Case study example
Case: Patient presenting to acute paediatrics with incidental finding of obesity
Setting: General paediatric on-call
How did the opportunity arise?
You are the paediatric ST4 working the night shift at a busy district general hospital. Your FY2 (foundation year) colleague has just seen a six week old with difficulty breathing. During the examination she notices a bruise on the cheek and asks your advice on further management.
As the senior clinician on duty you need to recognise that this finding may well represent non-accidental injury, especially in a non-mobile infant. You need to speak to the parents yourself to ask about the bruise, examine the child fully and document your findings on body maps.
You need to liaise with children’s social care, the safeguarding named nurse and doctor and admit the child for further investigation and speak to the family about the plan. You should also phone and speak to the consultant on call so they are aware of this child and can offer advice on any other immediate management.
How did this support your development?
This situation is not uncommon in paediatrics and can often feel daunting. Being up front with families about the management plan and the reasons further investigations are required can help foster good relationships with them.
This is a situation that demands a multi-professional approach as the observations of all staff looking after this child will be very important. It is also important to make the time to discuss the case with your FY2 and given them a chance to debrief as this may be the first time they have been in this situation.
Any practical tips?
Utilise your hospital’s safeguarding team (named nurse and doctor for child safeguarding) who have vast experience in these kinds of situations and will be able to offer you advice and support.
Make sure you document your findings clearly during or immediately after your consultation, including using body maps. You may have to write a statement, and it is much easier with detailed contemporaneous notes.