Paediatric history and age-adapted consultation — formative SAQs

SAQ 1 — Febrile toddler with caregiver concern (10 marks)

A 22-month-old is brought to the emergency department with fever. The caregiver says, “He is not himself.” Initial observations are only mildly abnormal. [10]

Questions

1. Structure an age-adapted history for this encounter, including historians, key domains and how you protect observation while you talk. (4 marks) [2] [13]
2. Explain how you would use caregiver concern in your problem representation and immediate plan. (3 marks) [10]
3. Outline teach-back and safety-net content before discharge if the child improves and a period of community observation is judged safe. (3 marks) [7] [11]

Model answer

History structure (4). Multi-party greeting; child first if possible, then caregiver. Note reliability of historians. Parallel observation of appearance, work of breathing and interaction while taking history. Domains: timeline of fever and behaviour change; intake and wet nappies; rash, breathing, seizures; immunisations; past history; medications and antipyretic dosing; social supports and ability to re-present; what has already been tried; caregiver’s exact concern. Avoid leading questions. Use professional interpreter if language discordant. [5] [10]

Caregiver concern (3). Treat “not himself” as high-value data associated with critical illness risk in prospective work. Put baseline change into the one-sentence problem representation. Do not close early because first numbers look mild. Escalate assessment and observation threshold accordingly. [10]

Teach-back and safety-net (3). Explain working impression and plan in plain language. Ask caregiver to restate in their own words; correct gaps. Safety-net: specific red flags (breathing harder, fewer wet nappies, non-rousable, non-blanching rash, caregiver still worried), when to return, how to access care overnight, and time for planned review if appropriate. Provide written instructions when possible. [7] [11]

SAQ 2 — Adolescent confidential interview (10 marks)

A 16-year-old is seen for recurrent abdominal pain. You suspect a mixed biomedical and psychosocial agenda. [1] [2]

Questions

1. How do you open confidential time and explain limits of confidentiality? (3 marks) [2] [3]
2. Map HEADSS or SSHADESS onto this consultation without turning it into an interrogation. (4 marks) [1]
3. What do you do if the young person discloses active suicidal intent with a plan? (3 marks) [3] [15]

Model answer

Opening confidential time (3). Explain why private time helps care. State limits before sensitive questions: ordinary private information stays private, but serious risk of harm to self or others, or other mandatory duties, require sharing. Invite caregiver out respectfully and agree how you will regroup. [1] [2] [3]

HEADSS/SSHADESS (4). Use as a scaffold. Start with less sensitive domains (home, school/strengths, activities), then substances, emotions/eating/depression, sexuality and safety. Prefer open questions and reflections. SSHADESS explicitly includes strengths and school. Do not machine-gun questions. Link findings to the abdominal pain agenda and follow-up. [1] [2]

Suicidal intent (3). Take it seriously. Ensure immediate safety. Do not promise secrecy. Involve appropriate senior, mental-health and caregiver supports according to local pathway and harm-prevention duties. Document and hand over clearly. [2] [3] [15]