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Interlocutor Role Play Card
Patient Setting: Baby Health Clinic
You are the mother of a 7-week-old baby boy. This is your first child. The baby has been breast-feeding well but often cries after feeds and seems to be in pain. He vomits small amounts of milk after most feeds and takes a long time to settle. You are breast-feeding on demand or every 4 hours. Your baby’s weight has been satisfactory. You are worried that your baby is sick and in need of medical attention.
Task
- Describe your baby’s problems after breastfeeding.
- Answer the nurse’s questions about the feeding routine.
- Ask what causes reflux. Is it dangerous?
- Be hard to reassure as you are certain that there is something wrong with your baby.
Candidate Role Play Card
Nurse Setting: Baby Health Clinic
Your patient is the mother of a 7-week-old baby boy. The baby has been breastfeeding well but has been frequently vomiting small amounts of milk and crying after feeding. The mother is worried that the baby has an illness and is very anxious to get advice and treatment for her son.
Task
- Ask the mother about her concerns for her baby.
- Ask the mother about the baby’s feeding patterns and problems.
- Explain your diagnosis of reflux (gastro-oesophageal reflux).
- Briefly describe the causes of reflux (Undeveloped muscle (valve) where food pipe joins the stomach; Can occur when baby’s stomach is full of milk and acid comes back up food pipe causing discomfort).
- Describe the treatment for reflux (Feed baby in an upright position; Hold baby upright for 30 minutes after feeds; Try giving smaller more frequent feeds; Add a thickener to expressed breast milk for 2 weeks).
- Reassure the mother that the baby is not sick and will improve with the right treatment.
Sample Role Play
Role Play Script: Baby Health Clinic
Nurse: Hello, I’m ______________________, one of the nurses here at the clinic. How can I help you and your baby today?
Mother: Hi, I’m Jessica. This is my first child, and I’m really worried about him. After breastfeeding, he often cries and seems to be in pain. He also vomits small amounts of milk after most feeds and takes a long time to settle.
Nurse: I can understand why you’re concerned, Jessica. Let’s try to get to the bottom of this. Can you tell me a bit more about your baby’s feeding routine? How often are you breastfeeding him?
Mother: I’m breastfeeding him on demand, which is usually every four hours.
Nurse: Okay, that’s good to know. And how long does he usually feed for each time?
Mother: He feeds for about 20 to 30 minutes each time.
Nurse: And during these feeds, does he latch on well and seem to be feeding effectively?
Mother: Yes, he latches on well and seems to be feeding effectively, but it’s the aftermath that worries me. He cries, arches his back, and sometimes spits up.
Nurse: I see. When he spits up, is it a lot of milk or just small amounts?
Mother: It’s usually just small amounts, but it happens after most feeds.
Nurse: It sounds like your baby might be experiencing reflux, also known as gastro-oesophageal reflux. This is quite common in young babies and can cause the symptoms you’re describing.
Mother: Reflux? Is that serious? What causes it?
Nurse: Reflux happens when the muscle at the top of the stomach, which acts as a valve, is not fully developed. This can allow milk and stomach acid to come back up into the food pipe, causing discomfort. It’s more likely to happen when the baby’s stomach is full. This is a common condition in infants and usually improves as they get older.
Mother: But is it dangerous? I’m really worried there’s something seriously wrong with him.
Nurse: I understand your concern, Jessica. Reflux can be uncomfortable for your baby, but it’s not usually dangerous. Most babies outgrow it as their digestive system matures. There are some things we can do to help manage his symptoms.
Mother: What can we do?
Nurse: Firstly, try feeding your baby in an upright position and keep him upright for about 30 minutes after feeds. This helps prevent milk from coming back up. You might also consider giving smaller, more frequent feeds. Instead of every four hours, try feeding him every two to three hours with smaller amounts.
Mother: Will this really help? I’m so worried about him.
Nurse: I know it’s hard to see your baby in discomfort, but these measures are usually very effective. Additionally, you might want to try adding a thickener to expressed breast milk for two weeks. This can help the milk stay down better and reduce the frequency of spitting up.
Mother: How do I add a thickener to breast milk? Is it safe?
Nurse: You can buy a thickener specifically designed for infants from most pharmacies. It’s safe and often recommended for babies with reflux. You simply mix it with the expressed breast milk according to the instructions on the package.
Mother: Okay, I can try that. But what if it doesn’t work?
Nurse: If these measures don’t seem to help, or if his symptoms worsen, we can explore further options. It’s important to monitor his weight and overall health. If he’s gaining weight well and generally seems healthy aside from the reflux, that’s a good sign.
Mother: He’s been gaining weight well so far, which is reassuring. But I’m still worried there might be something more serious going on.
Nurse: It’s completely normal to worry, especially as a first-time mother. However, based on what you’ve described, it sounds like typical reflux. I’ll provide you with some written information on managing reflux at home. Also, if you notice any alarming symptoms such as projectile vomiting, blood in the vomit, or significant weight loss, please seek medical attention immediately.
Mother: Thank you. I’ll try these suggestions and see how he goes.
Nurse: You’re doing a great job, Jessica. It’s clear you care deeply for your son. Remember, it’s important to look after yourself too. Don’t hesitate to ask for help from family or friends, and keep in touch with us for any concerns.
Mother: Thank you so much. I feel a bit more reassured now.
Nurse: You’re welcome. Take care, and we’ll see you and your baby for a follow-up soon. If you have any further questions or concerns, don’t hesitate to call us.
Mother: Thank you, I appreciate your help.
Nurse: Anytime, Jessica. Have a good day and all the best with your little one.
