a single episode or part of recurrent episodes. Warning signs Warning signs of the disorder include: A child who has one or more medical problems that do not respond to treatment or that follow an unusual course that is persistent, puzzling, and unexplained. Physical or laboratory findings that are highly unusual, discrepant with patient's presentation or history, or physically or clinically impossible. A parent who appears medically knowledgeable, fascinated with medical details and hospital gossip, appears to enjoy the hospital environment, and expresses interest in the details of other patients' problems. A highly attentive parent who is reluctant to leave their child's side and who themselves seem to require constant attention. A parent who appears unusually calm in the face of serious difficulties in their child's medical course while being highly supportive and encouraging of the physician, or one who is angry, devalues staff, and demands further intervention, more procedures, second opinions, and transfers to more sophisticated facilities. The suspected parent may work in the health-care field themselves or profess an interest in a health-related job. The signs and symptoms of a child's illness may lessen or simply vanish in the parent's absence (hospitalization and careful monitoring may be necessary to establish this causal relationship). A family history of similar or unexplained illness or death in a sibling. A parent with symptoms similar to their child's own medical problems or an illness history that itself is puzzling and unusual. A suspected emotionally distant relationship between parents; the spouse often fails to visit the patient and has little contact with physicians even when the child is hospitalized with a serious illness. A parent who reports dramatic, negative events, such as house fires, burglaries, or car accidents, that affect them and their family while their child is undergoing treatment. A parent who seems to have an insatiable need for adulation or who makes self-serving efforts for public acknowledgment of their abilities. A child who inexplicably deteriorates whenever discharge is planned. A child that looks for cueing from a parent in order to feign illness when medical personnel are present. A child that is overly articulate regarding medical terminology and their own disease process for their age. A child that presents to the Emergency Department with a history of repeat illness, injury, or hospitalization. Epidemiology FDIA is rare. Incidence rate estimates range from 1 to 28 per million children, although some assume that