Explain an inflicted immersion scald and the safeguarding plan to a non-offending parent — OSCE

Candidate instructions

You are the paediatric registrar in the emergency department. The father of an eighteen-month-old boy with a scald to both feet has ten minutes with you. The burn pattern — symmetrical, sharp upper margin, no splash marks — is not consistent with the cup-of-tea history the child's mother gave, and your consultant has initiated the safeguarding pathway. The child will be admitted to a place of safety. Explain to the father, in plain language and without accusation: (1) that the burn pattern does not fit the story and what that means; (2) why the team must run the safeguarding assessment in parallel with treating the burn; (3) what a strategy discussion and admission to a place of safety mean; and (4) that the team will support him and his son through the process. Invite his questions, acknowledge his fear, and check understanding. Do not name a perpetrator or accuse the mother; do not use jargon. [7]

Encounter

Father: "They said you can't tell me when I can take him home. He just needs his burn dressed, doesn't he?" [7]

Registrar: "I can see you are worried, and I want to be straight with you about what is happening. Your son's burn is being looked after — we have given him pain relief and we are treating the scald. But the pattern of his burn has raised a concern for us, and because of that concern we have a duty to make sure he is safe before anyone goes home. Let me explain what I mean." [1]

Father: "What concern? It was an accident." [1]

Registrar: "I understand that is what you have been told. What I can tell you is what the burn itself shows. His scald is on both feet and lower legs in a very even pattern, with a clear, sharp line across both legs at the same height, and the same depth all the way across. When a hot drink spills on a child, it splashes — you see drips, uneven edges, and shallower and deeper patches. What your son has looks more like his feet were held in hot water. That pattern does not match a spill, and when the pattern and the story do not match, our duty is to look into it properly." [1]

Father: "So you think someone did this to him?" [2]

Registrar: "I am not in a position to say who did what — that is not my role and I would not speculate. What I can tell you is that we have a clear, evidence-based checklist — it is called the BuRN-Tool — that helps us decide when a burn needs a child-safety assessment. Your son's burn meets that threshold, so we have to act on it. That is not the same as accusing anyone; it is us doing our job to keep him safe, which is something I think you want too." [2]

Father: "What does acting on it mean? Can I stay with him?" [6]

Registrar: "Yes, you can stay with him — we want you here. What happens now is two things at once. First, we keep treating his burn. Second, we start a child-safety process. A group of people — me and my consultant, a social worker, and sometimes the police — will have what we call a strategy discussion today to share information and agree on the safest plan. Very often that means your son stays in hospital on the ward for a few days while we do that assessment, because we need to be sure the place he goes back to is safe. That is what we mean by a 'place of safety' — it is the ward, with you able to be with him, while the assessment happens." [6]

Father: "How long does this take? And what happens after?" [6]

Registrar: "The strategy discussion happens today. The assessment usually takes a few days, and during that time your son is cared for on the ward and you can be with him. We may need to do some tests — for example, some X-rays to check he does not have any other injuries we cannot see — and we will talk you through each step. After the assessment, there is usually a bigger meeting called a case conference where everyone agrees a plan to keep your son safe going forward. I know this is a lot, and I know it is frightening. My job right now is to look after your son and to keep you informed at every step." [6]

Father: "Will he be okay — the burn, I mean?" [7]

Registrar: "We are treating the burn with the right dressings and pain relief, and we will keep a close eye on how deep it is over the next couple of days because burns can change. If it needs specialist care we will involve the burns team. The burn itself is one part of what we are managing; making sure he is safe is the other, and we are doing both at the same time. Before we finish, what questions do you still have, and is there anything you want me to go over again?" [7]

Marking domains

• Communication (25%): plain language, empathy, avoids jargon and accusation, checks understanding, invites questions throughout.
• Clinical content (30%): explains that the pattern does not fit the spill story using concrete, observable features; introduces the BuRN-Tool as an evidence-based threshold; describes the strategy discussion and place-of-safety admission accurately; names the parallel burn-care and safeguarding tracks. [2]
• Shared decision-making and non-judgement (20%): does not name or accuse a perpetrator; frames the process as a statutory duty to keep the child safe; supports the non-offending parent's involvement and presence.
• Safety and accuracy (15%): does not under-state the seriousness; confirms admission and the case-conference follow-up; explains the role of investigations such as X-rays. [6]
• Professionalism and global (10%): calm, collaborative, non-accusatory stance; treats the parent as a partner in the child's safety and care.