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
-
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
