Community Based Medicine - STSC - 3 minute checklist

Question 1

What is the 3 minute Toolkit for spotting a sick child?

Answer 1

A - Airways: Secretions - Stridor - Foreign Body

B - Breathing: RR- Muscle use - O2 Sats - Auscultation

C - Circulation: Colour (eg pale, mottled, HR, Capilliary refill, Temp of hands and feet

D - Disability: Pupils - Limb tone & movement - AVPU score/GCS

ENT - Ears, Nose and Throat examination

T - Temperature

T - Tummy

If drowsy or unwell, include:

DEFG - And as part of C

Question 2

Basic Child Assessment – 3 Minute Tool Kit: Learning Points

Answer 2

A – Airway – Is it obstructed?

• eg secretions, foreign body, stridor

B – Breathing – Is the child struggling to breathe?

• Assess respiratory rate, look for recession/accessory muscle use, check oxygen saturation, auscultate the chest

C – Circulation – Is there evidence of poor circulation?

• Assess colour skin, heart rate, capillary refill time (on sternum and fingers/toes), blood pressure, warm or cold hands/feet?

D – Disability – What is the child’s neurological state?

• Assess pupil response to light, limb tone and movement, AVPU score/GCS

E – Exposure – Have you exposed the child and examined top-to-toe?

• Rashes – viral rash, infectious disease rash, non-blanching rash (septicaemia?)
• Any evidence of injury/trauma
• Bruises – Always think Non-accidental injury in the non-mobile child
• Use any safeguarding skills you have learnt on accredited courses in child protection to identify any marks on the skin, or how a child is kept, or their interaction with the parent(s)/guardian(s).

ENT – Ears, Nose and Throat

• T – Temperature ­– Use a tympanic or axillary thermometer.
• You may require a rectal thermometer in the very unwell child
• T – Tummy – Is this soft? Distended? Tender? What are the bowel sounds like? Any masses? Any hernias?
• In boys, never forget to examine the testis (testicular torsion = surgical emergency)
• Urinalysis

D E F G – Don’t Ever Forget Glucose!

Question 3

Basic Child Assessment – Communication

Answer 3

• Good communication can help calm child and parents
• Be aware distraction techniques
• Be aware of the appropriate environment to assess the sick child

Question 4

Assessing and Treating Children?

Answer 4

• Let the anxious/crying child calm down first
• Observe from a distance
• Let the child see you talking with the parents
• Use family members to help calm the child down
• If the child is old enough, let them provide you with the history (which you will clarify with the parents)

Question 5

Try to befriend the child before examining them

Answer 5

• A lot can be gained from observation alone
• A distressed child can give false examination/physiological findings
• Get down to their level
• Appear non threatening
• Take an interest in their interests or the toy/teddy they have brought (does teddy need a check-up too?)
• Use parents
• Use toys and play
• Use positive body language and smile
• Keep the child close to the parents during examination if possible. Separating them can cause upset