Paediatric history and age-adapted consultation — branching viva

Stem

You are in a mixed acute paediatric setting. The examiner will move you through history technique, ethics and disposition. [2] [14]

Branch 1 — Opening and structure

Examiner: How do you open a paediatric consultation differently from an adult clinic visit? [2]

Strong answer: Multi-party encounter. Greet the child first when development allows. Set agenda with child and caregiver. Keep observing the child while gathering history. Adapt depth to purpose and acuity. [2] [14]

Examiner: Give me your history spine. [1] [13]

Strong answer: Identity and reliability; PC/HPI; systems; past medical/surgical; perinatal; development/growth/nutrition; medicines/allergies/immunisations; family; social/school; adolescent confidential screen when indicated; ICE; one-sentence problem representation. [1] [13]

Branch 2 — Toddler fever

Examiner: Mother says the toddler is not himself. Observations are only mildly abnormal. What now? [10]

Strong answer: Caregiver concern is clinically important and associated with critical illness risk. Put baseline change in the problem representation. Continue focused history on intake, urine output, lethargy, rash, breathing and prior presentations. Do not close early. [10]

Branch 3 — Language access

Examiner: Father offers that the 9-year-old sibling will translate. [5]

Strong answer: Decline child interpreting for clinical content. Use a professional interpreter. Evidence supports professional interpreters for hospitalised children with limited English proficiency and for paediatric ED discharge communication. [5] [6]

Branch 4 — Adolescent confidentiality

Examiner: How do you start HEADSS? [1] [2]

Strong answer: Private time first. Explain limits of confidentiality before sensitive questions. Use HEADSS or SSHADESS as a rapport scaffold, often strengths and school before higher-sensitivity domains. [1] [2]

Examiner: She discloses a plan for suicide tonight. [3] [15]

Strong answer: Safety first. Confidentiality yields to serious harm prevention and mandatory duties. Senior help, safe environment, appropriate information sharing, clear handover. No absolute secrecy promise. [3] [15]

Branch 5 — Close and handoff

Examiner: The toddler improves and may go home. Close the consultation. [7] [11]

Strong answer: Plain-language plan, teach-back, concrete red flags, when and how to return, written materials if possible, document source attribution and uncertainty. Structured communication prevents error at handoff and discharge. [7] [11] [12]

Examiner extras

• Permission vs assent vs consent. [3] [4]
• Trauma-informed injury history without humiliation. [15] [16]
• Medical complexity baseline question: what is different from usual? [13]