Kai Phosis
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You are an F1 doctor in A&E and have been asked to see a 3 year old boy with burns on his anterior thigh. He’s here with his mother and older sister. You see from the notes that he has only recently moved to the area.
Take a full history from Kai’s mother, Helen, and perform the appropriate examination. You will then be asked to present to the examiner for discussion.
You are Helen, Kai’s mother. Kai is a fun-loving little boy and has never been any bother, apart from being clumsy now and again. He is so enthusiastic and always gets a little bit ahead of himself when playing, alone or with friends. He’s like his dad!
HPC: Earlier today Kai was playing in your room and grabbed the plastic cable for the hair straighteners which you had recently used. They fell onto him and he had burnt his skin before you managed to get to him. You were in the next room and heard his cries. You wrapped his leg in cling film, gave him some calpol and brought him to hospital. You got a lift here from your boyfriend.
He has been crying since the incident, but seems otherwise well. You haven’t noticed any fevers, bleeding, loss of consciousness or any other symptom apart from pain.
Paeds history: Your pregnancy with Kai was uncomplicated- you gave birth by caesarean section at 37 weeks because you had a C-section with his older sister Nina due to failure to progress. He was a healthy baby. He eats 3 meals a day with his sister and snacks if he’s hungry between. He is mostly toilet trained but continues to have some accidents and has done so whilst at A&E.
He is a very outgoing child and can name objects and say a few names. He’s been to hospital a couple of times before for other bumps and scrapes. You did say he was clumsy! Otherwise, he is fit and well if a little on the small side. Ky and Nina both had chicken pox last year.
He is up to date on vaccinations and takes no other medication, has no allergies you know of.
Your mother and sister have both had ovarian cancer but nothing else runs in the family. At home, its just the three of you, and your boyfriend sometimes comes over. You are unemployed and the kids’ father is no longer around, so things are financially stressful. Kai doesn’t really see his dad any more.
You see your family occasionally but are not close. You smoke, but only in the garden. There has been no social services involvement with your family, though it was offered as Kai’s dad could be violent at times. Kai doesn’t go to nursery or playgroup and you mostly both stay in the house while Nina is at school.
You are not too worried as Kai’s leg isn’t bleeding or anything, and are expecting some cream to sort it out and take him home.
The student should take a thorough history regarding the incident, in addition to assessing for risk of abuse in this child. The candidate should present the case back to you with a plan of action which should include some consultation with the safeguarding team.
A reasonable differential diagnosis may include discussion of risk factors of a non-specifically violent father, though no immediate risk to Kai is present. The wound is a superficial burn.
Topics for discussion may include:
– Name some social risk factors for non-accidental injury/child abuse? – What types of child abuse exist? - What is written on a safeguarding report? – Who would be involved if you had concerns about non-accidental injury? - How would this wound be treated acutely?
