Explain a sentinel oral injury and the safeguarding plan to a carer — OSCE

Candidate instructions

Explain to the carer, with empathy and without accusation, that the torn frenum and ear bruise are injuries that require a full safeguarding assessment because they are not typical of the described mechanism in a non-mobile infant. Outline what the assessment involves (skeletal survey, scans, eye exam, blood tests), why the baby cannot go home until the assessment is complete, and that a report to child protection will be made as part of standard duty of care — not as an accusation. Agree a clear plan and safety-net. The examiner plays the mother. [3] [5]

Candidate scenario

You are the paediatric registrar in the emergency department. A mother has brought her 5-month-old baby in with poor feeding. On examination you found a torn upper labial frenum and a small bruise behind the ear. The baby does not roll, sit, or crawl. The mother says the baby bumped the mouth on the cot rail. You have discussed the case with your consultant and the child-protection team; a safeguarding workup and a mandatory report will proceed. You now need to explain this to the mother. [5]

Marking domains

• Empathy, non-judgmental stance, and clear agenda-setting
• Accurate plain-language explanation of why the injuries are concerning in a non-mobile infant
• Clear description of the safeguarding workup (skeletal survey, scans, eye exam, bloods) and why the baby cannot be discharged yet
• Transparent, non-accusatory framing of the mandatory report as standard duty of care
• Acknowledges the mother's perspective and distress without minimising the clinical concern
• Clear safety plan, named contact, and follow-up

Model outline

Open. Acknowledge the mother's distress and set a clear, calm agenda: "Thank you for bringing your baby in. I can see you are worried. I have examined your baby carefully, and I have found two things I need to talk to you about — a torn piece of skin inside the upper lip and a small bruise behind the ear. I want to explain what we do next and why." [5]

Why we are concerned. "At five months, most babies are not yet rolling, sitting, or crawling on their own. In a baby who is not yet mobile, an injury inside the mouth like this — or a bruise behind the ear — is very unusual from a bump, because the baby cannot move with enough force to cause it on their own. Our guidelines tell us that when we see this kind of injury in a baby who is not yet mobile, we have to look very carefully to make sure there are no other injuries we cannot see. This is about keeping your baby safe — it is not about blaming anyone." [1] [5]

The workup. "So we need to do a set of tests. We will take a series of X-rays called a skeletal survey to check for any hidden bone injuries, because some do not show up on the first set and we repeat it in two weeks. We will do a scan of the baby's head to be thorough. We will ask an eye specialist to look at the back of the eyes with drops. And we will do some blood tests, including checks for clotting and for any hidden internal injury. Because some of these tests take time, and because we need to make sure your baby is safe while we do them, your baby will need to stay in hospital with you." [2] [9]

The report. "I also need to be open with you about something important. As doctors, when we have concerns about an injury in a baby this young, we have a legal duty to let child protection services know — this is part of our job for every child, and it is not an accusation against you. It means a team who specialises in child safety will work with us to understand what has happened. I know this is distressing to hear, and I will support you through it." [5]

Close. "Your baby is safe here with you, and the tests are to make sure nothing is missed. You can ask me anything now and at any time. Here is the name of the nurse and the doctor looking after your baby, and we will update you at every step. Once the tests are complete and we are sure your baby is safe, we will agree a plan together for going home." [3] [5]