Recognising and responding to a sentinel injury — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar. A 3-month-old infant has been brought to the emergency department by the mother with a small bruise on the ear and a small bruise over the cheek, attributed to a feed-bottle knock. The infant, who does not yet roll, is alert and well. Your colleague was about to discharge the family. ^[8]

Your tasks are: ^[8]

1. Recognise the presentation as a sentinel injury and explain, to the mother, why you are concerned — in plain, non-accusatory language. ^[8]
2. Outline the plan you will run (examination, body map and photographs, a skeletal survey and a blood test, involving the child-protection team and a report to child protection) and why these happen now rather than later. ^{[9] [2]}
3. Respond to the mother's likely distress, anger and fear, using a trauma-informed, child-centred stance. ^[2]

You are not expected to confront or accuse the mother, nor to disclose suspicions of a specific perpetrator. ^[2]