Feeding problems OSCE — selective eating counselling and ARFID/PFD plan

Station A — Toddler food refusal counselling (8–10 minutes)

Candidate task. Take a focused feeding history from a parent actor, interpret a growth chart showing stable centiles, and counsel on management. [1]

Parent script highlights. Child is 26 months. Used to eat family foods. Now refuses vegetables and meats. Accepts yoghurt, banana, toast and cheese. Meals last 45 minutes with spoon-forcing and threats. No cough with drinks. Wet nappies normal. Development otherwise typical. [1]

Marks for. [1]

1. Structured history: accepted foods, textures, meal duration, force tactics, choking/cough, stools, energy, prior advice. [1]
2. Growth interpretation: stable trajectory lowers urgency but does not ignore family distress. [7]
3. Clear advice: stop force-feeding; structured meals/snacks; calm exposure; avoid turning every meal into a battle. [1]
4. Safety-net: what would change the plan (weight fall, dehydration, cough/cyanosis with feeds, total collapse of intake). [1]
5. Communication: non-blaming language; shared plan for this week. [1]

Failing behaviours. Moralising the child; ordering a large unnecessary work-up immediately; endorsing force-feeding; no follow-up plan. [1]

Station B — Autism selectivity multidisciplinary plan (8–10 minutes)

Candidate task. Explain to parents why this is more than “picky eating,” outline PFD domains/ARFID-pattern thinking, and propose a staged plan including when intensive support or tube feeding might be considered. [2] [3]

Clinical facts provided. Seven-year-old with autism. Two accepted dry foods. Iron deficiency on bloods. Slow weight centile fall. No wet voice. High mealtime conflict. [5]

Marks for. [2]

1. Problem representation naming sensory selectivity, nutritional risk and psychosocial conflict. [5] [2]
2. Explanation that autism-related sensory sensitivity commonly drives food selectivity. [6]
3. Plan: dietetics fortification and iron strategy; stop coercion; sensory-informed feeding therapy; school lunch plan; psychology if needed. [2] [4]
4. Escalation: intensive multidisciplinary programme if outpatient care fails; temporary tube only as bridge with exit plan. [8]
5. Family-centred communication without promising instant variety. [2]

Examiner global. Candidate must show they can protect nutrition and relationships at the same time. [2] [8]