or induced illness. In practice these cases are encountered more frequently due to the chronic nature of the presentations, the large number of professionals who may be involved and the broad spectrum including milder cases that may not all require a formal child protection response. Diagnosis of fabricated disease can be especially difficult, because the reported signs and symptoms cannot be confirmed (when they are being exaggerated or imagined) or may be inconsistent (when they are induced or fabricated). This paper highlights and discusses the controversies and complexities of this condition, the risks to the child and how it affects children; the paucity of systematic research regarding what motivates mothers to harm their children by means of illness falsification; how the condition should be managed and treated for both mother and child; and implications for policy and practice. (Contains 1 table and 1 note.)