Paediatric consultation with child, young person and family — formative SAQs

SAQ 1 (10 marks)

A 14-year-old girl attends with her mother for recurrent abdominal pain. The mother does most of the talking; the girl answers in single words and glances at the floor. The referral mentions school absence. There is no acute medical emergency. [1]

1. Describe how you would structure this consultation using an adapted Calgary-Cambridge framework, and name the single most important step that is currently missing. (4) [2]
2. Outline how you would conduct the adolescent component of the encounter, including confidentiality and the psychosocial screen. (3) [4] [5]
3. Give a defensible safety-netting and closure plan for a child sent home from this consultation. (3) [1]

Model answer

Structure the encounter through Calgary-Cambridge: initiate by greeting both and setting the scene; gather information by observing the young person and eliciting her own account then the parental ideas, concerns and expectations; examine while engaging her; explain and plan in plain language with teach-back; and close with an explicit safety-net. The most important missing step is offering the adolescent time alone after a confidentiality framing — without it the school-absence driver will stay hidden. [2] [1]

For the adolescent component, state that the conversation is confidential and explain its limits (risk to self or others, abuse), then see the young person alone and run a HEEADSSS screen covering home, education, eating, activities, drugs, sexuality, suicide and depression, and safety. This surfaces school, mood and risk data a parent-present history will not. [4] [5]

Closure safety-net: document the specific warning signs to watch for (worsening pain, red flags, worsening mood or self-harm), the timeframe, and exactly where and when to return, then confirm understanding with teach-back and arrange named follow-up. [1]

SAQ 2 (10 marks)

A 6-year-old boy is referred with a new mediastinal mass. His parents have been told privately that lymphoma is likely and ask you to tell the child "only good news." You are the consultant seeing the family together. [3]

1. Using the SPIKES protocol adapted for children, outline how you would deliver and discuss this diagnosis with the family. (5) [3]
2. Explain how you would address the parents' request to withhold difficult information, balancing truth-telling, the child's developmental stage and parental authority. (3) [1]
3. Name two consultation pitfalls specific to this scenario and how you would avoid them. (2) [1] [3]

Model answer

Apply SPIKES: set the stage in a private space with both parents and the child; assess perception by asking what the child and family already understand; obtain an invitation for how much detail they want; give knowledge in small, honest, developmentally-appropriate pieces; respond to emotions with silence and acknowledgement; and close with a strategy and summary, keeping the dialogue open over time. Tell the truth in words the child can hold rather than one devastating disclosure. [3]

Address the request by acknowledging the parents' protective instinct, then explain that children usually sense seriousness and that concealment erodes trust and cooperation with treatment. Negotiate a truthful, staged approach at the child's level, respecting parental partnership without agreeing to deception. [1]

Pitfalls: giving a single overwhelming disclosure rather than staged truth; and excluding the child from the conversation so he learns to fear rather than trust. Avoid both by small honest chunks, checking understanding, and keeping the child included at his developmental level. [1] [3]