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Child Health in General Practice

Child Health in General Practice. Dr. Kieran McGlade. Child Health Issues. Preventative Medicine Developmental Surveillance Family Health Common diseases of Childhood Common problems in children. Preventative Medicine in Child Care. Ante-natal care ante-natal screening

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Child Health in General Practice

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  1. Child Health in General Practice Dr. Kieran McGlade

  2. Child Health Issues • Preventative Medicine • Developmental Surveillance • Family Health • Common diseases of Childhood • Common problems in children

  3. Preventative Medicine in Child Care • Ante-natal care • ante-natal screening • folate supplements and nutrition • Neonatal care • environment • feeding • Immunisations

  4. The Old Childhood Immunisation Schedule • Primary immunisations at 8, 12 and 16 weeks • Diphtheria, Tetanus, Pertussis HIB and Polio(5 in one injection) • Meningitis C (single component injection) • Measles mumps and rubella vaccine (MMR) in second year of life (1 injection) – usually about 15 months. • Pre-school boosters • Diphtheria, Tetanus, Pertussis and Polio(4 in one injection) • MMR http://www.immunisation.nhs.uk/

  5. Changes to the Schedule • Addition of a pneumococcal conjugate vaccine (PCV) at 2,4 and 15 mths of age • One dose of Men C vaccine at 3 & 4 Mths • Booster dose of combined Hib & MenC 1t 12 Mths of age

  6. Immunisation Schedule 2006

  7. Immunisation Schedule 2006

  8. Effect of the changes to the old schedule • Infants will be offered different combinations of vaccines at the 2,3 and 4 mth visits • Three injections will be offered to infants at 4 mths of age • A new 12 Mth vaccine will be introduced. http://www.immunisation.nhs.uk/

  9. Things not to miss • Phenylketonuria • Hypothyroidism • Congenital dislocation of the hip • Retinoblastoma • Down’s Syndrome

  10. Developmental Surveillance • Periodic assessment of a child’s developmental progress with the aim of detecting pre-symptomatic disability • Screening procedures should be brief, simple, cheap and reliable • May be combined with immunisation visits - if so, screening should be done first

  11. What do we look for in developmental screening? • Normal growth pattern • Height, weight, head circumference • Achievement of developmental milestones(indicating neurological development) • Gross motor function • Fine motor function and vision • Hearing and speech • Social behaviour and play

  12. How do we carry out developmental screening • Often in a clinic • GP and Health visitor • Direct observation • Listening to parents / carers • History is important - we want to find out what the child can and cannot do • Specific tests

  13. Developmental Screening Tests 6 weeks • Head Control • usually achieved by 6 weeks • Moro response • present at 6 weeks, gone by 6 months • Gaze fixes in mother’s face, follows a brightly coloured object past the midline • Rattle or bell, 15cm at ear level - quietens or turns to sound.

  14. Family HealthFamily Life Cycle Stages • The new couple • Birth of first child • School age family • Adolescent family • Launching family • Empty nest • Ageing family

  15. Group Tasks • List the commonest diseases in childhood. • List the commonest presenting symptoms in childhood.

  16. Common diseases in Childhood • Nappy rash • Upper Respiratory Tract Infection • Infectious Diseases • Urinary tract infection • Asthma • Eczema and other rashes • Trauma

  17. Measles Mumps Rubella Pertussis Chickenpox URTI Otitis media Tonsillitis UTI Gastro-enteritis Herpes stomatitis Meningitis Infectious diseases and common infections

  18. Common Problems • Sore tummy • Headaches • Rashes and fevers • Bed wetting - enuresis • Behavioural problems / school refusal • Cough • Diarrhoea and vomiting

  19. Group tasks (2) • Discuss how you might manage the following scenarios: • A six month old baby presenting with a fever • A five year old presenting with a cough • A nine year old with an itchy rash on her trunk. • A ten year old child with recurrent headaches

  20. On observing a consultation with a child - questions to ask yourself • Who is the patient? • What is the reason for the consultation? • What opportunities does this consultation present? • Is the consultation structured any differently from an adult consultation?

  21. Summary • Child health is an integral part of GP. • It embraces prevention, diagnosis and treatment. • A knowledge of the family is an important key to the understanding of child health problems. • Flexibility of approach, attention to detail, observation and listening to children and parents are of crucial importance.

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