Safeguarding children — MCQs

10 questions

A 17-month-old boy presents to the emergency department with burns to both feet. The mother reports he climbed into the bath while she was answering the door and sustained the burns. The burns are symmetric, circumferential, with a clear demarcation line at the ankles, sparing the soles. There are no splash marks. The child appears frightened and clings to the mother. What is the most appropriate interpretation of these burn characteristics?

A multi-agency safeguarding conference discusses a 9-year-old girl living with her mother and mother's partner. The girl disclosed sexual abuse by the partner to her teacher. Medical examination findings are non-specific. The mother initially did not believe the disclosure but now states she will protect her child. The partner denies allegations and remains in the home. Social care recommends the child's name be placed on a child protection plan. What is the strongest evidence-based factor that should most heavily influence the decision about immediate safety?

A paediatric team reviews three infants with head circumference concerns. Infant A (4 months): head circumference crossing from 50th to 91st centile with bulging fontanelle and vomiting. Infant B (6 months): head circumference consistently on 98th centile since birth, father has large head. Infant C (5 months): head circumference crossing from 75th to 25th centile with developmental regression. Which infant requires the most urgent neuroimaging?

A 7-year-old boy is brought to the GP by his grandmother who recently gained custody. She reports he was living in poor conditions with his mother, who has substance misuse problems. The boy frequently wets the bed, hoards food in his room, is reluctant to be left alone, and has angry outbursts. Growth is on the 2nd centile for height and weight; he was on the 50th centile at age 2. Which aspect of this presentation is most concerning for long-term neurodevelopmental impact?

A 36-month-old girl is assessed in the developmental clinic. She speaks in 3-4 word sentences, can pedal a tricycle, builds a tower of 9 cubes, and can copy a circle. She cannot yet hop on one foot or copy a cross. She feeds herself with a spoon and fork but cannot yet use a knife. Which statement best describes her development?

A 11-month-old infant is brought to the emergency department by her father with a swollen right thigh. He reports she was crawling and suddenly started crying. X-ray reveals a spiral fracture of the right femur. The infant is pre-mobile and not yet pulling to stand. There is no history of trauma. On examination, there are no other injuries. What is the single most important next step?

A 8-year-old boy is referred to the community paediatrician because his height has dropped from the 50th centile at age 4 years to the 9th centile at age 8 years. He has gained weight appropriately (50th centile). His teacher reports he has been tired at school. Examination reveals mild pallor and a soft goitre. What is the most likely diagnosis?

A 5-year-old girl presents to the emergency department with her mother reporting a fall down three stairs resulting in a fractured clavicle. On examination, there are multiple bruises in various stages of healing on her upper arms, back, and buttocks. The mother explains these are from 'normal play'. The child appears withdrawn and makes little eye contact. What is the most appropriate immediate action?

A 25-month-old boy is brought to the GP by his mother with concerns about speech development. He uses approximately 15 single words and no two-word combinations. He follows simple commands, points to body parts, and engages in pretend play. Hearing assessment is normal. What is the most appropriate next step?

Q10

A safeguarding team discusses the legal framework for child protection. Following a strategy discussion where significant harm is suspected, which statutory assessment must be completed within 45 working days under the Children Act 1989?

Safeguarding children UK Medical PG Practice Questions and MCQs

Question 1: A 17-month-old boy presents to the emergency department with burns to both feet. The mother reports he climbed into the bath while she was answering the door and sustained the burns. The burns are symmetric, circumferential, with a clear demarcation line at the ankles, sparing the soles. There are no splash marks. The child appears frightened and clings to the mother. What is the most appropriate interpretation of these burn characteristics?

A. The absence of splash marks indicates the water temperature was not excessively hot
B. The symmetry and demarcation suggest forced immersion; inconsistent with the stated mechanism (Correct Answer)
C. The pattern is consistent with the child stepping into hot water accidentally
D. The sparing of the soles suggests protective flexor withdrawal reflex during accidental immersion
E. The circumferential distribution is typical of curious toddlers exploring bath water

Explanation: ***The symmetry and demarcation suggest forced immersion; inconsistent with the stated mechanism*** - **Symmetric, circumferential burns** with a sharp **demarcation line** (often called a stocking or glove burn) are highly indicative of **forced immersion**, a classic sign of **non-accidental injury**. - The absence of **splash marks** contradicts an accidental scenario where a child would struggle and cause splashing, suggesting the child was held still in the hot water. *The absence of splash marks indicates the water temperature was not excessively hot* - The lack of **splash marks** is a critical indicator of **forced immersion**, not necessarily of moderate water temperature; it implies the child was held motionless. - Water temperature primarily affects the **depth** and **severity** of the burn, whereas the pattern and presence of splash marks relate to the mechanism of injury. *The pattern is consistent with the child stepping into hot water accidentally* - Accidental stepping into hot water would typically result in **asymmetric burns** with **irregular margins** and often **splash marks** as the child attempts to withdraw. - The described **symmetric, circumferential pattern** with a sharp line is inconsistent with a child independently entering and immediately withdrawing from hot water. *The sparing of the soles suggests protective flexor withdrawal reflex during accidental immersion* - **Sparing of the soles** in immersion burns can occur when the soles are pressed firmly against the cooler bottom surface of the tub, protecting them from direct contact with the hot water. - While a **withdrawal reflex** exists, it would lead to erratic movements, splashes, and less defined, asymmetric burn patterns, not the neat demarcation observed. *The circumferential distribution is typical of curious toddlers exploring bath water* - Curious exploration by a toddler usually results in **irregular**, **asymmetric burns** (e.g., on one hand or foot) with significant **splash marks** due to active movement and curiosity. - A **circumferential burn** on both feet up to a clear demarcation requires prolonged, still immersion, which is not consistent with a toddler's natural exploratory behavior or reaction to pain.

Question 2: A multi-agency safeguarding conference discusses a 9-year-old girl living with her mother and mother's partner. The girl disclosed sexual abuse by the partner to her teacher. Medical examination findings are non-specific. The mother initially did not believe the disclosure but now states she will protect her child. The partner denies allegations and remains in the home. Social care recommends the child's name be placed on a child protection plan. What is the strongest evidence-based factor that should most heavily influence the decision about immediate safety?

A. The absence of definitive physical findings on medical examination
B. The mother's statement that she will now protect the child
C. The alleged perpetrator's denial of the allegations
D. The alleged perpetrator's continued presence in the household (Correct Answer)
E. The child's age and ability to provide a credible disclosure

Explanation: ***The alleged perpetrator's continued presence in the household*** - The single most significant **risk factor** for ongoing harm in cases of intrafamilial sexual abuse is the **continued proximity** of the alleged perpetrator to the child. - Research indicates that **immediate safety** cannot be guaranteed unless the alleged perpetrator is removed from the home or the child is moved to a **place of safety**. *The absence of definitive physical findings on medical examination* - Most cases of **child sexual abuse** do not result in definitive **physical evidence** or trauma detectable during a medical exam. - Non-specific findings do not negate the **validity of the disclosure** and should never be used to minimize the risk of ongoing harm. *The mother's statement that she will now protect the child* - A parent's verbal assurance is often **unreliable** as a sole safety measure, especially when there was **initial disbelief** of the child’s disclosure. - Parental protection must be evidenced by **decisive action**, such as removing the partner, rather than just expressed **intent**. *The alleged perpetrator's denial of the allegations* - **Denial** is a standard response from alleged perpetrators and does not lower the **risk profile** or clinical suspicion of abuse. - Protective decisions must be based on the **child’s safety needs** rather than the perpetrator's refusal to admit to the actions. *The child's age and ability to provide a credible disclosure* - While the child's age and **disclosure to a teacher** are key parts of the case, they do not constitute the primary measure of **current safety**. - The **credibility** of the disclosure is already established; the decision about immediate safety must focus on mitigating the **environmental risk**.

Question 3: A paediatric team reviews three infants with head circumference concerns. Infant A (4 months): head circumference crossing from 50th to 91st centile with bulging fontanelle and vomiting. Infant B (6 months): head circumference consistently on 98th centile since birth, father has large head. Infant C (5 months): head circumference crossing from 75th to 25th centile with developmental regression. Which infant requires the most urgent neuroimaging?

A. Infant A only
B. Infant B only
C. Infant C only
D. Infants A and C (Correct Answer)
E. All three infants

Explanation: ***Infants A and C*** - **Infant A** needs urgent imaging because upward **crossing of centiles** (50th to 91st) combined with a **bulging fontanelle** and **vomiting** are classic signs of **raised intracranial pressure**, often indicative of conditions like **hydrocephalus**. - **Infant C** requires urgent evaluation because **downward centile crossing** (75th to 25th) paired with **developmental regression** is a major red flag for **neurodegenerative disorders**, **microcephaly**, or significant structural brain damage. *Infant A only* - While Infant A has acute symptoms of **increased intracranial pressure**, this option ignores the equally significant and urgent risk factors present in Infant C. - Only imaging Infant A would fail to investigate the concerning **microcephaly** and **developmental regression** in Infant C, which also requires immediate specialist diagnostic workup. *Infant B only* - Infant B's presentation is consistent with **benign familial macrocephaly**, as the head size has remained **consistently on the 98th centile** since birth with a positive family history and no neurological symptoms. - In the absence of **neurological red flags** or crossing centiles, this infant is the least likely to require urgent neuroimaging. *Infant C only* - Although **developmental regression** and loss of head growth centiles are critical indicators, this option neglects the acute and potentially life-threatening condition presented by Infant A. - Both **upward and downward crossing** of head circumference centiles require urgent attention when associated with concerning clinical signs. *All three infants* - This option is incorrect because **Infant B** does not demonstrate any clinical "red flags" such as a **bulging fontanelle**, vomiting, or crossing centiles. - Unnecessary neuroimaging in Infant B is avoided if the child is **meeting milestones** and has a normal physical examination consistent with family traits.

Question 4: A 7-year-old boy is brought to the GP by his grandmother who recently gained custody. She reports he was living in poor conditions with his mother, who has substance misuse problems. The boy frequently wets the bed, hoards food in his room, is reluctant to be left alone, and has angry outbursts. Growth is on the 2nd centile for height and weight; he was on the 50th centile at age 2. Which aspect of this presentation is most concerning for long-term neurodevelopmental impact?

A. Current height and weight on 2nd centile
B. Nocturnal enuresis at age 7 years
C. Food hoarding behaviour
D. Growth faltering from 50th centile to 2nd centile between ages 2-7 years (Correct Answer)
E. Separation anxiety and angry outbursts

Explanation: ***Growth faltering from 50th centile to 2nd centile between ages 2-7 years***- A significant drop across multiple centiles indicates **chronic malnutrition** during a critical period of **brain maturation**, which can lead to irreversible neurodevelopmental deficits.- Persistent **growth faltering** is a clinical marker for severe **neglect**, often correlating with lower cognitive scores, poor educational attainment, and long-term behavioral issues.*Current height and weight on 2nd centile*- A single point on the growth chart is less clinically significant than the **downward trajectory** (velocity) shown over time.- Some children are constitutionally small; it is the **loss of centiles** from a higher baseline that indicates a pathological process like neglect.*Nocturnal enuresis at age 7 years*- While common in children experiencing **trauma** or psychological stress, this is often a **reversible** symptom that improves with stability and behavioral support.- It is a symptom of **emotional distress** rather than a primary driver of long-term neurodevelopmental structural changes like malnutrition.*Food hoarding behaviour*- This is a classic indicator of **prior food insecurity** and **emotional neglect**, representing an adapted survival mechanism.- Although it highlights a history of neglect, it is generally considered a **behavioral adaptation** rather than a cause of permanent neurodevelopmental insult.*Separation anxiety and angry outbursts*- These features suggest **insecure attachment** or trauma-related emotional dysregulation resulting from the mother's substance misuse and poor living conditions.- While they require **therapeutic intervention**, these emotional manifestations often show significant recovery once the child is in a **stable, nurturing environment**.

Question 5: A 36-month-old girl is assessed in the developmental clinic. She speaks in 3-4 word sentences, can pedal a tricycle, builds a tower of 9 cubes, and can copy a circle. She cannot yet hop on one foot or copy a cross. She feeds herself with a spoon and fork but cannot yet use a knife. Which statement best describes her development?

A. Global developmental delay requiring urgent investigation
B. Age-appropriate development across all domains (Correct Answer)
C. Isolated gross motor delay with other domains appropriate
D. Fine motor delay with speech and gross motor appropriate
E. Speech and language delay with motor skills appropriate

Explanation: ***Age-appropriate development across all domains*** - At **36 months (3 years)**, a child is expected to speak in **3-4 word sentences**, pedal a **tricycle**, build a tower of **9 cubes**, copy a **circle**, and feed with a **spoon and fork**, all of which this child can do. - The skills she lacks, such as **hopping on one foot**, **copying a cross**, and **using a knife**, are typical **4 to 5-year-old milestones**, indicating her current development is perfectly normal for her age. *Global developmental delay requiring urgent investigation* - **Global developmental delay** is defined by significant delays in two or more developmental domains, which is not applicable here as the child meets age-appropriate milestones in all areas. - Urgent investigation is typically warranted for significant delays or **developmental regression**, neither of which is observed in this child. *Isolated gross motor delay with other domains appropriate* - Being able to **pedal a tricycle** is an appropriate gross motor milestone for a **3-year-old**; hopping on one foot is a **4-year-old milestone**. - Since the child meets the expected gross motor skills for her age, there is no evidence of an isolated gross motor delay. *Fine motor delay with speech and gross motor appropriate* - Building a **tower of 9 cubes** and **copying a circle** are appropriate fine motor milestones for a **3-year-old**. - Copying a **cross** and using a **knife** are more advanced fine motor/adaptive skills usually acquired around **4 to 5 years**, so their absence is not a sign of delay at 36 months. *Speech and language delay with motor skills appropriate* - Speaking in **3-4 word sentences** is an age-appropriate language milestone for a **36-month-old child**. - A speech or language delay would typically involve significantly fewer words, simpler sentence structures, or unintelligible speech, none of which are indicated here.

Question 6: A 11-month-old infant is brought to the emergency department by her father with a swollen right thigh. He reports she was crawling and suddenly started crying. X-ray reveals a spiral fracture of the right femur. The infant is pre-mobile and not yet pulling to stand. There is no history of trauma. On examination, there are no other injuries. What is the single most important next step?

A. Discuss with orthopaedics for fracture management and discharge home with follow-up
B. Arrange bone profile and vitamin D level to investigate for metabolic bone disease
C. Contact the named nurse for safeguarding and initiate child protection procedures (Correct Answer)
D. Obtain detailed history from the mother separately to corroborate the mechanism
E. Request a full blood count and clotting screen to exclude bleeding disorder

Explanation: ***Contact the named nurse for safeguarding and initiate child protection procedures*** - A **spiral fracture** of the femur in a **pre-mobile infant** (11 months old, not yet pulling to stand) with a reported mechanism of "suddenly started crying" while crawling and **no history of trauma** is highly suspicious for **Non-Accidental Injury (NAI)**. - In such cases, the immediate priority is to ensure the **child's safety**, which mandates initiating **child protection procedures** and contacting the **safeguarding team**. *Discuss with orthopaedics for fracture management and discharge home with follow-up* - While **orthopaedic management** is crucial for the fracture itself, discharging the infant home without a thorough **safeguarding assessment** would be negligent given the high suspicion of NAI. - The **child's safety** is paramount, and a discharge plan cannot be made until the risk of further harm has been adequately assessed and mitigated through **child protection protocols**. *Arrange bone profile and vitamin D level to investigate for metabolic bone disease* - Investigations for underlying medical conditions like **metabolic bone disease** (e.g., osteogenesis imperfecta, rickets) are important but are **secondary** to ensuring immediate safety and should not delay **child protection procedures**. - A **spiral fracture** in a non-ambulatory child is rarely caused by **metabolic bone disease** alone; NAI is a much more common cause in the absence of significant trauma. *Obtain detailed history from the mother separately to corroborate the mechanism* - While gathering more information from other caregivers is a valid part of the assessment, the stated mechanism of "crawling and suddenly crying" is **biomechanically inconsistent** with a **femoral spiral fracture** in a pre-mobile infant. - This discrepancy already constitutes a **safeguarding concern** requiring immediate action, and delaying the referral to obtain more history from another parent would not be the **single most important next step** for ensuring safety. *Request a full blood count and clotting screen to exclude bleeding disorder* - A **clotting screen** and **full blood count** may be part of a comprehensive workup for NAI to rule out coagulation disorders that could predispose to fractures or excessive bruising, but they do not explain the **spiral fracture**. - These investigations are **diagnostic aids** but do not address the immediate safety concerns or initiate the essential **child protection process**, which is the most critical first step.

Question 7: A 8-year-old boy is referred to the community paediatrician because his height has dropped from the 50th centile at age 4 years to the 9th centile at age 8 years. He has gained weight appropriately (50th centile). His teacher reports he has been tired at school. Examination reveals mild pallor and a soft goitre. What is the most likely diagnosis?

A. Constitutional delay of growth and puberty
B. Growth hormone deficiency
C. Coeliac disease
D. Hypothyroidism (Correct Answer)
E. Chronic kidney disease

Explanation: ***Hypothyroidism*** - The combination of **growth deceleration** (height dropping from 50th to 9th centile) with preserved **appropriate weight gain** is highly suggestive of acquired hypothyroidism in a child. - Clinical findings like **fatigue** at school, **mild pallor**, and the presence of a **soft goitre** are classic signs, often indicative of **Hashimoto's thyroiditis**. *Constitutional delay of growth and puberty* - Children with this condition typically follow a **lower but consistent growth curve**, rather than a **sudden drop in height centiles** after age 4. - It does not account for the systemic symptoms like **tiredness** and **pallor**, nor the presence of a **goitre**. *Growth hormone deficiency* - While it causes **growth failure** and can lead to short stature, it is not associated with the presence of a **goitre**. - Although fat accumulation can occur, **pallor** and thyroid enlargement are not typical features of isolated growth hormone deficiency. *Coeliac disease* - This condition primarily causes **failure to thrive**, meaning **weight gain is usually more significantly affected** than height, which contradicts this patient's appropriate weight. - While it can cause **pallor** due to malabsorption and iron deficiency, it would not present with a **goitre**. *Chronic kidney disease* - CKD can lead to **growth failure**, but it is generally accompanied by **poor weight gain**, anorexia, and specific biochemical abnormalities, which are not mentioned in this case. - The presence of a **goitre** is not a feature of chronic kidney disease-related growth failure.

Question 8: A 5-year-old girl presents to the emergency department with her mother reporting a fall down three stairs resulting in a fractured clavicle. On examination, there are multiple bruises in various stages of healing on her upper arms, back, and buttocks. The mother explains these are from 'normal play'. The child appears withdrawn and makes little eye contact. What is the most appropriate immediate action?

A. Document the injuries photographically, treat the fracture, and discharge with GP follow-up
B. Arrange X-ray skeletal survey, discuss with senior ED staff and paediatrics, and initiate safeguarding procedures (Correct Answer)
C. Contact the school to enquire about any previous concerns before proceeding further
D. Refer to orthopaedics for fracture management and arrange routine outpatient follow-up
E. Discuss concerns with the mother and provide written safety advice about home environment

Explanation: ***Arrange X-ray skeletal survey, discuss with senior ED staff and paediatrics, and initiate safeguarding procedures*** - The combination of a **fractured clavicle** from a minor fall (inconsistent mechanism), **multiple bruises in various stages of healing** in atypical locations (upper arms, back, buttocks), and the child's withdrawn demeanor strongly indicates **non-accidental injury (NAI)**. - Immediate actions include a **skeletal survey** to identify other occult fractures, consultation with **senior ED staff and paediatrics** for expert assessment, and **initiating safeguarding procedures** to ensure the child's safety and welfare. *Document the injuries photographically, treat the fracture, and discharge with GP follow-up* - While photographic documentation is important, **discharging** a child with strong suspicion of NAI would put them at **immediate risk of further harm** and is a failure of professional **safeguarding duties**. - A GP follow-up is entirely inadequate for a complex child protection concern; comprehensive, multi-agency intervention is required. *Contact the school to enquire about any previous concerns before proceeding further* - Delaying direct medical assessment and urgent safeguarding action to gather information from external sources is inappropriate when there is an **immediate concern for child safety**. - The priority is to secure the child's safety and initiate medical evaluation within the hospital, before external inquiries are made. *Refer to orthopaedics for fracture management and arrange routine outpatient follow-up* - This option focuses solely on the medical management of the fracture, completely **missing the crucial signs of potential child abuse**. - **Routine outpatient follow-up** is insufficient for a child presenting with injuries inconsistent with the reported mechanism, which necessitates immediate and thorough investigation. *Discuss concerns with the mother and provide written safety advice about home environment* - Directly confronting the mother with suspicions and providing advice is insufficient and potentially detrimental in suspected child abuse; it may not lead to disclosure and does not fulfill **statutory safeguarding obligations**. - The clinical findings of inconsistent injury and multiple bruises in various stages of healing override the caregiver's explanation and mandate a formal **safeguarding referral**.

Question 9: A 25-month-old boy is brought to the GP by his mother with concerns about speech development. He uses approximately 15 single words and no two-word combinations. He follows simple commands, points to body parts, and engages in pretend play. Hearing assessment is normal. What is the most appropriate next step?

A. Reassure that this is within normal limits and review in 6 months
B. Refer to speech and language therapy for assessment and intervention (Correct Answer)
C. Arrange chromosomal microarray for suspected genetic syndrome
D. Advise the mother to limit screen time and increase verbal interaction at home
E. Refer urgently to paediatric neurology for investigation of global developmental delay

Explanation: ***Refer to speech and language therapy for assessment and intervention*** - By the age of **24 months**, a child should typically use at least **50 single words** and be combining two words; having only 15 words without two-word phrases at 25 months signifies a significant **expressive language delay**. - Early referral to speech and language therapy is crucial for timely assessment and intervention, which can significantly improve long-term language outcomes during this critical developmental period. *Reassure that this is within normal limits and review in 6 months* - This child's expressive vocabulary of 15 words is well below the expected **milestone of 50+ words** and two-word combinations for a 25-month-old, making reassurance inappropriate. - Delaying professional assessment and potential intervention could miss a crucial window for supporting language development, leading to more persistent difficulties. *Arrange chromosomal microarray for suspected genetic syndrome* - **Chromosomal microarray** is typically considered when there are multiple developmental delays, dysmorphic features, or other systemic concerns pointing to a genetic syndrome. - This child presents with an **isolated expressive language delay** while other domains like receptive language, social interaction, and pretend play appear intact. *Advise the mother to limit screen time and increase verbal interaction at home* - While reducing **screen time** and increasing verbal interaction are beneficial for language development, they are supportive measures and not a substitute for professional assessment for a significant delay. - A professional **speech and language therapist** can identify specific areas of difficulty and provide targeted strategies and therapies that go beyond general home interaction. *Refer urgently to paediatric neurology for investigation of global developmental delay* - An urgent **paediatric neurology referral** is not indicated as the child demonstrates normal receptive language, follows commands, points to body parts, and engages in pretend play. - **Global developmental delay** involves significant delays in two or more developmental domains, which is not the case here as the delay appears to be primarily in expressive language.

Question 10: A safeguarding team discusses the legal framework for child protection. Following a strategy discussion where significant harm is suspected, which statutory assessment must be completed within 45 working days under the Children Act 1989?

A. Child protection medical examination
B. Section 47 enquiry leading to a child protection conference
C. Core assessment to inform decision-making about the child's needs (Correct Answer)
D. Interim care order application to the family court
E. Multi-agency risk assessment conference (MARAC)

Explanation: ***Core assessment to inform decision-making about the child's needs*** - Under the **Children Act 1989** and "Working Together to Safeguard Children," a comprehensive **single assessment** (previously known as a core assessment) should be completed within a maximum of **45 working days**. - This assessment evaluates the child's **developmental needs**, parenting capacity, and family/environmental factors using the **Assessment Framework triangle**. *Child protection medical examination* - This is a clinical evaluation to look for physical evidence of **abuse or neglect** and should be conducted as early as possible. - It does not have a 45-day statutory timeline and is often performed **urgently** following a referral or strategy discussion. *Section 47 enquiry leading to a child protection conference* - A **Section 47 enquiry** is initiated when there is "reasonable cause to suspect significant harm," but it operates on a much tighter schedule. - If the enquiry suggests risk, an initial **Child Protection Conference (ICPC)** must typically be held within **15 working days** of the strategy discussion. *Interim care order application to the family court* - This is a **legal application** for the local authority to share parental responsibility when a child is at immediate risk. - While it involves the court system, it is not a statutory 45-day assessment; it is a legal measure taken during **care proceedings**. *Multi-agency risk assessment conference (MARAC)* - A **MARAC** is a meeting primarily focused on managing high-risk cases of **domestic abuse** and the safety of the adult victim. - It is a multi-agency information-sharing meeting rather than a primary child protection assessment with a statutory **45-day completion target**.

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