PLAB 2 paediatric stations: you're really talking to the parent

You’ve walked into a PLAB 2 paediatric station. The child is either a mannequin, a cooperative actor, or—more likely—absent entirely. The examiner isn’t assessing your ability to auscultate a six-year-old’s chest; they’re watching how you handle the parent sitting opposite you. This is a consultation about a child, but it’s a consultation with an adult. The parent is anxious, possibly frightened, and they need to trust you before they’ll let you near their child. Your job is to gather information, address their concerns, and safety-net—all while appearing calm and competent. Here’s how to do it without overcomplicating it.

Start by acknowledging the parent’s anxiety upfront. A simple, “I can see you’re worried about [child’s name]—let’s go through what’s been happening,” does two things: it validates their concern, and it shifts the focus to the history, where most of the marks are. From there, structure the consultation as you would any adult station, but with paediatric-specific tweaks. ICE (Ideas, Concerns, Expectations) isn’t optional here—it’s the backbone of the station. Parents often arrive with a diagnosis in mind (usually from Dr Google), and if you don’t ask about it, they’ll assume you’re dismissing their concerns. Use the phrase, “What’s been going through your mind about what might be causing this?” It’s open-ended, non-judgemental, and invites them to share their fears (e.g., meningitis, cancer, allergies) so you can address them directly.

History: the parent is the historian

The child isn’t going to tell you about the 48-hour history of fever, the rash that appeared at 3 a.m., or the fact that they’ve only had two wet nappies in 12 hours. The parent is your historian, and you need to extract a detailed, chronological account. Start with open questions: “Tell me about the fever—when did it start, how high has it been, and how have you been managing it?” Then drill down with closed questions to fill in the gaps. For fever, ask:

• “Has the fever been constant, or does it come and go?” (intermittent fever suggests viral; persistent suggests bacterial)
• “Have you given any paracetamol or ibuprofen? Did it bring the temperature down?” (if not, consider serious infection)
• “Has [child] been drinking? Any vomiting or diarrhoea?” (dehydration is a red flag in children)
• “Any rash? If so, where did it start, and has it changed?” (non-blanching rash = immediate 999)

For respiratory symptoms, ask about:

• “Has the cough been wet or dry?” (wet = lower respiratory tract infection; dry = croup, asthma)
• “Any wheeze or difficulty breathing?” (if yes, ask about recession, grunting, or head bobbing)
• “Has [child] been able to finish sentences or feed without stopping?” (if not, consider severe asthma or bronchiolitis)

For abdominal pain, ask:

• “Where exactly is the pain? Does it move?” (appendicitis pain starts periumbilical, moves to RIF)
• “Any vomiting? What did it look like?” (bilious vomiting = surgical emergency)
• “When was the last bowel movement? Any blood?” (constipation is common, but blood is a red flag)

Avoid leading questions like, “So the rash is non-blanching, right?” Instead, say, “Can you describe the rash to me?” and let them tell you. If they say, “It doesn’t disappear when I press it,” you’ve got your answer without putting words in their mouth.

ICE: the parent’s agenda, not yours

Parents often arrive with a specific worry, and if you don’t address it, they’ll leave feeling unheard. Use the phrase, “What’s been worrying you the most about this?” It’s direct and forces them to articulate their biggest fear. Common concerns include:

• “Is this meningitis?” (if the child has fever + rash + lethargy, say, “I’m glad you mentioned that—it’s something we always consider with these symptoms. The rash you’ve described does blanch, which is reassuring, but I’d still like to examine [child] thoroughly.”)
• “Could this be an allergy?” (if the child has urticaria + wheeze, say, “Allergies can cause these symptoms, and we’ll need to explore that. Have you noticed any pattern—e.g., after eating certain foods?”)
• “Is this asthma?” (if the child has recurrent wheeze, say, “Asthma is a possibility, but we’d need to see a pattern of symptoms and response to treatment. Have you noticed if the wheeze is worse at night or after exercise?”)

After addressing their concern, ask, “What were you hoping we’d be able to do today?” This reveals their expectation (e.g., antibiotics, a scan, a referral) and gives you a chance to manage it. If they want antibiotics for a viral illness, say, “I understand you want [child] to feel better as soon as possible. Antibiotics won’t help with this virus, but we can focus on keeping [child] comfortable and monitoring for any red flags.”

Examination: the child is a prop, the parent is the audience

In PLAB 2, the examination is often brief and focused. The examiner isn’t testing your paediatric clinical skills in depth—they’re testing whether you can examine a child while keeping the parent onside. Here’s how to do it:

1. Explain what you’re going to do before you do it. For example, “I’d like to listen to [child]’s chest now—it won’t hurt, but the stethoscope might feel a bit cold. Is that okay?” This gives the parent a chance to prepare the child (or themselves).

2. Involve the parent. If the child is anxious, ask the parent to hold them or distract them. Say, “Could you sit [child] on your lap and sing their favourite song while I listen?”

3. Narrate your findings. Don’t leave the parent in the dark. Say, “I can hear some crackles in the left lung, which suggests there’s some fluid there—this is common with chest infections.” If the examination is normal, say, “The ears, throat, and chest all look and sound normal, which is reassuring.”

4. Wash your hands before and after. It’s a small detail, but it shows you’re thinking about infection control, which parents notice.

Safety-netting: the parent’s lifeline

Safety-netting is non-negotiable in paediatrics. Parents need to know exactly when to come back, and you need to document that you’ve told them. Use the phrase, “Most children with [symptom] get better on their own, but it’s important to know when to come back. Please return immediately if you notice any of the following:” Then list 2–3 red flags, tailored to the presentation. For example:

• Fever + rash: “If the rash changes and doesn’t disappear when you press a glass against it, call 999.”
• Cough + wheeze: “If [child] is struggling to breathe, can’t finish sentences, or their lips turn blue, call 999.”
• Vomiting + diarrhoea: “If [child] hasn’t had a wet nappy in 12 hours, or if they become very sleepy and difficult to wake, come back straight away.”

Give written advice if possible (in PLAB 2, you can say, “I’ll print out a leaflet for you with this information”). If the parent seems unsure, ask, “Can you repeat back to me when you’d need to come back?” This ensures they’ve understood.

Red flags: know them cold

You don’t need to memorise every paediatric red flag, but you do need to recognise the ones that come up in PLAB 2. Here are the most common:

• Fever in under-3s: Any child under 3 months with a fever >38°C needs a full septic screen. For 3–6 months, >39°C is a red flag. Say, “Fever in young babies can be serious, so we’d want to do some blood tests and possibly a lumbar puncture to rule out meningitis.”
• Non-blanching rash: Immediate 999. Say, “This rash is a sign of bleeding under the skin, which can be very serious. We need to get [child] to hospital right away.”
• Bilious vomiting: Green vomit = surgical emergency. Say, “This suggests there’s a blockage in the bowel, which needs urgent surgery.”
• Stridor: A harsh, high-pitched noise on inspiration. Say, “This is a sign of narrowing in the airway, which can be life-threatening. We need to get [child] to hospital now.”
• Severe dehydration: Sunken eyes, dry mouth, no wet nappies for 12+ hours. Say, “[Child] is showing signs of dehydration, which can be dangerous. We need to give fluids through a drip.”

If you spot a red flag, don’t panic. Stay calm, explain what it means, and say what you’re going to do next (e.g., call an ambulance, refer to hospital). The examiner wants to see that you’ve recognised the seriousness and acted appropriately.

Common pitfalls and how to avoid them

1. Ignoring the parent’s agenda. If you launch into a history without asking about their concerns, they’ll feel dismissed. Always start with, “What’s been worrying you about this?”

2. Over-examining. In PLAB 2, you don’t need to do a full top-to-toe examination. Focus on the relevant system (e.g., respiratory for cough, abdominal for pain). If the examiner wants more, they’ll prompt you.

3. Using medical jargon. Parents don’t know what “tachypnoea” or “recession” mean. Say “fast breathing” and “the skin sucking in between the ribs” instead.

4. Forgetting to safety-net. This is the most common reason candidates lose marks. Always end with, “Please come back if…” and list 2–3 red flags.

5. Assuming the child is well. Even if the parent says, “They’re usually fine,” ask about red flags. A child with a fever and a non-blanching rash is never fine, no matter how well they look.

Worked example: fever in a 2-year-old

Parent: “My daughter’s had a fever for two days. She’s not herself—she’s been clingy and not eating much.”

You: “I can see you’re worried—let’s go through what’s been happening. When did the fever start, and how high has it been?”

Parent: “It started yesterday morning. It’s been up to 39.5°C. I’ve given her paracetamol, but it only comes down a bit.”

You: “Has she had any other symptoms—cough, rash, vomiting, diarrhoea?”

Parent: “She’s had a bit of a cough, but no rash or vomiting.”

You: “What’s been going through your mind about what might be causing this?”

Parent: “I’m worried it might be meningitis. My friend’s son had it, and he was really poorly.”

You: “I’m glad you mentioned that—it’s something we always consider with fever. The good news is that [child] doesn’t have a rash, and she’s still alert and drinking a bit, which is reassuring. But I’d like to examine her to be sure. Is that okay?”

(Examination: normal ears, throat, and chest. No rash. No signs of dehydration.)

You: “Everything looks normal, which is reassuring. Most fevers in children are caused by viruses and get better on their own. But it’s important to know when to come back. Please return immediately if:

• The fever lasts more than 5 days
• She develops a rash that doesn’t disappear when you press a glass against it
• She becomes very sleepy and difficult to wake
• She’s not had a wet nappy in 12 hours

Can you repeat back to me when you’d need to come back?”

Parent: “If the fever lasts more than 5 days, or if she gets a rash, or if she’s not weeing.”

You: “Exactly. I’ll also give you a leaflet with this information. Do you have any other questions?”

Parent: “No, that’s great. Thank you.”

How to practise

Paediatric stations are about confidence and clarity. The more you practise, the more natural your phrasing will become. Use worked examples like the one above to rehearse your history-taking, ICE, and safety-netting. If you’re looking for mock stations to refine your approach, OSCEPilot offers timed, examiner-marked scenarios that mirror the real exam.

FAQ

1. How much of the station should I spend on history vs examination? Aim for 60% history, 30% examination, and 10% safety-netting. The history is where most of the marks are, but you must do a focused examination and safety-net to pass.

2. What if the parent is hostile or dismissive? Stay calm and professional. Acknowledge their frustration (e.g., “I can see you’re frustrated—let’s work through this together”) and focus on the child’s needs. If they refuse examination, say, “I understand you’re worried, but it’s important we check [child] to make sure they’re okay. If you’d prefer, we can call a senior colleague to help.”

3. How do I handle a child who won’t cooperate with the examination? Involve the parent. Say, “Could you hold [child] on your lap and sing their favourite song while I listen to their chest?” If they still won’t cooperate, say, “It’s okay—we can try again in a few minutes. In the meantime, let’s talk about what’s been happening.” In PLAB 2, the examiner will usually prompt the child to cooperate, so don’t panic if they’re uncooperative at first.