Community child health Flashcards
1
Q
Key legislation regarding child protection
A
- Children act 1989 (2004)
- Section 17: places duty on local authorities to provide support and services for children in need
- Section 47: places duty on local authorities to make enquiries in cases where there is reasonable cause to suspect that a child is suffering or is likely to suffer significant harm
2
Q
Stats regarding community child health concerns
A
- 1-2 children die each week as a result of abuse and neglect
- 7% of children suffer serious physical abuse at the hands of their parents and carers
- 2/3 of children killed by another in England and wales are <5yrs
- 52% of 1yr olds are hit weekly or more by parents
- 109,000 babies <1yr live with parents who is a drinker/ druggie
- 144,000 babies <1yr have a parent with a mental health problem
- 39,000 babies <1yr have a parent who has experienced domestic abuse in the last yr
3
Q
Bruises suggestive of abuse
A
Sites: over bony prominence is more suggestive of accidental injury
- Head, neck and face
- On or around ears, eyes or mouth
- Lumbar region, chest, back, buttocks
- Genitals
- Inner thighs
- Feet
Types
- Patterns matching an implement
- Petechiae
4
Q
Discuss abusive head injury
A
- Most common cause of fatal child maltreatment
- Approx. 24/100,000 babies under 12months are victims of AHI
- Not always a hx of trauma
- Not always an acute presentation
- Diagnosis may be delayed
- Subdural/ retinal haemorrhages
5
Q
Outline the multidisciplinary teams involved in the care of children
A
- GPs carry out routine examination as part of house surveillance programs and all the first contact during illness
- Health visitors offer general support and advice to children under the age of five years for example parenting skills, health, nutrition and child development. They also offer support for vulnerable children
- Community paediatricians oversee care for children with significant problems or more complex needs, they usually take the lead in child protection cases and have a key role in monitoring the health of children in foster care
- Hospital paediatricians treat acute illness that cannot be managed in primary care and paediatric conditions outside the scope of general practice
6
Q
What forms the 6-in-1 vaccine?
A
- Diphtheria
- Hepatitis B
- Hib (Haemophilus influenzae type b)
- Polio
- Tetanus
- Whooping cough (pertussis)
7
Q
What forms the 3 in 1 vaccine?
A
The 4-in-1 pre-school booster vaccine is offered to children from the age of 3 years and 4 months to boost their protection against 4 different serious diseases:
- Diphtheria
- Tetanus
- Whooping cough
- Polio
8
Q
Immunisation schedule for children born prematurely
A
- Follow immunisation according to chronological age rather than corrected gestational age
9
Q
Primary and secondary vaccine failure
A
- No vaccine will offer 100% production and vaccine failure can occur, this will either be primary or secondary
- In primary failure there is no initial immune response to the vaccine – this occurs in 5–10% of children who have the first dose of the MM are vaccine
- In secondary failure at the initial immune response is good but the resulting protection decreases over time – hence the need for a preschool booster of the pertussis vaccine before school
10
Q
What is the child health surveillance programme?
A
- This is a formalised program to overview the physical social and emotional health and development of every child
- Aims to improve health and well-being during childhood and beyond as health during childhood and adolescence impacts health during adult hood
- Surveillance begins in childhood and continues in too late teenage years but primarily focuses on the early years
- Child health surveillance programs usually include:
- Monitoring physical growth
- Monitoring intellectual and social development
- Screening for certain conditions
- Immunisation
- Health promotion including provision of information and support for parents
11
Q
What is the healthy child programme?
A
- Delivered by health visitors and school nurses, a program for children, young people and families which focuses on early intervention and prevention and offers research based guidance on development reviews, immunisations, screenings and healthy choices
- Health visitors and school nurses are responsible for delivering public health programs and interventions to improve health outcomes for parents, children, young people and families.
- Some of these key public health issues include breastfeeding, dental health, growth and development, healthy weight and physical activity, emotional health and well-being, sexual health and guidance, smoking cessation and drug/alcohol misuse
- Additional interventions are then targeted at children considered to be risk of worse outcomes for example those with chronic illness or those subject to social deprivation
- Use standardise documentation for example the Redbook is used in England Scotland and Wales, the Redbook is given at the time of birth and it is the child’s personal health record and functions as a method of communication between healthcare professionals – this is used up to the age of five
12
Q
Outline examples of child health promotion strategies
A
- General health promotion: diet and exercise advice to prevent obesity, promotion of benefits of breastfeeding, advice regarding smoking cessation and accident prevention advice both at home and on the road
- Disease prevention: folic acid to prevent neuron tube defects, vitamin K to prevent haemorrhagic disease of the newborn, immunisations, vitamin D supplementation and sleeping advice to prevent sudden unexpected infant death
- Screening: screening mothers for HIV and hep B, newborn hearing screening, newborn blood spot screening, physical examination at birth, six weeks and eight months to identify congenital anomalies including heart, hip and eye problems
13
Q
When is the newborn bloodspot screen carried out?
A
Offered in the first days of life – days 5–8 in England
14
Q
Outline hearing screening in children
A
- All babies undergo hearing screening soon after birth using an otoacoustic emission test (1st line in the UK) which records the response of the cochlear to sound or the automated auditory brainstem response test which records brain activity in response to sound
- Early identification of hearing impairment enables early intervention to help with language and communication, children also have a further hearing test on entry to primary school
15
Q
Outline some child development red flags
A
- Gross motor skills: excessive had like past the age of six weeks, inability to sit or wait bear at 12 months, not standing or walking by 18 months or asymmetry of gait or unsteadiness at 2–3 years
- Fine motor skills and vision: not staring or fixing on face by six weeks, no pincer grip by 12–18 months, hand preference before 18 months, unable to build a three brick tower at the age of 2
- Hearing, speech and language: failure to respond to sound at any age, no babbling by 9–12 months, no words with meaning or recognition of own name by 18 months, fewer than 50 words by two years, no plurals or asking questions by three years
- Personal and social skills: no social smile by six weeks and not playing with other children by three years
