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Dr Laura Patterson

'If I felt the boy was at risk I would admit him'

This is not going to be an easy consultation. The situation needs defusing quickly. Felix needs to be tactfully pacified. If he remains angry, is under the influence of alcohol, or becomes violent, the police may be needed.

When he is calm, I would elicit his concerns and discuss his weekends with Hugo. I would note the language Felix uses and assess his mental state. It would be important to observe Hugo and Alice's reaction. Is Hugo fearful or withdrawn? Is Alice visibly frightened?

With the situation calmer, I would examine Hugo and make clear and detailed notes of this and Hugo's reactions. I may gently ask Hugo how the bruise happened.

If I feel Hugo is at risk I will admit him to hospital. If the situation appears fully defused I may let him go home with mum. I would try to have a quiet word with Alice to see if she feels safe going home, and whether she has been subject to violence.

I would want to discuss the situation with social services, the police and the paediatric team. Concerns could also be raised with Hugo's school. I would need to inform the partners.

Child abuse may be top of my list, especially with such a typical presentation of deteriorating academic performance, and emotional and social difficulties. It would certainly not be uncommon where there is domestic violence involving the parents.

Other diagnoses may be depression or even Asperger's syndrome.

Either would mean that dad might find Hugo difficult to cope with. A paediatric referral will clarify this.

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