Developmentally appropriate communication — formative SAQs

SAQ 1 — Preschooler, pain drawing and procedural preparation (10 marks)

A 4-year-old presents with ear pain and fever. The caregiver says the child "won't let anyone look." You need to examine the ears and explain an oral antibiotic plan. [1]

Questions

1. How do you set the environment and engage this preschooler developmentally before examination? (4 marks) [1] [9]
2. Describe how you ask about pain without leading questions, and how you explain the examination honestly. (3 marks) [1]
3. Outline a teach-back and age-appropriate safety-net for the discharge plan. (3 marks) [5]

Model answer

Engagement (4). Sit at eye level. Reduce noise and crowding. Offer toys, drawing materials and a teddy. Greet the child first, then the caregiver. Use parallel play and a teddy-bear examination to model what you will do. Use short, concrete, honest sentences. Avoid jargon and baby talk. Match register to preoperational concrete thinking. [1] [9]

Pain without leading questions (3). Ask the child to point or draw where it hurts. Use open prompts ("Tell me about your ear") and accept "I don't know." Do not ask "Does it hurt here?" repeatedly, because suggestible preschoolers will endorse. Explain the otoscope honestly: "I have a little light to look in your ear — it might feel cool." [1]

Teach-back and safety-net (3). Explain the antibiotic plan in plain language. Ask the caregiver to restate the dose, route and duration in their own words — teach-back as dialogue. Safety-net in concrete, time-bounded language: return if breathing harder, drowsy, drinking less, rash, or pain worse despite antipyretic; give a clear return pathway. [5]

SAQ 2 — Non-verbal child, behavioural pain and adolescent confidentiality (10 marks)

A 10-year-old with severe cerebral palsy and no spoken language is brought in grunting and arching. In the next bay, a 15-year-old asks to speak alone about low mood. [13] [1]

Questions

1. How do you assess pain in the non-verbal child and communicate the plan to the family? (5 marks) [13]
2. How do you open confidential adolescent time, state limits of confidentiality, and use HEADSS or SSHADESS? (5 marks) [1] [2]

Model answer

Non-verbal pain (5). Read behaviour as communication: arching, grimacing, groaning, reduced interaction. Use a validated behavioural pain tool such as the revised-FLACC scale matched to cognitive impairment. Integrate caregiver expertise on baseline and usual pain cues. Treat the pain you find. Communicate the plan using plain language, the preferred channel, and a professional interpreter if language is discordant. Never assume "that is just his baseline" without measuring. [13]

Confidential adolescent interview (5). Explain why private time helps care. State limits of confidentiality before sensitive questions: ordinary private information stays private unless there is risk of serious harm to the young person or someone else, or another mandatory duty applies. Invite the caregiver out respectfully. Use HEADSS or SSHADESS as a rapport scaffold — strengths and school before substances, emotions, sexuality and safety. Prefer open questions and reflections. If imminent self-harm is disclosed, act on safety, share only what duty requires, never promise absolute secrecy. [1] [2]