Explain suspected poisoning as maltreatment to a parent — OSCE

Candidate instructions

You are the paediatric registrar. The mother of a two-year-old girl admitted for the third time with an unexplained seizing illness and a high sodium has ten minutes with you. She is frightened, watchful, and articulate. She wants to understand, in plain language: (1) why the team is doing so many blood and urine tests and what each is for; (2) why a child-protection nurse is involved and why she cannot take her daughter home today; (3) whether the doctors think she has been poisoning her child; and (4) what happens next, including her other children. Explain with empathy and honesty, do not accuse, check understanding throughout, and agree a clear plan. [1]

Encounter

Mother: "Why are they taking so much blood and urine? And why do they keep writing down exactly what I say and when she gets sick? Nobody is telling me what they think is going on." [1]

Registrar: "I can hear how frightening and confusing this has been, and I am sorry it has felt unclear. Let me explain plainly. Your daughter has had this serious pattern of illness three times now, and each time her blood sodium has been very high. We do not yet have a full explanation for why that is happening, and our job is to look at everything carefully so we get the right answer — for her, and for you. The blood and urine tests help us measure exactly what is happening in her body. The notes are kept in detail because, in a complicated recurring illness like this, the timeline is often the thing that points us to the answer." [1]

Mother: "There's a child-protection nurse here. Do you think I've been poisoning her?" [3]

Registrar: "I want to be honest with you. When a child has a serious, unexplained, recurring illness like this, we have a professional duty to make sure she is safe, and that is true whoever is looking after her. 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 a complete answer, and we will not jump to one. Our aim is to finish the tests, understand what is happening, and keep your daughter safe while we do it." [3]

Mother: "Why can't I take her home today? She's better already." [3]

Registrar: "She is more settled, which is good, but we still need to finish some tests and to watch her carefully. Because we do not yet have the full picture, we need to be sure she is in a safe place while we work it out. That is the standard we follow for any child in this situation, not a judgement about you. We will keep her comfortable, keep you informed at every step, and talk together about going home once the tests are done and we are clear about what has been happening." [3]

Mother: "What about my other children? What happens next?" [2]

Registrar: "The team will meet to review everything together, and then a senior doctor will sit down with you and explain what we have found and what we think. Because part of keeping a family safe is checking on everyone, we will also make sure your other children are well — that is routine in this situation. Please ask me anything, at any time; there is no such thing as a silly question. What worries you the most right now?" [2] [4]

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 toxicology and the chronology, the role of the child-protection team, and why the child cannot be discharged; conveys that safeguarding is standard, not a verdict. [3]
• 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. [3]
• Safety (15%): confirms the child remains in a safe place, that siblings will be checked, and names who the family can contact. [2]
• Professionalism and global (10%): maintains a calm, non-judgemental, collaborative stance; appropriate documentation and handover implied. [4]