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Paeds Casesprofessional-practice-and-evidence

Paeds Cases · professional-practice-and-evidence

Consent, parental responsibility and mature-minor frameworks — OSCE

OSCE station: obtaining parental permission and child assent for a lumbar puncture in a school-age child, managing dissent and disagreement.

osce communication and management station2 min readVerification in progress

Target exams

MRCPCH ClinicalRACP DCERCPSC Pediatrics
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Study tools

Target exams

MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
A 6-year-old with suspected meningitis needs a lumbar puncture; the mother consents, the father phones to refuse, and the child is frightened and pulling away.

Objectives

  1. Confirm who holds parental responsibility and how to weigh conflicting parental views for an urgent decision. [1]
  2. Seek age-appropriate assent and manage dissent in a frightened school-age child. [2] [12]
  3. Disclose material risks, benefits and alternatives in plain language with teach-back. [1]
  4. Apply the emergency principle and escalate appropriately if disagreement threatens the child. [1] [9]
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References5ShowHide
  1. [1]COMMITTEE ON BIOETHICS Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456514
  2. [2]Katz AL, Webb SA Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456510
  3. [3]Appelbaum PS, Grisso T Assessing patients' capacities to consent to treatment. N Engl J Med, 1988.PMID 3200278
  4. [9]Diekema DS Revisiting the best interest standard: uses and misuses. J Clin Ethics, 2011.PMID 21837884
  5. [12]Levetown M Communicating with children and families: from everyday interactions to skill in conveying distressing information. Pediatrics, 2008.PMID 18450887
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