Mother Afraid Her Coughing Child Has Whooping Cough, Child Found to Be Unvaccinated — Free SCA Practice Case
Mother afraid her coughing child has whooping cough, child found to be unvaccinated
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
Freddie Marsh
Age
3 years
Consultation Type
TelephoneAge
3
Situation
Telephone Consultation. The child's mother is calling.
Reason for Encounter
"My little boy's got a nasty cough and there's whooping cough going round his nursery. I'm scared he's got it."
Medical Records (Freddie Marsh)
- ●PMH: Nil significant.
- ●Immunisations: No childhood immunisations recorded.
- ●Medications: None.
- ●Allergies: NKDA.
Patient Script
For the friend playing the patient role
Character Overview: You are Danielle, mother of Freddie, who is 3. He has had a cough and cold for about four days — a runny nose, mild cough, low-grade temperature, still eating, drinking, and playing. You are frightened because there is whooping cough going round his nursery. When asked, you will explain that Freddie has not had any of his childhood vaccinations — you had concerns and kept putting it off, and you feel a bit defensive about it. Freddie's cough is not the classic whooping-cough pattern (no coughing fits, no whoop, no vomiting after coughing, no going blue). You are anxious but reasonable, and will engage about vaccinations if you are not judged.
Opening Sentence: "Hi Doctor. Freddie, my three-year-old, has had a cough for a few days, and I've heard there's whooping cough going round his nursery. I'm really worried that's what he's got. Should I be scared?"
History if Asked (Data Gathering Phase)
- ●The cough/illness: "A cough for about four days, runny nose, bit of a temperature. Nothing dramatic — he's still eating, drinking, and playing."
- ●Whooping-cough features (if asked): "No coughing fits as such, no whooping noise, he's not been sick after coughing, and he's not gone blue or stopped breathing. It's more a normal cough and cold."
- ●The nursery: "There's a notice up saying there've been whooping cough cases."
- ●Immunisations (emerges on PBIND history): "He hasn't had any of his jabs, actually. I had worries about them and kept putting it off. I know I probably should have… I feel a bit judged about it, to be honest."
- ●What she wants: "To know if this is whooping cough and whether he needs anything."
ICE — Ideas, Concerns, Expectations
The mother does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.
- ●Ideas: Danielle fears this is whooping cough because of the nursery outbreak. "I'm scared it's whooping cough because of what's going round nursery."
- ●Concerns: She is worried about whooping cough being serious, and — beneath it — anxious and defensive about not having vaccinated him. "I'm scared it's serious, and I feel awful and a bit judged about not getting his jabs done."
- ●Expectations: She wants reassurance/assessment about the cough. "I want to know if it's whooping cough and what to do."
If Asked — Pertussis, Severity, and PBIND Screen
The mother answers these only when directly asked.
- ●If asked about paroxysmal coughing fits, an inspiratory 'whoop', post-tussive vomiting, or apnoea/cyanosis (pertussis features): "No — none of those. It's a fairly ordinary cough and runny nose." (Not the classic pertussis pattern.)
- ●If asked about duration and progression: "About four days, and he seems to be over the worst if anything."
- ●If asked about severity/red flags (breathing difficulty, poor feeding, drowsiness, high fever, reduced wet nappies): "No — his breathing's fine, he's eating and drinking, alert, plenty of wet nappies, temperature's only mild."
- ●If asked about PBIND (pregnancy, birth, immunisations, nutrition, development): "Normal pregnancy and birth, growing and developing well, eats well — but no immunisations at all."
- ●If asked about contact with vulnerable people (young babies, pregnant women): "He's around his baby cousin sometimes, who's only a few weeks old."
- ●If asked about reasons for not vaccinating: "I read things online that worried me, and I kept putting it off. I'm not totally against it — I'm just not sure."
Responses to Management (The Negotiation Phase)
- ●If the Doctor assesses and explains the cough sounds viral: "So it sounds more like a normal virus than whooping cough? That's a relief." (The tested point is a sound acute assessment distinguishing viral URTI from pertussis.)
- ●If the Doctor explains what would suggest whooping cough and when to worry: "What would make you think it was whooping cough, and when should I worry?" (The tested point is explaining pertussis features and safety-netting.)
- ●If the Doctor raises immunisation non-judgementally — key: "You're not telling me off about the jabs? I expected a lecture." (The tested point is a non-judgemental catch-up-immunisation conversation — exploring her concerns and offering catch-up.)
- ●If the Doctor addresses the vulnerable baby contact: "Could Freddie be a risk to his newborn cousin?"
- ●If the Doctor discusses notifiable disease/public health (if pertussis suspected): "Would this need reporting to anyone?"
Mark Scheme
Domain 1: Data Gathering and Diagnosis
Domain 2: Clinical Management and Medical Complexity
Domain 3: Relating to Others
Clinical Learning Points
Distinguishing Pertussis from Viral URTI
- ●Pertussis (whooping cough) classically causes paroxysmal coughing fits, an inspiratory 'whoop', post-tussive vomiting, and (in infants) apnoea/cyanosis, often after a coryzal prodrome. A mild coryzal illness in a well child without these features is more likely a viral URTI — but remain cautious in an unvaccinated child during an outbreak.
Pertussis Is Notifiable
- ●Pertussis is a notifiable disease. If suspected/confirmed, notify UKHSA, arrange testing, consider early macrolide antibiotics (within ~21 days of cough onset), and manage contacts — especially vulnerable infants and pregnant women.
Protect Vulnerable Contacts
- ●Pertussis is dangerous to young infants. Advise reducing contact between a potentially infectious child and newborns/young babies and pregnant women.
The Non-Judgemental Immunisation Conversation — the Key Skill
- ●When a child is unvaccinated, raise it without judgement: explore the parent's concerns, address them with clear evidence-based information, explain the benefits and risks, and offer catch-up on the UK schedule. A judgemental or coercive approach entrenches vaccine hesitancy.
Practical Catch-Up
- ●Offer a realistic route to catch-up vaccination (practice nurse, the UK catch-up schedule) and reliable information, and keep the door open even if the parent is not ready immediately.
Acute Assessment and Safety-Netting
- ●Assess severity and red flags (breathing difficulty, feeding, hydration, drowsiness), and safety-net clearly for pertussis features and general deterioration.
Follow-Up
- ●Arrange follow-up for the acute illness and to progress the immunisation catch-up.
Common Candidate Mistakes in This Case
- ●Missing or mishandling the unvaccinated status: not taking a PBIND history, or reacting judgementally.
- ●Lecturing about vaccination: alienating a hesitant parent instead of exploring and addressing concerns.
- ●Getting pertussis wrong: not knowing its features, notifiable status, treatment window, or contact management.
- ●Ignoring vulnerable contacts: overlooking the risk to the newborn cousin.
- ●Weak safety-netting: not advising on pertussis features and general red flags.