Explain suspected abusive head trauma to a frightened parent — OSCE

Candidate instructions

You are the paediatric registrar. The mother of a four-month-old boy admitted with encephalopathy and a subdural bleed has ten minutes with you. She is frightened and tearful. She wants to understand, in plain language: (1) why the team is arranging so many tests and what each is for; (2) why a child-protection team is involved and why she cannot take him home today; (3) whether the doctors think she has hurt her baby; and (4) what happens next. Explain with empathy and honesty, do not accuse, check understanding throughout, and agree a clear plan. [1]

Encounter

Mother: "Why are they doing a skeleton X-ray and an eye test? He fell off the bed. Nobody is saying what they think is going on." [1]

Registrar: "I can see how frightening this is, and I am sorry it has felt unclear. Let me explain plainly what we are doing and why. Your baby has a small bleed on the surface of his brain and some swelling, and we are not yet sure how it happened. Because a bleed like that in a baby this young can have several causes, our job is to look at everything carefully so we get the right answer — for him, and for you. The X-rays and the eye examination are part of that careful look; they are routine in this situation, not a judgement about you." [1]

Mother: "But there's a child-protection nurse here. Do you think I shook him?" [4]

Registrar: "I want to be honest with you. When a baby this young has this kind of brain finding, we have a professional duty to make sure he is safe, and that is true whoever is looking after him. That means our child-protection team is involved as a matter of course, and we ask careful questions of everyone. I am not accusing you of anything. Right now we do not have an answer, and we will not jump to one. Our aim is to complete the tests, understand what happened, and keep your baby safe while we do it." [4]

Mother: "Why can't I take him home today?" [1]

Registrar: "Because he still needs observation and a few more tests — the MRI scan and the eye examination — and because, while we work out how this happened, we need to be sure he is in a safe place. That is not a punishment. It is the standard we follow for any baby in this situation. We will keep him comfortable, we will keep you informed at every step, and we will talk together about going home once the tests are done and we are clear about what happened." [1]

Mother: "What happens next, then?" [3]

Registrar: "We will finish the tests today and tomorrow, the team will meet to review all of it together, and then a senior doctor will sit down with you and explain what we have found and what we think. We will also check that your other children are well, because that is part of keeping the whole family safe. Please ask me anything, at any time — there is no such thing as a silly question here. What worries you the most right now?" [3]

Marking domains

• Communication (25%): plain language, empathy, checks understanding, invites questions, avoids jargon and does not accuse. [1]
• Clinical content (30%): explains the rationale for the workup (skeletal survey, ophthalmology, MRI), the role of the child-protection team, and why the child cannot be discharged; conveys that safeguarding is standard, not a verdict. [1]
• Honesty and shared decision-making (20%): is truthful about uncertainty and about the professional duty, frames the process as protective, and agrees a clear next-step plan. [4]
• Safety (15%): confirms the child remains in a safe place and that contacts will be screened; names who the family can contact. [3]
• Professionalism and global (10%): maintains a calm, non-judgemental, collaborative stance; appropriate documentation and handover implied. [1]