Discuss a perplexing presentation with the safeguarding team — OSCE

Candidate instructions

You are the paediatric registrar. You have looked after a two-year-old admitted for the fourth time this year with apnoea that nobody on the ward has witnessed. Between his mother's reports he feeds, plays, and grows normally, and his objective findings are normal — yet his mother, a former enrolled nurse, is pressing for a central line and a gastrostomy. You suspect a perplexing presentation with fabricated-or-induced-illness alerting features. You have ten minutes with the designated doctor for child protection to present the case concisely and agree the plan. Establish the alerting features, the differential including a genuine rare disease, the immediate safety and observation plan, the multi-agency information-gathering, the sibling assessment, and what must not happen — never confronting the suspected caregiver alone. [1]