Assess a child's pain across developmental and cognitive ability — OSCE

Candidate instructions

You are the paediatric registrar on the ward. A nine-year-old boy with severe cerebral palsy is on day one after posterior spinal fusion. He is non-verbal, documented as "settled," but his mother says he is "not right," grimacing and arching intermittently. You have 8 minutes to assess his pain, choose and apply the correct validated tool, involve the mother, set the reassessment and documentation plan, and explain how the plan changes if he is admitted to the PICU and requires neuromuscular blockade. ^[6]

The four tasks are: explain why the generic behavioural approach is unsuitable for this child and which validated tool you use instead; involve the mother as the expert on this child's baseline pain behaviour and explain what baseline change means; set the reassessment and documentation plan that protects him across the postoperative course; and explain how the plan changes if he is intubated and paralysed in the PICU. ^{[6] [10]}

You may use the mother as the simulated participant. You do not need to prescribe the analgesic regimen in detail, but you must link each score to a documented analgesic decision and a reassessment. ^[9]