Factitious illness occurs when a caregiver exaggerates, falsifies, and/or induces symptoms of illness in a child. Emergency care providers are often in a unique position to evaluate these children and may be the first to recognize that factitious illness is present. The varied and unusual presentations of this entity present diagnostic challenges for the medical provider. Using a case-based approach, this article identifies important red flags that should alert the emergency care clinician to consider the possibility that a child is the victim of factitious illness.