Symptom control in serious paediatric illness — branching viva

Opening

Examiner: A 7-year-old boy with a progressive brainstem glioma is on your ward. He is breathless, in pain, and frightened, and his parents are frightened too. Take me through how you assess and treat his symptoms. ^[1]

Candidate (model answer): I start with the goals of care. I sit with the parents, confirm the trajectory and what they and he are hoping for, and frame the plan around that. Then I assess each symptom. For pain I use a validated tool by age — a numeric or faces scale here, and behavioural tools (FLACC, revised-FLACC, the Paediatric Pain Profile) in the non-verbal child. For breathlessness I look at the work of breathing, the single-breath count and the anxiety, and remember the oxygen saturation measures oxygenation, not the suffering of breathing. I treat the pain and the breathlessness in parallel, and I look for reversible causes in parallel — a pleural effusion, a pneumothorax, severe anaemia — that might bend to disease-directed treatment rather than comfort opioids alone. ^{[1] [9]}