Responding to a distressed child in the ED — OSCE

Station brief (8–10 minutes)

A five-year-old needs a cannula for antibiotics in the ED. The child is hypervigilant and recoils from staff. The family has recently experienced domestic violence. Apply a trauma-informed approach to the procedure and the encounter. Address the child's distress and arrange appropriate follow-up. Do not invent local statutory wording. [10] [11]

Tasks for the candidate

1. Recognise the child's hypervigilance as a stress response and modify your approach accordingly. [11]
2. Apply the SAMHSA principles of safety, choice, collaboration and empowerment to the procedure. [10] [11]
3. Use trauma-informed procedural techniques: topical anaesthesia, comfort positioning, distraction, clear explanation. [11]
4. Identify and strengthen the buffering relationship (the mother) and connect the family to supports. [13] [10]
5. Arrange appropriate follow-up and recognise safeguarding obligations. [10]

Expected performance

Must hit. Recognises the child's behaviour as a stress response, not defiance; pauses and lowers the sensory load; uses comfort positioning on the parent's lap rather than restraint; applies topical anaesthesia and distraction; explains each step and offers choice; identifies the mother as the buffering relationship and connects the family to social work; uses a trained interpreter; recognises the safeguarding obligation. [10] [11]

Merit. Names the SAMHSA framework explicitly; distinguishes TIC from trauma-focused therapy; addresses vicarious trauma risk in staff; describes the toxic-stress mechanism linking ACEs to lifelong disease. [10] [13]

Fail. Forces the cannula through restraint while the child is hypervigilant; ignores the stress response; uses the child or a family member as interpreter; fails to recognise the safeguarding obligation; leaves the family with no follow-up or support pathway. [10] [11]

Sample candidate structure

"I can see that [child] is very frightened right now, and I want to change how we do this so it feels safer. First, I would bring mum close and let [child] sit on her lap — we call that comfort positioning, and it is very different from holding a child down. I would put on some numbing cream so the cannula does not hurt as much, and we can use a video or a toy to distract. I will explain every step before I do it, and [child] can tell me when they are ready. If at any point it is not working, we stop and try again — we are not going to force this." [10] [11] [13]