Sim Library: Communication 3: Child Protection / Angry Parent

Theme: Breaking bad news / Child Protection
Suitable for: Paediatric trainee (ST3+)
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: The X-ray was ordered by the nurse at triage and shows a spiral fracture. Your SHO has taken a history – the partner (not baby’s father) was looking after the baby last night and said the baby rolled off the bed. The family is known to social services.

You are asked to communicate the results of the X-ray and tell the mother what will happen next.

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 obstructive. You are very upset about the fracture.

You do not want to stay in hospital and do not want any more social services involvement. The following details can be volunteered if you are asked:

You noticed something was wrong this morning as Mason was crying when 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 spent some time 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.

There are no known musculoskeletal problems in the family.

Information for scenario lead: Terminate the scenario when a resolution has been reached or the candidate asks for senior involvement.
Possible points for discussion in debrief: Breaking bad news

Communicating with a parent who is hostile / obstructive

Body language, choice of words

Negotiation of difficult conversation

Clinical discussion – what needs to be done immediately for the baby?

What is the procedure for investigating possible NAI?

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.