Telephone call from a parent — bruises on a three-year-old

Candidates: do not open until you have consulted.

Persona and manner

• Kelly Marsh, 27. Two children: Alfie, 3, and Maisie, 6 months. You live with your partner Dean — Maisie’s father, not Alfie’s.
• Tired, guarded, speaking quietly: Dean is asleep upstairs after a night shift. You love your children. You are frightened of Dean’s temper and of social services.

Opening line — say this verbatim

• “Hiya. It’s about my little boy — he fell down the stairs the other day and he’s come up in bruises. I just wanted to check that’s normal. I can’t really bring him in.”

Volunteer freely if given the space

• It happened on Saturday, two days ago. You were bathing the baby; Dean was watching Alfie. You heard a bang and crying. Dean said he had slipped on the stairs.
• Alfie was a bit quiet afterwards but ate his tea. He seems all right now.

Only if asked

• Telephone checks: Alfie’s date of birth is 4 May 2023; you are at home; it is safe to ring this mobile until four o’clock.
• You did not see the fall.
• The bruises: both upper arms — “sort of round marks, like fingertips, on both arms”; several across his back; one on his bottom. You cannot explain the ones on his back. No new bruises on his shins or forehead.
• The ear: mention it only if asked about his head, face or ears, or “anywhere else at all?” — otherwise keep it until you are invited to add anything.
• Alfie now: playing, eating, walking normally. No vomiting, not drowsy, no fever, no rash or tiny red-purple spots, no nosebleeds or bleeding gums, not pale, not more tired than usual. He does not usually bruise easily. Nobody in the family has a bleeding problem.
• Why you did not call sooner: “Dean said he was fine and not to make a fuss.”
• The pulled elbow four months ago: “Dean was swinging him round.”
• Dean: drinks most nights and “has a temper”. If asked gently, and told why the doctor is asking: he has grabbed Alfie by the arms before when he would not stop crying. He has pushed you — once while you were holding the baby. You have never told anyone.
• Maisie: “She’s fine, I think. She cries a lot and it winds him up.”
• You missed the health visitor’s appointments. There is no social worker.
• Right now Dean is asleep; he leaves for work at six. You have no car.

Impact on daily life — home and family (only if asked)

• Alfie has become clingy, will not go upstairs on his own and flinches when Dean raises his voice.
• You are not sleeping. You have stopped seeing your mum because Dean does not like her.
• You do not feel safe in your own home, but the tenancy is in Dean’s name and you have nowhere else to go.

Ideas, concerns and expectations

• Idea: the bruises are from the fall — “kids bruise, don’t they?”
• Concerns: “Are you going to report me? Will they take my kids?” — and what Dean will do if he finds out you rang.
• Expectation: to be told the bruises are normal, and not to have to come in.

Cues to deliver, timed

• Minute 2: “I didn’t actually see it happen.” — then, quickly — “But Dean said he slipped.”
• Minute 4: “He’s got a temper, that’s all.”
• If asked abruptly “Is Dean hitting him?”: “No! Why would you say that?” — and say you should go. Stay on the line only if the doctor is kind.

If the doctor summarises and asks whether you want to add anything

• If the ear has not come up: a pause — “There’s a mark on his ear as well. It’s gone purple. I didn’t say because it looks bad.”
• If it has: “He grabbed him by the arms last month too.”

How to respond to the doctor

• If the doctor explains calmly that bruises in those places do not fit a fall, that Alfie needs to be examined by a children’s doctor today — to check he is not hurt more than it looks and to rule out medical causes of bruising — that they have to involve children’s social care so that Alfie and Maisie are safe, that you are not being accused, and that they want to help you too: you cry, then agree — “As long as Dean doesn’t find out it was me.” Your mum could drive you if someone rang her.
• If asked whether you and the children are safe right now: “He’s asleep. We’re okay till he wakes up about four.”
• If the doctor says “it’s probably just from the fall, keep an eye on it”: relieved — “Thanks, doctor” — and end the call.
• If the doctor threatens (“I’m calling the police”, “social services will take them”): panic — “Forget I rang” — and hang up.
• If the doctor promises to keep it secret: “So you won’t tell anyone? Promise?”

Do not

• Volunteer the fingertip pattern, the ear, Dean’s temper or that he has pushed you, unless asked or invited to add anything.
• Describe Alfie as unwell — he is not.

Domain marks — with the key facts that earn a 4 at this station

Examiner's overall judgement (standard-setting only — it does not decide your result): ☐ Unsatisfactory   ☐ Borderline   ☐ Satisfactory   ☐ Good

Marks are 1 to 4 in each domain; the generic descriptor for each mark is on the mark scheme page, and the structure of the eight minutes is on the 8-minute station page. The full standard for this case is in section 3 and the GMC feedback statements, with examples from this case, are in section 4.

The top row is the full picture of what a competent F2 could do at this station, including the working diagnosis with its justified differentials, the safety-net and the follow-up; lower rows describe how performance falls away. It is a debriefing aid, not a checklist to recite: nobody says every line in eight minutes, and a 4 is a judgement that the essentials — the italic key facts on the mark sheet — were done well, in plain language and at the patient’s pace. Acumen training standard — the GMC does not publish station mark sheets.

A feedback statement marks where underperformance was identified in the consultation. With PLAB 2 results the GMC may attach any combination of the ten statements to a station — none, one or several. The right-hand column shows what each one looks like at this station. Record the statements that applied in the practice log.

Points of fact the examiner should have to hand

1. NICE CG89: suspect maltreatment when bruising is in the shape of a hand, grip, ligature, stick or implement, or when there are bruises in a child who is not independently mobile, multiple bruises or clusters, bruises of similar shape and size, or bruises on non-bony parts of the body or face — including the eyes, ears and buttocks — without a suitable explanation. “Suspect” means refer to children’s social care.
2. Accidental bruises in mobile toddlers are typically over bony prominences at the front of the body — shins, knees, forehead. Bruising to the torso, ears, neck, cheeks, buttocks and upper arms is not (the “TEN-4-FACESp” rule in under-fours: Torso, Ears, Neck; Frenulum, Angle of jaw, Cheeks, Eyelids, Subconjunctivae; any patterned bruise; and any bruise at all in a baby under five months).
3. Bruises cannot be aged from their colour (RCPCH child protection evidence review). Describe site, size, shape and number; do not write “bruises of different ages”.
4. Medical differentials must be excluded, not assumed: ITP, leukaemia, inherited clotting disorders, IgA vasculitis, meningococcal disease, and congenital dermal melanocytosis (formerly called “Mongolian blue spots”). A child protection medical includes a full blood count, film and clotting studies.
5. A non-mobile baby in the same household is at particular risk. “Those who don’t cruise rarely bruise.”
6. GMC, Protecting children and young people: you must tell an appropriate agency promptly if you are concerned a child is at risk of, or suffering, abuse or neglect. Ask for consent to share information unless that would increase the risk or cause delay; you can share without consent when it is justified to protect a child. Tell parents what you are doing unless that would put the child at greater risk.
7. In England the framework is Working Together to Safeguard Children (2026): telephone referral to the local authority children’s social care team the same day, confirmed in writing; 999 if a child is in immediate danger. An F2 never manages this alone — the supervising GP and safeguarding lead are told at once.
8. The mother is also a victim. Children who see, hear or experience the effects of domestic abuse are victims in their own right (Domestic Abuse Act 2021). Ask whether it is safe to talk and agree a safe way to call back.
9. Record the call verbatim, with times, and who said what. Do not ask the child leading questions.

Where candidates lose marks at this station

• “Kids bruise — keep an eye on it.”
• Promising to keep the call confidential.
• Forgetting the six-month-old baby.
• Writing “bruises of different ages”.
• Frightening her off the line before there is a plan.

Guidelines for this station

• NICE CG89 — Child maltreatment: when to suspect maltreatment in under 18s
• NICE NG76 — Child abuse and neglect
• GMC — Protecting children and young people: the responsibilities of all doctors
• RCPCH — Child protection evidence: bruising
• GOV.UK — Working Together to Safeguard Children

Record your three domain marks, your station total, the GMC feedback statements that applied (where underperformance was identified), and what you will keep and change. The form is already labelled with this case and its web address; a copy of your entry is emailed to you, so your practice log builds up in your inbox and can be downloaded.

Record my marks and reflection for P2-06