Sim Library: Communication 2: Child Protection History Taking

Theme: History Taking / Child Protection
Suitable for: F1/F2; Junior paediatric trainee (ST1-3); GP trainee
Clinical scenario: Two month old baby who was brought in not moving his leg.

X-ray shows there is a spiral fracture of the femur.

Information for candidate: Two month old baby with a spiral fracture of the femur. The X-ray was ordered by the nurse at triage – the parent does not know the result yet (and you are not expected to communicate it as your senior will be down soon). You are asked to go and take a history from the parent.
Information for actor: You are the parent of Mason, a two month old baby who you have brought to A&E as he is not moving his right leg.

You are reluctant to talk to the doctor – you can be rude and uncommunicative. The following details should only be volunteered if you are specifically asked:

You noticed something was wrong this morning as Mason was crying a lot whenever you picked him up. You were not with him last night as you were out with friends – your partner was looking after him. You have been with this man for five months.

Your partner said to you that the baby rolled off the bed and onto the floor last night while you were out, but seemed ok at the time so wasn’t worried.

Your partner is not Mason’s father. Mason’s father is not in contact with you as he was arrested for domestic violence and you spent some time in a women’s shelter after this.

You have a social worker and were in foster care yourself as a teenager. You also have a two year old, Emma, from a previous relationship. She is being looked after by your current partner at home at the moment.

The other adults who sometimes look after the children are your mother and stepfather, but they have not had any contact with the children in the last 24 hours. Emma also sometimes goes to nursery school.

Other history – Mason was born at term and kept in for three days on antibiotics, you are not sure why. He is not on any medicines, has no allergies, and has missed his first lot of vaccinations. He has had one other hospital admission overnight for bronchiolitis. He is developing normally, he smiles and wriggles around on the bed but has not learnt to roll.

Information for scenario lead: Terminate the scenario when the candidate has finished taking the history.
Possible points for discussion in debrief: History taking in child protection – what details are important/essential:

Timeline, mechanism of injury (does it make sense), baby’s developmental stage, who has had contact with baby, social services involvement, location / safety of other children

Do not forget full paediatric history!

Communicating with a parent who is hostile / uncommunicative

Body language, choice of words

Negotiation of difficult conversation and escalation to senior

Communicating to senior – what are your concerns?

Examination – what would you be looking for on examination?

Body maps?

Clinical discussion – what will happen to the baby next? What investigations need doing?

The clinical details of this simulation scenario are not based on any one particular case. Similarity to any real life clinical scenario or child is purely coincidental.