Poor feeding OSCE — neonate triage and preschool feeding plan

Station A — Day-6 neonate (10 minutes)

Candidate task: Take a focused history from the caregiver, state bedside priorities, give a problem representation and outline immediate management. ^{[26] [5]}

Actor script (caregiver)

• Baby 6 days old, born term, home day 2. ^[26]
• Breastfeeding was “okay,” then last 18 hours much less interested. ^[5]
• Only three wet nappies since yesterday. ^[5]
• Sleepier, harder to rouse for feeds. ^[26]
• No cough, no bilious vomit reported. ^[5]
• Parent is scared and asks if this is “just breastfeeding establishing.” ^[26]

Expected candidate performance

1. Greets, checks urgency, does not normalise lethargy. ^[26]
2. Focused history: volumes/minutes, wet nappies, colour, tone, temperature, breathing, pregnancy/GBS/risk factors, prior weights. ^[5]
3. States ABCDE + glucose + sepsis pathway thinking before long technique advice. ^{[26] [25]}
4. One-sentence problem representation with threat-led differentials. ^[5]
5. Clear plan: observations, glucose, septic work-up/treatment per local pathway, admission, parent explanation without blame. ^[26]

Examiner prompts

• “Would you send them home if the first saturation is normal?” ^[26]
• “Where does tongue-tie sit in this presentation?” ^[5]

Marking anchors

• Pass: Threat-first plan, glucose/sepsis addressed, no premature discharge reassurance. ^{[26] [25]}
• Borderline: Mentions sepsis late after lengthy latch lecture. ^[26]
• Fail: Reassures “normal establishing breastfeeding” and discharges the lethargic neonate. ^[26]