Paediatric training panels test child protection because every paediatric registrar will face it, usually at night, usually with a family who are frightened or angry, and usually with a decision that cannot wait. The scenarios recur, the structure that scores is consistent, and the law differs by state in ways the panel expects you to know. This guide covers all three.
The scenarios
- A toddler has bruises of different ages and the parents' account does not fit.
- Parents refuse a blood transfusion for their child on religious grounds.
- Parents want to take their child home against advice.
- A child discloses something at the bedside that worries you.
- A mother with a baby appears intoxicated.
- A fifteen year old wants contraception and does not want her parents told.
The structure
The child first. Is the child safe now and does the child need treatment? The bruised toddler needs a full examination; the child needing a transfusion needs it.
Gather information without accusing. A careful history of how the injury happened, from each parent separately where possible, and a full examination documented in detail with a body map. Your role is to notice and record, not to investigate or confront. Say that you would not tell the parents you suspect abuse; you would tell them the injuries need to be looked into, which is routine when the explanation does not fit.
Involve the senior and the child protection team early. The consultant, the hospital's child protection unit or team, the social worker. Before the family leaves.
Know the law. Every state and territory has mandatory reporting for doctors, with differences in the threshold and the categories of harm covered. Know your state's: who must report, what must be reported, to whom, and the protection for reporters. Say that you would make the report and that it is a legal obligation rather than a judgement.
The investigations. The skeletal survey, the bloods, the ophthalmology review, the imaging, and the fact that the child may need to stay in hospital while they happen. Say that the child protection team coordinates this and that you would explain it to the parents honestly.
Communicate with the parents. Honestly and without accusation. They are often not the perpetrators, and even when they are, the child's safety depends on the family staying engaged.
Document and hand over. Everything, contemporaneously, factually.
The refused transfusion
The child's interests come first. Explore the refusal with respect, explain the risks plainly, offer alternatives where they exist, involve the consultant and the hospital's legal team early, and know that where a treatment is life saving and the parents refuse, the court can authorise it and in a genuine emergency the doctors act to save the child's life and justify it afterwards. Say that the parents are not acting from malice and that you would keep them involved throughout.
Leaving against advice
Assess whether the parents can consent for the child, find out why they want to go, address what you can, explain the risks, involve the senior, and if the child is at risk and they still insist, know that the child protection team and the state's child protection authority can act to keep the child safe. Most of these resolve with listening and a senior conversation; say that first.
The teenager
Assess her capacity to consent, explain confidentiality and its limits, encourage a trusted adult, and involve the child protection team if there is any concern about the age or nature of the relationship, coercion or exploitation. Know your state's age of consent and the rules on treating minors without parental consent. Say that you would discuss it with the consultant.
The intoxicated mother
The baby's safety now: the baby does not go home with a parent who cannot care for them safely. Then the mother: not a criminal, and possibly in need of help herself. The social worker, the child protection team, the other family members, and the mandatory report if the threshold is met.
What the panels score
The child kept safe throughout, information gathered without confrontation, early involvement of the right people, accurate knowledge of your state's obligations, honest communication with the parents, and documentation. The common failures are confronting the parents, discharging the child, and not knowing who the child protection team are or what the law requires.
Preparing
Learn your state's mandatory reporting law and the hospital's child protection pathway. Talk each scenario through aloud with the next step ready for "and if they refuse?" and "what would you say to the mother?". The follow ups are where the marks sit.