OET Doctors Speaking: Child Earache and a Parent’s Observations

Learning outcome: Clarify what a parent has seen, heard or measured, then explore what they think it means. Practise a child’s earache consultation with two five-task cards, condition teaching, task coaching and an extended doctor model. Keep the child’s present condition at the centre of the conversation.

“He kept rubbing his ear, so I think he needs antibiotics” contains an observation and a proposed explanation or solution. Both matter. The doctor should find out what happened and why the parent is concerned without converting either part into an examination finding.

Clarifying a parent’s account should sound respectful. They know the child’s usual behaviour and may notice a change before anyone else. The aim is to make that information specific enough to guide assessment, not to challenge their right to be worried. A careful response also leaves room for the child’s own words and behaviour.

1. Original paired cards: a parent worried after a difficult night

These original Jobins Training role cards are independent learning material, not official OET cards or a score prediction. The candidate reads the doctor card. The partner reads the parent card and reveals details naturally in response to questions.

Preparation prompt: Make three columns in your notes: “parent noticed,” “parent thinks” and “still to assess.” Keep the child’s current condition separate from what happened during the night. These notes are for preparation; the spoken consultation should remain a connected conversation.

2. Understand earache and fever before giving advice

Earache is a symptom, not a completed diagnosis

Young children may show ear discomfort through crying, rubbing the ear, disturbed sleep or a change in usual behaviour. NHS ear-infection information describes a range of possible symptoms and explains that assessment may include looking into the ear with an otoscope, a light and magnifying instrument. The location and cause of an ear problem affect treatment.

Leo’s behaviour makes ear pain plausible, but it does not tell the doctor what the eardrum looks like. His mother cannot supply an otoscope finding by saying that the outside of the ear looked red after rubbing. The learner must explain the planned examination and then avoid reporting its results unless the role-play supplies them.

What a middle-ear infection means

The middle ear is the area behind the eardrum. An acute middle-ear infection can produce pain and fever. Viruses, bacteria or both may be involved, and symptoms alone do not reliably separate them. A worried parent’s explanation may be understandable without being a confirmed diagnosis.

Explain the possibility briefly: “An infection behind the eardrum is one explanation we need to consider.” Then return to Leo’s assessment. Do not use the medical name as if saying it confirms it. “Acute otitis media” is a label for a condition, not a substitute for gathering and assessing information.

Feeling hot and measuring a temperature are different reports

A parent’s report that a child feels hotter than usual is relevant. Ask whether a thermometer was used, what it showed, when it was taken and how the child was at that time. If no measurement exists, do not invent one. NHS fever guidance defines a high temperature as 38°C or more and describes using a digital thermometer under the arm.

For this card, “felt hot during the night” remains the accurate description until a temperature is measured. Avoid changing it into “a fever of 39°C.” Equally, do not dismiss the concern because there is no number. The child’s responsiveness, breathing, drinking and other symptoms remain important to the assessment.

Ask what ordinary words mean in this child

“Sleepy,” “quiet” and “not himself” need clarification. Ask the parent for a concrete example and compare it with the child’s usual behaviour. A child who wakes easily and talks normally after a broken night is a different account from a child who is difficult to wake or does not respond normally.

That distinction is central to the repeat exercise. The parent first explains the behaviour as tiredness, then describes difficulty waking Leo. The observation must change the action even if the parent offers a reassuring explanation. Do not accept “just tired” as a clinical finding.

Antibiotic decisions follow assessment

NICE NG91 describes no antibiotic, a back-up prescription or immediate antibiotics as possible approaches, depending on the child’s presentation. Most children with uncomplicated acute middle-ear infection improve without antibiotics. Symptoms commonly last around three days and sometimes up to a week; this is general information, not a promised recovery date for Leo.

Explain that an antibiotic is not an immediate painkiller and is not automatically required because a child cried a lot. The decision considers the overall assessment, severity and relevant risk factors. Some children need prompt treatment or hospital assessment. This lesson supplies no findings that permit the learner to choose Leo’s treatment in advance.

NICE’s evidence discussion weighs limited benefits for many uncomplicated cases against possible adverse effects, including diarrhoea, vomiting or rash. Use that balance to explain the purpose of a decision, not to deliver a lecture about resistance while the parent is asking how to relieve pain tonight.

A back-up prescription is a specific plan

If a back-up antibiotic is chosen after assessment, explain exactly when to use it and when to seek help. Do not present it as a universal feature of every earache consultation. The parent needs to understand both the prescription instructions and the separate advice for deterioration.

Under NICE guidance, rapidly or significantly worsening symptoms or a child becoming very unwell require medical help; a prescription does not replace reassessment. Avoid the instruction “If he gets worse, just start it and wait.” No back-up prescription has actually been issued in this original card.

Pain relief needs the real medicine details

Ask which product has been given, its strength, the amount, the time and the effect. Check suitability, allergies and relevant health history before individual advice. Children’s formulations differ, so the word “syrup” is not enough information for a dose. Use the bottle and the actual prescribing or package instructions.

General fever advice uses suitable paracetamol or ibuprofen for distress or discomfort. It does not recommend routinely alternating them without professional advice. The learner should not create a dosing schedule from the child’s age alone or praise an unknown dose as correct. This exercise deliberately withholds the product details so that asking to check them is part of the communication task.

Home care includes watching the child, not only a number

When home care is appropriate after assessment, explain fluids, comfort, regular checks and the agreed medicine plan in manageable portions. Ask who will care for the child and whether they understand the instructions. A parent may need help turning general advice into a plan for the coming evening.

A lower temperature does not by itself explain new abnormal drowsiness or difficulty breathing. The NHS identifies difficulty waking, abnormal responsiveness, breathing difficulty, a stiff neck or a non-fading rash among emergency features. In the UK, call 999 for these concerning presentations rather than waiting for the routine review. In the clinic, activate emergency assessment immediately.

Changes around the ear also need attention

The NHS mastoiditis page, reviewed in August 2026, describes pain or swelling behind the ear, sometimes pushing the ear outwards, as features that need urgent medical assessment. Mastoiditis is a rare but serious infection of the bone behind the ear. A parent should not be told to wait for several routine doses of medicine before seeking help for that change.

Other changes, such as discharge, a new hearing problem, reduced intake or worsening general condition, should be discussed through the appropriate urgent pathway. Explain the action in plain language and make it fit the child’s assessment. Do not use a long list of rare complications as a way of sounding thorough while leaving the parent unsure whom to contact.

3. Coaching for the five doctor tasks

Task 1: recognise two people in the consultation

Greet the parent and acknowledge the child. A short, age-appropriate invitation such as “Leo, can you show me where it hurts?” can include him without demanding a detailed history from a four-year-old. Observe and assess his present condition while listening to the parent.

“That sounds like a difficult night” acknowledges the experience without promising that the child is fine. Ask how he is now. A parent may begin with the most upsetting event from hours earlier; the doctor still needs to identify any current deterioration.

Task 2: clarify without making the parent defensive

Use neutral questions: “What did you notice?” and “How did you check his temperature?” These invite useful detail. “Are you sure he had a fever?” can sound as though the parent must defend their account. Explain that you are trying to understand the change accurately.

Keep the parent’s words attributed in the summary: “You felt his chest was hotter than usual, but no temperature was measured.” Ask for confirmation. Do not describe the report as unreliable simply because it is an observation rather than a measurement.

Task 3: find the concern beneath the requested treatment

Ask what the parent hopes an antibiotic will do. Ms Green may think it is the only way to relieve pain or prevent another difficult night. If you respond only with “antibiotics do not always help,” she may hear that there is no help available at all.

Reflect the actual concern: “You want him comfortable, and you want to know when you should seek help.” That creates a clear purpose for the next explanation. It also avoids labelling a worried parent as demanding when the request is based on a misunderstanding.

Task 4: explain the examination and decisions in steps

Describe the instrument and what you need to assess. Explain to Leo as well as his mother in language he can follow. Ask permission appropriately and respond to distress. The teaching model stops short of inventing a red or bulging eardrum.

Then explain that the findings and overall condition guide treatment. Ask what Ms Green has understood before discussing more options. You do not need to list every possible medicine. The aim is an understandable reason for the next step, with room for questions.

Task 5: check whether the plan can be followed

Ask to see the bottle and timing note before discussing the next dose. Explain how the final instructions will be checked and recorded. If another carer will take over, explore how the information will reach them and how doses already given will be communicated.

Check the routine plan and emergency action separately. “What would you do if he became difficult to wake?” is more informative than “Do you understand?” If the answer suggests waiting until morning, explain again and check the action. The point is to make the plan usable, not to test memory.

4. Extended doctor-viewpoint model with listening pauses

This doctor-only model is a teaching resource rather than a speech to deliver in full. Pause for answers, choose relevant follow-up questions and change direction if the child’s condition requires it. No temperature, examination result or medicine regimen should be added unless supplied in the role-play.

“Hello, Ms Green. Hello, Leo. I understand his ear has been painful. How is he doing right now?” Listen and assess the child’s current responsiveness and breathing.

“That sounds like a difficult night. Could you tell me what you first noticed?” Let the parent describe the experience before narrowing the questions.

“Leo, can you show me where it hurts?” Include the child in a way that suits his age and comfort; do not force an answer.

“You noticed him rubbing the right ear and crying. When did that begin?” Separate what was seen from the conclusion about the cause.

“What has the pain been like since then?” Explore changes, sleep and what the child has said, without assuming the pain has stayed constant.

“You said he felt hot. How did you check his temperature?” Give a neutral invitation. Do not suggest a number.

“So his chest felt warmer than usual, but you did not measure a temperature. Have I understood that correctly?” Accept a correction and preserve the distinction in the later summary.

“How has he been drinking today?” Listen before asking separately about urine output or other signs relevant to hydration.

“Has he been passing urine as usual?” Clarify a change if one is reported rather than accepting ‘probably’ as a complete answer.

“What has he been like when awake compared with his usual self?” Ask for an example if the answer is ‘quiet’ or ‘sleepy’; difficulty waking changes the priority immediately.

“Have you noticed any change in his breathing?” Assess the answer and the child. Do not let a reassuring interpretation hide a concerning observation.

“Have you seen any fluid coming from the ear or swelling around it?” Explore any positive answer and complete other relevant safety questions one at a time.

“What other symptoms have you noticed?” Continue the appropriate history and assessment, including warning features; this model is not an exhaustive clinical checklist.

“Has Leo had any similar ear problems or other important health problems before?” Explore relevant history and avoid assuming this is a repeat of a previous diagnosis.

“What medicine have you given him so far?” Wait for the bottle and the parent’s account.

“Thank you for bringing the bottle and the time you gave it. Let us check the exact product, strength and amount before discussing what he can have next.” Check the actual instructions, allergies and suitability rather than supplying a generic dose.

“You feel that the amount of crying means he needs an antibiotic. What are you hoping the antibiotic would help with most?” Explore the expectation without describing the parent as demanding.

“You want him comfortable tonight, and you want to know when it is safe to care for him at home. Is that your main concern?” Check that this reflects her priority.

“An infection behind the eardrum is one possible cause of ear pain. We need to assess him and look in his ear before deciding what treatment fits.” Pause for the parent’s response.

“I would like to look with a small light and magnifying instrument. Leo, I will explain what I am doing before I look in your ear.” Seek appropriate permission and support; do not invent the examination finding.

“The crying tells us he has been distressed. It does not tell us by itself whether an antibiotic is needed. The examination and how he is overall help us decide.” Check whether this addresses her interpretation.

“Some ear infections improve without antibiotics. If that approach is suitable after assessment, it still includes help with pain, advice on care and a clear plan for review. What would worry you about that?” Listen before explaining another option.

“If an antibiotic is prescribed, I will explain whether it is to start now or is a back-up, and we will check the exact instructions. A child becoming much more unwell still needs medical help.” Do not imply that a prescription has already been issued.

“Once we have assessed him, we can agree the medicine and care plan for tonight. Who will be looking after him, and what might make the instructions difficult to follow?” Explore an actual practical barrier and provide the plan in a usable form.

“If he becomes difficult to wake or has serious breathing difficulty, seek emergency help immediately: call 999 in the UK. Do not wait for another dose or for morning. What would you do if that happened?” Check the action and explain other relevant warning signs and urgent contacts.

“To check I have explained clearly, could you tell me what we are doing next and what you would watch for at home if home care is appropriate?” Correct any assumption that infection or treatment has already been confirmed, and invite the remaining question.

5. Speaking tips for a parent’s account

Use the parent’s knowledge of the child. Ask what has changed from usual behaviour. “Not himself” can be the beginning of important information. Follow it with an example instead of replacing it with a label of your own.

Clarify one uncertain word. If the parent says “burning,” ask what they mean in this context. Do they mean the child felt hot, complained of pain or had a thermometer reading? One brief clarification can prevent a long explanation based on the wrong meaning.

Preserve who said what. “You noticed…” and “You are worried that…” are useful when they distinguish an observation from a concern. Do not repeat them so often that the conversation sounds like a statement being dictated. Use attribution where it prevents ambiguity.

Keep the child visible in your language. Speak to Leo when appropriate and explain what you are doing. A conversation with the parent should not make the child disappear. Adjust your words to his age and distress rather than treating every child like an adult patient.

Recognise when the next question is no longer routine. If a parent describes difficulty waking, stop the explanation about ordinary ear infections. State the urgent action clearly. Good listening is shown by the change in your response, not by an empathetic phrase followed by the same prepared speech.

Make reassurance conditional on what is known. A general statement that ear infections are common can orient the parent. It cannot prove that this child has an uncomplicated infection. Link reassurance to assessment and a usable plan.

6. Useful questions and explanations

• Invite the observation: “What did you first notice?”
• Clarify a word: “When you say sleepy, what is he doing?”
• Compare with usual behaviour: “How is that different from his normal tiredness?”
• Check a measurement: “Was his temperature measured? What did it show?”
• Preserve the report: “You felt he was hotter than usual, but there was no reading.”
• Explore an interpretation: “What makes you think an antibiotic is needed?”
• Find the desired help: “What are you most worried about managing tonight?”
• Explain the assessment: “Looking in the ear helps us decide what is happening and what care is needed.”
• Respond to a warning change: “That is different from ordinary tiredness, and he needs emergency help now.”
• Check the action: “What would you do if he became difficult to wake?”

Practise the question and then leave silence. Do not add several suggested answers before the parent can respond. If they struggle to describe the change, ask for the most recent example rather than requiring medical vocabulary.

7. Common mistakes and repairs

“He has a high fever of 39°C.” No measurement was supplied. Repair the statement to describe the parent’s observation, then assess the temperature and the child’s condition appropriately. Do not create certainty through a number.

“His ear is red, so this is bacterial.” Clarify which part the parent saw and what they noticed. Ear rubbing or external redness is not an examination of the eardrum, and the account does not establish the cause.

“You are worrying too much.” Replace the judgement with a specific acknowledgement and question. The parent’s concern may contain a useful observation or a practical need that has not yet been heard.

“No antibiotic means there is nothing to do.” Explain assessment, appropriate pain relief, care advice and review. If an antibiotic is not needed after assessment, the parent should still leave with an understandable care plan.

“Give the usual spoonful.” Product strength and measuring devices vary. Check the actual medicine and instructions. A vague quantity is not made safe by calling it usual.

“His fever came down, so let him sleep.” This fails if the child is difficult to wake or not responding normally. Repair it by attending to the present warning symptom and arranging emergency help.

“I can see a bulging eardrum.” The role card contains no examination finding. Explain what you intend to assess rather than pretending the examination has occurred. If a different role-play supplies findings, use only those supplied.

8. Repeat with a changed observation

First attempt: observation, interpretation and next step

Run the consultation using the first parent card. Record only with agreement. Afterwards, identify two observations and two interpretations in the conversation. Check whether the doctor kept them distinct while still acknowledging the parent’s concern. Find the moment when the worry about another difficult night affected the explanation.

Second attempt: “just tired” means difficult to wake

Replace the parent’s report of normal alertness with: “He is just tired after the bad night. But I cannot get him to wake properly, and he is not responding to me as he normally does.” The partner should state this information; no physical acting of an unresponsive child is needed. Give your immediate response before opening the suggestion.

Third attempt: another carer will take over

Return to the first-attempt current condition, then change the practical information: Leo’s grandmother will care for him that evening, and she does not know what medicine has already been given. Ask how the agreed instructions and dose record will be shared. Do not invent another dose or assume a verbal message has reached her.

Review one exchange closely

Choose the sentence where the parent’s explanation and observation were mixed. Write down the doctor’s reply exactly. Did it ask for useful detail, reflect the worry and lead to an appropriate next step? Rewrite one sentence that assumed too much. Repeat the exchange and check whether the revised reply actually changes what the parent can explain or do.

Source and course connection: This original lesson draws on the complete parent-and-child earache Role-Play 4 in Jobin Thomas’s OET Speaking for Doctors: Mastering Role-Plays and Professional Communication, including its paired cards, condition explanation and sample response. The Ms Green and Leo scenario and doctor-only model are independently written. Current assessment and prescribing principles replace invented examination findings, automatic back-up prescriptions and fixed recovery assurances. The full saved OET Speaking for Doctors — Course 5 outline includes other common presentations, rare-condition role-plays and communication practice. Use another case to practise preserving the difference between an observation and its interpretation.

Source: OET DOC SP 132.epub, Jobins Training. Examples labelled original or illustrative were written for this article. Independent exam preparation; no affiliation with or endorsement by the examining body. Practice does not predict an official score.