Explain an unsafe-sleep presentation to a frightened parent — OSCE

Candidate instructions

You are the paediatric registrar. The mother of a four-month-old boy admitted pale and apnoeic after being found face-down in the soft bedding of the parental bed has ten minutes with you. She is frightened and tearful. She wants to understand, in plain language: (1) what happened to her baby and why he is having so many tests; (2) why a child-protection team is involved and why she cannot take him home today; (3) whether the doctors think she has hurt him; and (4) how to make sure this never happens again. Explain with empathy and honesty, do not accuse, check understanding throughout, and agree a clear plan. [1]

Encounter

Mother: "He was fine when I fed him. I just dozed off. Why is he having scans and blood tests — what's actually wrong with my baby?" [1]

Registrar: "I can see how frightening this is, and I am sorry it has felt unclear. Let me explain plainly. Your baby was found not breathing in the bed, and when that happens to a baby this young the cause is usually that his airway was blocked — his face pressed into the soft bedding so he could not get enough air. That is called an asphyxial event. We are doing the scans and blood tests to see how much his brain has been affected, to make sure there is no other cause, and to support his breathing while he recovers. They are part of giving him the best care, not a judgement about you." [1]

Mother: "But there's a child-protection nurse here. Do you think I did this to him?" [7]

Registrar: "I want to be honest with you. When a baby this young has this kind of event in a sleep space, we have a professional duty to make sure he is safe — and that duty is the same whoever is looking after the baby. 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 the full answer, and we will not jump to one. Our aim is to understand what happened and to keep your baby safe while we do it." [7]

Mother: "Why can't I take him home today?" [1]

Registrar: "Because he still needs observation and a few more tests, and because while we work out exactly how this happened we need to be sure he is in the safest possible place. That is not a punishment — it is the standard we follow for any baby in this situation. We will keep him comfortable, we will keep you informed at every step, and we will plan going home together once he is stable and we are confident about his safety." [1]

Mother: "How do I make sure this never happens again?" [8]

Registrar: "There are simple, evidence-based steps that make a real difference, and we will go through them together before you go home. The safest sleep is: on his own, on his back, in a bare cot on a firm flat surface — no pillows, soft bedding or bumpers — in your room but not in your bed, and away from anyone who has been drinking or smoking. I know that sounds simple, and I know how hard the nights are. We will give you written information, we can arrange a safe-sleep support visit, and there is no blame here — the aim is simply to make the sleep as safe as it can be. What worries you the most right now?" [8]

Marking domains

• Communication (25%): plain language, empathy, checks understanding, invites questions, avoids jargon and does not accuse. [1]
• Clinical content (30%): explains the asphyxial mechanism in plain terms, the rationale for the workup (imaging, bloods, observation), the role of the child-protection team, and why the child cannot be discharged; conveys that safeguarding is standard, not a verdict. [1]
• 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. [7]
• Safety and prevention (15%): delivers the safe-sleep ABCs, names the modifiable hazards, and offers written information and follow-up support; confirms the child remains in a safe place. [8]
• Professionalism and global (10%): maintains a calm, non-judgemental, collaborative stance; appropriate documentation and handover implied. [1]