Procedural consent, preparation and child-life support — branching viva

Opening (warm-up)

Examiner: A four-year-old needs intravenous cannulation for antibiotics on the ward. The team plans to hold her down. Walk me through your approach. ^[1]

Candidate: Before any needle, I run a four-question bedside assessment — who decides, what the child understands, what her current state is, and whether this procedure is right for her now. For consent, I take parental permission from the person with parental responsibility and layer in developmentally appropriate assent from the four-year-old, using the AAP consent-permission-assent framework; I document the basis on which I am acting. For preparation, because she is a preschool child, I prepare 30 to 60 minutes before with play and a simple, honest, concrete sequence — I show the equipment on a doll, use short concrete words like squeeze and cold, never say it will not hurt, and offer a real choice only where one genuinely exists. I would not hold her down: that is restraint, not a comfort position, and for a non-emergency procedure the least-restrictive alternative is the right approach. ^{[1] [3]}