Poor feeding OSCE — neonate triage and preschool feeding plan

Station A — Day-6 neonate (10 minutes)

Candidate task: Take a focused history from the caregiver, state bedside priorities, give a problem representation and outline immediate management. [26] [5]

Actor script (caregiver)

• Baby 6 days old, born term, home day 2. [26]
• Breastfeeding was “okay,” then last 18 hours much less interested. [5]
• Only three wet nappies since yesterday. [5]
• Sleepier, harder to rouse for feeds. [26]
• No cough, no bilious vomit reported. [5]
• Parent is scared and asks if this is “just breastfeeding establishing.” [26]

Expected candidate performance

1. Greets, checks urgency, does not normalise lethargy. [26]
2. Focused history: volumes/minutes, wet nappies, colour, tone, temperature, breathing, pregnancy/GBS/risk factors, prior weights. [5]
3. States ABCDE + glucose + sepsis pathway thinking before long technique advice. [26] [25]
4. One-sentence problem representation with threat-led differentials. [5]
5. Clear plan: observations, glucose, septic work-up/treatment per local pathway, admission, parent explanation without blame. [26]

Examiner prompts

• “Would you send them home if the first saturation is normal?” [26]
• “Where does tongue-tie sit in this presentation?” [5]

Marking anchors

• Pass: Threat-first plan, glucose/sepsis addressed, no premature discharge reassurance. [26] [25]
• Borderline: Mentions sepsis late after lengthy latch lecture. [26]
• Fail: Reassures “normal establishing breastfeeding” and discharges the lethargic neonate. [26]

Station B — Preschool selective feeding (10 minutes)

Candidate task: Explain findings and co-produce a plan with a caregiver of a 3-year-old with autism, three accepted foods and falling weight centiles. [1] [14]

Actor script (caregiver)

• Child gags on new textures; mealtimes are battles. [1]
• No cough or wet voice. [2]
• Weight has crossed centiles down over 6 months. [1]
• Parent feels judged and asks for a “quick tube or a magic formula.” [35]

Expected candidate performance

1. Validates caregiver effort; avoids blame. [1]
2. Explains PFD domains in plain language and possible ARFID-pattern overlap without body-image concerns. [1] [14]
3. Safety screen: aspiration signs, dehydration, rapid loss. [2]
4. Stepwise plan: dietetics, feeding therapy, medical review as needed, no force-feeding. [1]
5. Tube discussion only with goals and exit plan if oral route cannot meet needs. [35]
6. Safety-net and follow-up booking; teach-back. [1]

Examiner prompts

• “Is this just picky eating?” [1] [14]
• “Should we start a PPI today?” [1]

Marking anchors

• Pass: Multidisciplinary plan, growth safety, respectful communication, avoids unnecessary PPI/tube as first move. [1] [14]
• Borderline: Correct labels but no concrete follow-up or safety-net. [1]
• Fail: Moralises, force-feeding advice, or permanent tube without goals. [35]

Shared debrief points

• Poor feeding is a presentation; acuity decides the first minute. [5] [26]
• Observe feeds when safe; history alone is incomplete. [5]
• Cardiac load and aspiration are “must not miss” mechanisms after sepsis/glucose. [19] [2]
• Chronic care is domain-based and family-centred. [1] [14]