Impetigo Who Provides Childcare for An Immunosuppressed Grandmother — Free SCA Practice Case
Mother of a child with impetigo who provides childcare for an immunosuppressed grandmother
Station Timer
Golden Minute
Initial Introduction
•Introduce yourself
•Ask an open question — "How can I help you today?"
•Listen — don't interrupt
•Catch early cues
Data Gathering
History, ICE & Diagnosis
Clinical Management
Diagnosis, Plan & Decisions
Safety Net
Follow-up & Close
Materials for Candidate
Please review before starting the consultation
Full Name
Alfie Barker
Age
5 years
Consultation Type
VideoAge
5
Mother's Name
Leanne Barker (age 32)
Situation
Video Consultation. Alfie's mother, Leanne, has booked a video appointment and sent in a photograph of the rash.
Reason for Encounter
"My little boy's got a crusty rash on his knee that I think is impetigo. My mum looks after him a lot and she's on chemotherapy — is it safe for him to be around her? And I work full time, so I need to know about school and time off."
Medical Records (child)
- ●PMH: Nil significant. Immunisations up to date.
- ●Medications: None.
- ●Allergies: NKDA.
Examination (Visual provided during consult)
- ●Photograph (sent in before the call): A localised cluster of lesions on one knee with golden/honey-coloured crusting on an erythematous base; no surrounding spreading cellulitis; no other sites shown.
Patient Script
For the friend playing the patient role
Character Overview: You are Leanne, Alfie's mum. You are organised and a little stressed — you work full time and rely heavily on your own mother (Alfie's grandmother) for childcare, but she is currently having chemotherapy for breast cancer, and you are worried about the rash being dangerous to her. You want clear answers on treatment, whether Alfie can be near his grandmother, school, and what you do about work.
Opening Sentence: "Hi Doctor, thanks for seeing me. My son Alfie, who's five, has come up with this crusty, yellowy rash on his knee — I sent a photo. I'm fairly sure it's impetigo. My main worry is my mum: she looks after Alfie while I work, and she's halfway through chemo. Is it safe for him to be around her? And what do I do about school and my job?"
History if Asked (Data Gathering Phase — gathered via the mother)
- ●The rash: "It started as a little sore on his knee a couple of days ago, and now it's got that golden crusty look. It's just on the one knee, hasn't spread much."
- ●How he is in himself: "He's absolutely fine in himself — running around, eating well, no temperature. Just the rash."
- ●Other children/contacts: "It's just Alfie. My other little one hasn't got it. He's been at school and with my mum this week."
- ●The grandmother: "My mum's having chemotherapy for breast cancer. She has Alfie three days a week while I work. She's obviously more vulnerable to infections right now, which is why I'm so worried."
- ●Work and childcare: "I work full time. If Alfie can't go to school or to my mum's, I'm stuck — I'd have to take time off, and I'm not sure how my work will take it."
ICE — Ideas, Concerns, Expectations
The caller does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.
- ●Ideas: Leanne is fairly sure it is impetigo and knows it is "catching," but is unsure how serious it is or how long Alfie is infectious. "I think it's impetigo — I know it spreads — but I don't know how long he's contagious or how careful we need to be."
- ●Concerns: Her overriding concern is passing an infection to her immunosuppressed mother, who could become seriously unwell. A close second is the practical bind of work and childcare. "The thing that scares me is making my mum ill when her immune system's already down. And honestly, I'm panicking about how I cover work if Alfie has to stay off."
- ●Expectations: She wants treatment for Alfie, clear guidance on keeping her mother safe, and advice (and, ideally, a fit note) for the work/childcare problem. "I want him treated, I want to know he's safe around my mum, and I need to sort out school and work."
If Asked — Background Questions
The caller answers these only when directly asked.
- ●If asked about the grandmother's treatment: "She's mid-chemotherapy for breast cancer — so her immune system's low, yes."
- ●If asked whether Alfie has been near his grandmother since the rash: "He was at hers two days ago, before the rash really came up. That's what's worrying me."
- ●If asked about spread, weeping, or multiple sites: "Just the one knee, a bit crusty and slightly weepy. Not all over."
- ●If asked about systemic illness (fever, off food, lethargy): "No — he's completely well in himself, no fever."
- ●If asked about allergies/previous skin problems: "No allergies, no eczema, first time he's had anything like this."
- ●If asked about who else is at home: "Me, Alfie, and his little sister. My partner works away a lot."
Responses to Management (The Negotiation Phase)
- ●If the Doctor advises keeping Alfie away from the grandmother until he is no longer infectious: "So he can't go to my mum's for now? For how long? She does three days of childcare — that's a real problem." (The tested point is clear advice to protect the immunosuppressed contact, with a defined timeframe, while acknowledging the childcare impact.)
- ●If the Doctor explains treatment options: "Do I need to get him antibiotics, or is there a cream? Which is best for just the one patch?" (The tested point is knowing the NICE stepped treatment for localised impetigo.)
- ●If the Doctor advises school exclusion: "How long does he have to be off school? He's missing his lessons."
- ●If the Doctor offers a fit note for time off: "Could you give me something for my work, to explain why I need to be off with him?"
- ●If the Doctor gives hygiene advice: "What do we need to do at home to stop it spreading to his sister and me?"
Mark Scheme
Domain 1: Data Gathering and Diagnosis
Domain 2: Clinical Management and Medical Complexity
Domain 3: Relating to Others
Clinical Learning Points
Recognising Impetigo
- ●Impetigo is a common, highly contagious superficial bacterial skin infection (usually Staphylococcus aureus, sometimes Streptococcus). Non-bullous impetigo shows golden/honey-coloured crusts on an erythematous base.
- ●It is a clinical diagnosis; most children are systemically well with localised disease.
Treatment (NICE NG153)
- ●Localised non-bullous impetigo, systemically well: hydrogen peroxide 1% cream first-line; a topical antibiotic (fusidic acid) if hydrogen peroxide is unsuitable or ineffective.
- ●Widespread, bullous, or systemically unwell / high-risk: oral flucloxacillin (a macrolide such as clarithromycin/erythromycin if penicillin-allergic).
- ●Reserve antibiotics appropriately to support antimicrobial stewardship.
School and Childcare Exclusion
- ●Children with impetigo should stay away from school, nursery, or childcare until the lesions are healed, dried, or crusted over, or until 48 hours after starting antibiotic treatment.
- ●The same principle applies to any setting where they could transmit infection.
Infection-Control Measures
- ●Advise hand hygiene, not sharing towels/flannels/bedding, avoiding touching or scratching lesions, covering lesions where possible, and keeping the child's personal items separate — to limit spread within the household.
Protecting Immunosuppressed Contacts
- ●Immunosuppressed individuals (e.g. those on chemotherapy) are at higher risk of severe infection. A child with impetigo should avoid close contact with such a person until no longer infectious.
- ●Advise vigilance for signs of infection in the vulnerable contact and prompt contact with their specialist team if they become unwell.
Practical and Occupational Support
- ●Recognise the real-world impact of exclusion on working parents. A fit note and practical planning support the family in following the exclusion advice safely.
Safety-Netting
- ●Safety-net for spreading, extensive weeping, failure to improve within 48 hours, cellulitis, or systemic illness in the child, and for illness in the immunosuppressed contact.
Common Candidate Mistakes in This Case
- ●Not protecting the grandmother: failing to advise avoiding the immunosuppressed contact, or giving no timeframe — the key safety error.
- ●Over-treating with oral antibiotics: prescribing oral antibiotics for a single localised lesion rather than topical-first per NG153.
- ●Wrong or missing exclusion advice: giving incorrect school/childcare exclusion guidance.
- ●Ignoring the practical bind: not offering a fit note or acknowledging the work/childcare problem.
- ●Weak infection control: failing to give hygiene measures to protect the sibling and household.