MRCPCH Recall: 3 years old child came with his brothers 6 years old, and 6 months old, his elder brother has URTI, he impacted his head on his parent bed, refuse paracetamol offered by his mother, he has zygomatic bruising(2.5cm), last year he had head trauma while he was climbing his bed, yellowish brownish secretion from his nose and coryzal signs, safe guard register checked and the family not known to social service. What is the best action to be done?
MRCPCH Recall: 3 years old child came with his brothers 6 years old, and 6 months old, his elder brother has URTI, he impacted his head on his parent bed, refuse paracetamol offered by his mother, he has zygomatic bruising(2.5cm), last year he had head trauma while he was climbing his bed, yellowish brownish secretion from his nose and coryzal signs, safe guard register checked and the family not known to social service. What is the best action to be done?
A. Ask to examine other brothers
B. Discharge to follow up in the pediatric OPD
C. Discharge and plan for health visitor
D. Admit, coagulation profile and skeletal survey
E. Refer to social services
Rewiew ExplanationAns- D
Explanation
Important Context
- Child: 3 years old, with two siblings (6 years and 6 months old)
- Presentation:
- Zygomatic bruising (2.5 cm) after hitting head on bed
- Refused paracetamol
- Yellow-brown nasal discharge and coryzal signs (suggestive of URTI)
- History: Previous head trauma last year while climbing bed
- Family: Not known to social services, safeguarding register checked
- Concern: Recurrent injuries in a young child, facial bruising, and siblings present
Reasoning
- Facial bruising in a young child — especially over the zygomatic area — is a red flag for possible non-accidental injury (NAI), particularly if the history is inconsistent or there are repeated injuries.
- Recurrent trauma in a child under 5 should always raise suspicion, even if there is a plausible explanation.
- Safeguarding principle: If there is any suspicion of abuse, the priority is to ensure the child’s safety and assess risk to siblings.
- Guidelines:
- Examine siblings for signs of injury.
- Consider full safeguarding assessment.
- Involve social services early.
- Hospital admission may be needed for further investigation (skeletal survey, coagulation profile) if abuse is suspected.
Option Analysis
| Option | Comment |
| A. Ask to examine other brothers | This is part of safeguarding, but on its own is insufficient — you must also escalate to social services. |
| B. Discharge to follow up in OPD | Unsafe — risk of harm if abuse is ongoing. |
| C. Discharge and plan for health visitor | Too low-level for the risk profile. |
| D. Admit, coagulation profile and skeletal survey | Appropriate if there is suspicion of NAI — allows thorough assessment and protection. |
| E. Refer to social services | Essential step in safeguarding — but in this acute setting, admission for investigation is also indicated. |
Best Answer
✅ D. Admit, coagulation profile and skeletal survey
Why?
- Admission ensures the child is in a safe environment while investigations are done.
- Skeletal survey and coagulation profile help differentiate between inflicted injury and medical causes (e.g., bleeding disorders).
- Social services referral will be part of the safeguarding process once admitted.
