Paediatric consultation with child, young person and family — formative SAQs

SAQ 1 (10 marks)

A 14-year-old girl attends with her mother for recurrent abdominal pain. The mother does most of the talking; the girl answers in single words and glances at the floor. The referral mentions school absence. There is no acute medical emergency. ^[1]

1. Describe how you would structure this consultation using an adapted Calgary-Cambridge framework, and name the single most important step that is currently missing. (4) ^[2]
2. Outline how you would conduct the adolescent component of the encounter, including confidentiality and the psychosocial screen. (3) ^{[4] [5]}
3. Give a defensible safety-netting and closure plan for a child sent home from this consultation. (3) ^[1]

Model answer

Structure the encounter through Calgary-Cambridge: initiate by greeting both and setting the scene; gather information by observing the young person and eliciting her own account then the parental ideas, concerns and expectations; examine while engaging her; explain and plan in plain language with teach-back; and close with an explicit safety-net. The most important missing step is offering the adolescent time alone after a confidentiality framing — without it the school-absence driver will stay hidden. ^{[2] [1]}

For the adolescent component, state that the conversation is confidential and explain its limits (risk to self or others, abuse), then see the young person alone and run a HEEADSSS screen covering home, education, eating, activities, drugs, sexuality, suicide and depression, and safety. This surfaces school, mood and risk data a parent-present history will not. ^{[4] [5]}

Closure safety-net: document the specific warning signs to watch for (worsening pain, red flags, worsening mood or self-harm), the timeframe, and exactly where and when to return, then confirm understanding with teach-back and arrange named follow-up. ^[1]