Cough and falling weight in a three-year-old
AMC Clinical practice station

The task

You are a doctor in a general practice. Ms Jade Mitchell has brought her three-year-old son Mason because of a cough for three days. The practice nurse recorded his weight before the visit and has told you he has dropped across the centile lines on his growth chart since you last saw him. Mason is playing with the practice nurse in the next room. Take a focused history from Ms Mitchell, discuss your concerns with her and explain what will happen next. Examination findings will be given on request. The examiner will not take part.

What this station tests

• Ask about immediate safety for the child and parent, including family violence, before anything else.
• Be honest about reporting duties in general terms, note that rules vary by state and territory, and never promise secrecy.
• Neglect often sits with poverty, violence and parental illness; offer support alongside reporting.
• Plot growth and exclude medical causes, but do not delay the safety response for test results.
• Record observations and the parent's own words objectively, and seek senior and legal advice.

Sources for the clinical content

• Australian Institute of Family Studies: Mandatory reporting of child abuse and neglect
• Royal Children’s Hospital Melbourne: Child abuse clinical practice guideline
• 1800RESPECT: National domestic, family and sexual violence support
• Medical Board of Australia: Good medical practice, a code of conduct for doctors in Australia

An original practice scenario with invented patients. Not an exam question.

Practise next

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• A teenager asks about the pill on her own
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