Examining and counselling the family of a high-risk infant — OSCE

Task

Examine the infant and then counsel the parents. You have eight minutes — approximately three minutes for the focused examination and five for the communication. Demonstrate an organised, empathic and accurate explanation that addresses the four questions a fellowship communication station rewards: what the findings are and what they may mean, how you will confirm it, what the plan and the timeframe are, and what the family should watch for. The framework follows the international early-detection pathway for cerebral palsy. [8]

The examination to perform

Perform the focused infant neurological examination with the parents watching, narrating gently as you go. Observe the posture and the quality and symmetry of spontaneous movement first. Assess the tone by passive movement of each joint, slowly and then quickly, and by the traction response (pull to sit) and the ventral suspension. Elicit the deep tendon reflexes at the knees and ankles and grade them, comparing right to left. Check the plantar response on both sides. Perform the General Movements Assessment by observing the spontaneous movement repertoire. Plot the head circumference and palpate the fontanelle. The key findings are the right-sided hypertonia with a velocity-dependent catch, the brisk right-sided reflexes, the asymmetric extensor plantar, and the absent fidgety movements. [6]

What the family needs to hear

Open by acknowledging the fear and the guilt before any finding. The premature birth was not their fault, and the stiffness they have noticed is the very reason the follow-up clinic exists — to catch changes early, when the developing brain is most responsive. Acknowledge that the word cerebral palsy is frightening, and that you will use it carefully, because what you have found today places their baby on a pathway that can genuinely help. [9]

Explain the findings in plain language. The baby is alert, socially engaged, and growing along the line — all reassuring. The stiffness down the right side, the brisk reflexes, and the way the right hand stays fisted show that the messages from the brain to the muscles are not coming through evenly on that side, which is a pattern we take seriously in a baby born early. The movement assessment showed that the small, continuous fidgety movements we look for at this age are reduced, and we know from research that this combination can be an early sign of cerebral palsy. Be honest that this is not yet a diagnosis — it is a signal that we act on. [4]

The plan, the timeframe, and the safety-net

Address the plan clearly, because uncertainty is harder to bear than a clear next step. The next step is a magnetic resonance imaging of the brain to look at the detail of the wiring, a formal scored assessment called the Hammersmith Infant Neurological Examination, and a referral to the paediatric neurology and early-intervention teams — arranged within weeks, not months. Explain that acting early matters because the first two years are the window in which the brain is most able to adapt, and that early intervention can shape the motor development. [8] [9]

Give the safety-net in writing and name a single point of contact. Return urgently with any change in feeding or breathing, any change in the baby's conscious state or alertness, any seizures or abnormal movements, or any rapid change in the stiffness or the head size. Reassure them that they know their baby best, that they are the most important member of the team, and that nothing they did caused this. Close by naming the trajectory: this is the beginning of a watched, supported pathway, not a verdict, and the family will not be alone in it. [9]