Children's Health in Primary Care Flashcards
Describe how extremes of age can have an effect on health
There is no homeostasis in the very young and the very old. This means elderly people are more likely to have respiratory disease and delierium and young children have less adaptability and immunity.
Define milestones
An approximate guide used by HCPs (GPs, HVs and paediatricians) as to how baby is progressing against certain criteria that has been accepted as being within normal limits. These will vary between healthy babies. Parental interaction is very important in achieving milestones.
Describe the developmental milestones for the following time periods: 1-4 weeks 2-4 weeks 4-6 weeks 5-12 weeks 3-5 months 6 months 6-8 months 6-9 months 10-18 months
Startled by loud noises Face contact awareness Smiling and facial responses Able to lift head while lying on stomach Reaches for objects (then into mouth) Sits up without support Able to hold an object with both hands Crawling Walking alone
State the advantages and disadvantages of milestones:
Adv:
Aid management in child development and provide clear cut off points for referral
Make it easier to reassure anxious patients about the range of normality and provide parents with a logical progression for developmental process
Provides a structure for developmental assessment
Aids parental interaction for child development
Use in research allows peer group comparison
Disadv:
May cause parental anxiety
Scope for misinterpretation of guidelines
Medicalisation of normally
May place dr in difficult situation e.g. parental anxiety may cause unnecessary referral
May be difficult to balance confounding factors like premature against guidelines
Describe some communication issues when discussing milestones with concerned parents
Listen.
Balance referring and causing anxiety with missed diagnoses. Parents will forgive reassurance given in good faith but are less likely to forgive dismissiveness.
Listen, ask questions about PMH and other milestones, fully examine child, involve health visitor, see them back.
HV will see mum and baby with in 10 days of coming home - usually pick up problems
Social work may be involved with single parents, low income, drug users etc. GPs and paediatricians need to be aware of role and responsibilities, primarily to the child.
Define: Low Birth Weight Stillbirth rate Perinatal mortality Neonatal death Infant mortality
40 or
Give the following key statistics on global child health
Infant mortality in UK, India and Sierra Leone
Number of under 5’s underweight for their ages
Number of newborns dying in first month of life
4/1000, 44/1000, 117/1000
14.8M
4M
Lists strategies for improving global child health
Vaccines Education Better nutrition Clean water Better contraception Crop growth Insecticides and malarial nets Better maternal care Persuading governments they can do more Equal wealth distribution
List factors that may enhance a child’s development in the UK
Good parenting (couple) (establish habits and lifestyles in adolescence; smoking x2 more likely if you smoke) Nutrition (breast feeding) Screening tests (CF, PKU etc) Check-ups with HV Immunisation schedule adhered to Establishment of healthy lifestyle
List factors that may hinder a child’s development
Poor housing
Poverty
Emotional deprivation
Abuse by parents and others in early years including sexual abuse (tends to recur)
Poor nutrition in early years (sugar) (Scotland - highest premature death form heart disease rates - low fruit and veg, high sat fats )
Lack of exercise
Poor schooling and education
List factors that are detrimental to foetal wellbeing
Smoking (low birth weight)
Alcohol (more than 5-6 units - FAS, premature delivery and IUGR)
Illicit drugs
Prescription drugs (check BNF and refer if on ant-epileptics or psychiatric medication)
OTC medication, internet and herbal remedies
Radiation from X-rays (later cancer risk)
Dietary factors - folic acid supplements to prevent spina bifida up to 12th week, soft cheese and pate (cancer risk)
Infectious diseases - Toxoplasmosis (cat litter, brain problems) O Rubella (intrauterine death, developmental and brain problems) Cytomegalovirus, Chickenpox (do immunoglobulins), Herpes (pneumonia and hypoxia, do C-section)
Discuss the problems a single parent family might encounter and how the government can address this.
Breakdown of family structure
Likely to be on a lower income - less money for nutritional food etc.
Parent less likely to have time to spend on interaction.
Parent may find it more difficult to get a job.
Making benefits easily available will enable them to provide better resources to children.
Government should provide free high quality education and free school meals.
Describe how a GP might respond to child protection concerns
Refer to Practice Child Protection Folder, National Guidance for Child Protection SCOTLAND 2010, RCGP - Safeguarding Children. Healthcare professionals must ensure that the appropriate agencies are informed so that the child does not come to further harm.
List the common presentations of children in primary care
Feeding problems
Pyrexia
URTI: coughs, colds, rashes, otalgia, sore throat
Vomiting with or without diarrhhorea
abdominal pains
Behavioural problems (older infants, depends on parental situation)
Describe the important parts of the consultation
Listen, watch, observe, examine properly, put parent and child at ease, take it seriously, ask parental understanding, explain in clear language what your plans are.
Strike a balance between what is needing done and not.
ICE, rapport, consensus, allow questions, offer second opinion, no dogma, facilitate return visit.
