Preschool school-entry check — OSCE · Paeds Cases

Prompt

4-year-old for school-entry health assessment; caregiver speech and behaviour concerns.

Objectives

Structure a preschool health supervision visit beyond form-signing. [4]
Elicit and act on speech/school-readiness concerns. [1] [2]
Counsel on sensory referral, oral health and lifestyle without blame. [5] [6]
Safety-net referrals with teach-back. [16]

Candidate brief

12-minute station. Caregiver and preschool child present. Task: complete a focused preschool preventive assessment plan and counsel. [4]

Expected actions

Open agenda and caregiver concerns; do not only chase paperwork. [4] [11]
Plot growth/BMI plan and developmental domain observation. [1] [2] [4]
Include vision and hearing pathways when communication is limited. [1]
Explain surveillance vs screening in plain language. [1]
Cover fluoride toothpaste/dental home and media/sleep/safety headlines. [5] [6] [8]
Reconcile immunisation against official schedule principle. [4]
Refer early for speech/hearing as indicated; safety-net wait. [1] [16]
Use professional interpreter if language discordance arises; never the child. [12]

Marking

Pass: structured preschool package, action on concern, correct tool limits, clear counselling and safety-net. [1] [4]
Fail: form-signing only; pure wait-and-see despite red flags; screen treated as diagnosis; child used as interpreter. [1] [3] [12]

References

[1]Lipkin PH Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics, 2020.PMID 31843861
[2]Zubler JM Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics, 2022.PMID 35132439
[3]Robins DL Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 2014.PMID 24366990
[4]COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE 2023 Recommendations for Preventive Pediatric Health Care. Pediatrics, 2023.PMID 36938620
[5]COUNCIL ON COMMUNICATIONS AND MEDIA Media and Young Minds. Pediatrics, 2016.PMID 27940793
[6]Clark MB Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics, 2020.PMID 33257404
[7]Flynn JT Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics, 2017.PMID 28827377
[8]Durbin DR Child passenger safety. Pediatrics, 2011.PMID 21422094
[9]US Preventive Services Task Force Screening for Elevated Blood Lead Levels in Children and Pregnant Women: US Preventive Services Task Force Recommendation Statement. JAMA, 2019.PMID 30990556
[10]Kuo DZ Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731
[11]Mills E Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study. The Lancet. Child & adolescent health, 2025.PMID 40451224
[12]Boylen S Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI evidence synthesis, 2020.PMID 32813387
[13]Starmer AJ Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
[14]Katz AL Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456510
[15]Forkey H Trauma-Informed Care. Pediatrics, 2021.PMID 34312292
[16]Burvenich R Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis. The British journal of general practice : the journal of the Royal College of General Practitioners, 2025.PMID 39117428

Expected actions

Open agenda and caregiver concerns; do not only chase paperwork. [4] [11]

Plot growth/BMI plan and developmental domain observation. [1] [2] [4]

Include vision and hearing pathways when communication is limited. [1]

Explain surveillance vs screening in plain language. [1]

Cover fluoride toothpaste/dental home and media/sleep/safety headlines. [5] [6] [8]

Reconcile immunisation against official schedule principle. [4]

Refer early for speech/hearing as indicated; safety-net wait. [1] [16]

Use professional interpreter if language discordance arises; never the child. [12]

Marking

References

[1]Lipkin PH Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics, 2020.PMID 31843861
[2]Zubler JM Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics, 2022.PMID 35132439
[3]Robins DL Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 2014.PMID 24366990
[4]COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE 2023 Recommendations for Preventive Pediatric Health Care. Pediatrics, 2023.PMID 36938620
[5]COUNCIL ON COMMUNICATIONS AND MEDIA Media and Young Minds. Pediatrics, 2016.PMID 27940793
[6]Clark MB Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics, 2020.PMID 33257404
[7]Flynn JT Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics, 2017.PMID 28827377
[8]Durbin DR Child passenger safety. Pediatrics, 2011.PMID 21422094
[9]US Preventive Services Task Force Screening for Elevated Blood Lead Levels in Children and Pregnant Women: US Preventive Services Task Force Recommendation Statement. JAMA, 2019.PMID 30990556
[10]Kuo DZ Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731
[11]Mills E Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study. The Lancet. Child & adolescent health, 2025.PMID 40451224
[12]Boylen S Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI evidence synthesis, 2020.PMID 32813387
[13]Starmer AJ Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
[14]Katz AL Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456510
[15]Forkey H Trauma-Informed Care. Pediatrics, 2021.PMID 34312292
[16]Burvenich R Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis. The British journal of general practice : the journal of the Royal College of General Practitioners, 2025.PMID 39117428