Child Health Other

Question 1

What are the 5 different groups of patients in paediatrics ?

Answer 1

• Newborn, infant and preschool child are the most difficult
• Schoolchild is reasonable and rational
• Teenagers are challenging
• Communication - aspects of history and examinat

Question 2

General enquiry and systems review in children

Answer 2

1. General health – active and lively?
2. Growth – normal and following centiles
3. Feeding/drinking and appetite
4. Recent change in behaviour or personality (not his usual self)
   • Systems review
   • Symptoms for each system
   • Past medical history (follow chronologically) • Antenatal including maternal obstetric history
   • Birth weight and gestation
   • Perinatal issues and admission to baby units
   • Immunisations
   • Past illness/ accidents, injuries

Question 3

How would you asses Neurology – co-ordination in a child?

Answer 3

• Finger nose testing
• Heel toe, jump, hop
• Drawing, placing blocks
• Sensation – ability to feel light touch is a screening test
• Reflexes – approach with care and ensure he is relaxed • Brisk reflexes may indicate anxiety
• Plantar response (unreliable under 1 year)
• Patterns of movement (look for asymmetry)
• Assess walking and running; heel toe walk
• Fog’s test, Gower’s signs
• Ask children to stand up from lying supine – upto 3 years will turn supine and stand
• Examine spine

Question 4

Rights of Child

Answer 4

• Survival
• Right to life and basic needs – food, shelter and access to healthcare
• Developmental
• Achieve full potential – education, play
• Protection
• Against abuse of any form
• Participation • In society

Question 5

Types of abuse

Answer 5

• Physical abuse
• Neglect
• Emotional abuse
• Sexual abuse
• Fabricated Induced Illness

Question 6

Risk factors for child abuse

Answer 6

• Child: disability, ‘wrong gender’, result of non consensual sex
• Parent: mental health problems, substance misuse, indifference
• Family: domestic violence, social isolation, young age, multiple births, step parent rather than biological parent
• Environment: poverty, poor housing

Question 7

Bruises suggestive of abuse

Answer 7

• Bruising in babies
• Children not independently mobile
• Bruises away from bony prominences
• Bruises to face, back, abdomen, buttocks, arms and ears • Clusters of multiple bruises
• Multiple bruises of uniform shape
• Bruises that carry an imprint
• Bruises associated with petechiae

Question 8

Investigations for suspected child abuse

Answer 8

• Bloods - ?clotting in bruising • Skeletal survey
• Fractures • CT brain
• Intracranial haemorrhages • Ophthalmology
• Retinal haemorrhages
• Forensic
• Child death
• Sexual abuse

Question 9

What to do in case of suspected child abuse?

Answer 9

• Escalate concerns to person in charge
• Communicate your concern to other agencies using paperwork
designed for this purpose i.e. MARF
• Contribute to safeguarding processes (meetings)
• Where is a place of safety for the child? (should we admit?)
• Ensure multidisciplinary members are included in discussions
• Document clearly (the cases have shown you how important neat handwriting is!) and factually
• Safeguarding is everyone’s responsibility