Long case management topics Flashcards
School options for children with disability
Mainstream vs specialist school
- firstly: important for all children to attend schol
- family decision, every child has a right to attend mainstream school with support
- my role as a general paed: support the family in identify the needs of the child (neuropsych assessments for cognitive testing IQ and specific learning disabilities; PT/OT assessments to assist with functional assessments; vision and hearing) , and inform
- family decision - tour schools, where other children are.
Sleep optimisation
Non-pharmacological options
- infants: controlled crying
Communication aids in children with diability
eye-gaze
NDIS advocacy
Maximise the patient’s functional independence
What you can do
- write a letter of support, outlining the medical issues and recommendations for carer hours and support required
- liaise with NDIS coordinator and allied health professionals to optimise functional independence
Carer stress
- liaise with GP and explore with parents psychological inout through mental health care plans
- think about carer cognitive capacity
General management issues for preschool age children (0-6yo)
Play and kinder
Development
Growth
Independence (maximise functional independence)
General management issues for primary school age children (6-12yo)
School
Self-image
Self-esteem
Sports
Peers
Independence (maximise functional independence)
General management issues for secondary school age children (12-18yo)
School
Peers
Sexuality
Fertility
Drugs and Alcohol
Vocation
Driving
independence (maximise functional independence)
Transition
Global developmental delay vs dev delay vs ID
ID >6yo
Developmental delay <6yo before can do a proper cognitive assessment
Intellectual disability with physical disability/functional impairment in the following domains *** - for older children
Global
Midline defects
School refusal
Barriers: talk to teachers - bullying
- specific learning disabilities, vision and hearing, behaviours
Address psychological aspects: anxiety
Follow up appointments: at a time that he is not meant to be at school
Open communication with school and parents
Graded approach
- Look for triggers‐parental conflict/trauma/bullying
- Educational support therapy‐ having a nominated teacher/aide to be the child’s contact person in school who will
help child negotiate the school yard and class - Systematic desensitization
- Rewards for practicing going to go school
- Response shaping‐see above
- Referral for Group CBT
- Parent MH ax for anxiety/trauma or family trauma
Drooling/sialorrhoea
Drooling
- its not about having increased amount of saliva but an inability to swallow or social issue where they arent aware of a wet chin
MDT approach
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Indigenous Health
Impact: experience of healthcare system, average lifespan 20yrs younger
infant mortality x3
increased diseases triggered by poverty/ crowding/ ↓ education/ poor access to medical care/ ↓nutrition
Access and minimising time in hospital, local indigenous health services
ARLO - consent and then link in (liaise)
Identify individuals needs
- culturally appropriate education
- interpreter
- social support
patient centred care - addressing cultural and spiritual needs
Immunisations (5 yearly pneumococcal (WA/NT/QLD); menB, HepA) and health screening
↑ awareness of scabies/ head lice/ RHD/ AOM/ alcohol & drug use
may be using alternative therapies – important to know about
Poor compliance in teenager
Medication review: reduce pill burden, change timing to before and after school
Screen patient and parent: mental health and self esteem issues, barriers, SE, understanding of condition, support groups
Need to give child opportunity to maintain independence - reminder/habbit systems
review in 2 weeks time and see if this has worked
If not enlist support from the family
Bone Health Management
Management (FESSHB)
1. Fracture risk – optimise vision (improve lighting/ contrast, eliminate glare)
- review medication (esp sedatives/ altering gait/ hypotension)
- home modification ‐ rails for toilet, involve OT, reduce steps – have ramps
- Weight‐bearing exercise program
Education and address risk factors
Sunlight
Supplements
- Calcium – caltrate 600mg od; between meals for absorption
- vitamin D
– D2 (ergo) – 1000IU/day
– D3 (cholecalciferol) (25OHvitd) 200‐400IU/day
– Calcitriol (1,25OHvitd) – 0.5mcg 3x/week
Hormonal therapy
Bisphosphonates
- used for osteogenesis imperfecta initially, or x2 fragility fractures
- only if have had at least one fracture (controversial)
- impairs osteoclastic function, “anti‐resorptive” agent
- Pamidronate – need to use up to monthly, takes 2‐3 hours, less powerful
- Zolendronate – can use up to 6 monthly, takes 20‐30mins, more powerful
- S/e
– post‐dose fevers, myalgia, rigors, vomiting, lowered seizure threshold
– low Ca – 24 hours post‐dose; thus give calcium and calcitriol during infusion
– Check Ca/PO4 levels 2‐3 days post infusion
– AVN of TMJ – must get dental assessment prior to starting treatment
– unknown longterm effects (therefore refer to endocrinology)
– monitor treatment with ALP
Challenging behaviours
Hx - Identify issues and co-morbidites (ADHD, sleep, nutrition)
Safety assessment - harm to self or others (if at risk, Mx would change), harm perpetrated by the family
Big source of distress - when they feel other people aren’t understanding (ipad, education)
MDT approach
- OT: star chart, 5min warnings (agency)
- education/enlist kinder and parents - set expectations, consistency and long term plans
Pharmacotherapy
normal challenging behaviour vs oppositional defiant disorder
and addressing this before becomes conduct disorder
Parent management therapy: Parent management therapy involving behavioural charts, rewards such as scheduling pleasant events for the child
at a set time afterwards and using praise for desirable behaviours and no reinforcement (planned ignoring) for
undesirable behaviours, parent problem solving skills training.
Undiagnosed developmental disorder or specific learning disorder affecting behaviour and causing emotional sx
Autism screen
IQ and learning assessment
Speech and language assessment for dyspraxia and receptive and expressive language disorder
Developmental coordination disorder‐OT ax
Transition to adult services
Early engagment is important
Pt: estab understanding and education, increasing independence (w supervision and encouragement w family)
Fam: process of transition, realisitic expectations, listen to fears and concerns and address these
Adult team - identify who will help; GP and Sub-specialist - medical handover (relevant Ix)
Dual appointment
MDT - allied health
Referral to transition services
Rebook for 6months later: touch base and psychological assessment of process
Carer Burden
Acknowledge and giving space to share
find out what they enjoy doing ?make a wish
Safety assessment of the carer
- MH/ambulance
- GP - MCHN
SAfety of assessment of child
back up plan if mum unwell
