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Department of General Practice Queen’s University, Belfast
Child Health in General Practice
Dr. Kieran McGlade
Department of General Practice Queen’s University, Belfast
Child Health Issues
Preventative Medicine Developmental Surveillance Family Health Common diseases of Childhood Common problems in children
Department of General Practice Queen’s University, Belfast
Preventative Medicine in Child Care
Ante-natal care ante-natal screening folate supplements and nutrition
Neonatal care environment feeding
Immunisations
Department of General Practice Queen’s University, Belfast
The Old Childhood Immunisation Schedule
Primary immunisations at 8, 12 and 16 weeks Diphtheria, Tetanus, Pertussis HIB and Polio
(5 in one injection) Meningitis C (single component injection)
Measles mumps and rubella vaccine (MMR) in second year of life (1 injection) – usually about 15 months.
Pre-school boosters Diphtheria, Tetanus, Pertussis and Polio
(4 in one injection) MMR
http://www.immunisation.nhs.uk/
Department of General Practice Queen’s University, Belfast
Changes to the Schedule
Addition of a pneumococcal conjugate vaccine (PCV) at 2,4 and 15 mths of age
One dose of Men C vaccine at 3 & 4 Mths
Booster dose of combined Hib & MenC 1t 12 Mths of age
Department of General Practice Queen’s University, Belfast
Immunisation Schedule 2006
AGE Immunisations to be Given
How
2 mths
Diphtheria, Tetanus, Pertusis , Polio and Haemophilus influenzae type bPneumococcal (PCV)
1 injection
1 injection
3 mths
Diphtheria, Tetanus, Pertusis, Polio and Haemophilus influenzae type bMeningitis C (Men C)
1 injection
1 injection
4 mths
Diphtheria, Tetanus, Pertusis, Polio and Haemophilus influenzae type bPneumococcal (PCV)Meningitis C (Men C)
1 injection
1 injection1 injection
Department of General Practice Queen’s University, Belfast
Immunisation Schedule 2006
AGE Immunisations to be Given
How
12 mths
Haemophilus influenzae type b and Meningitis C (Men C)
1 injection
15 mths
Measles Mumps and Rubella (MMR)Pneumococcal (PCV)
1 injection1 injection
40 - 60 mths
Diphtheria, Tetanus, Pertusis and Polio Measles Mumps and Rubella (MMR)
1 injection1 injection
14 – 18 yrs
Tetanus. Diphteria and polio 1 injection
Department of General Practice Queen’s University, Belfast
Effect of the changes to the old schedule
Infants will be offered different combinations of vaccines at the 2,3 and 4 mth visits
Three injections will be offered to infants at 4 mths of age
A new 12 Mth vaccine will be introduced.
http://www.immunisation.nhs.uk/
Department of General Practice Queen’s University, Belfast
Department of General Practice Queen’s University, Belfast
Department of General Practice Queen’s University, Belfast
Department of General Practice Queen’s University, Belfast
Things not to miss
Phenylketonuria Hypothyroidism Congenital dislocation of the hip Retinoblastoma Down’s Syndrome
Department of General Practice Queen’s University, Belfast
Developmental Surveillance
Periodic assessment of a child’s developmental progress with the aim of detecting pre-symptomatic disability
Screening procedures should be brief, simple, cheap and reliable
May be combined with immunisation visits - if so, screening should be done first
Department of General Practice Queen’s University, Belfast
What do we look for in developmental screening?
Normal growth pattern Height, weight, head circumference
Achievement of developmental milestones(indicating neurological development) Gross motor function Fine motor function and vision Hearing and speech
Social behaviour and play
Department of General Practice Queen’s University, Belfast
How do we carry out developmental screening
Often in a clinic GP and Health visitor Direct observation Listening to parents / carers
History is important - we want to find out what the child can and cannot do
Specific tests
Department of General Practice Queen’s University, Belfast
Developmental Screening Tests 6 weeks
Head Control usually achieved by 6 weeks
Moro response present at 6 weeks, gone by 6 months
Gaze fixes in mother’s face, follows a brightly coloured object past the midline
Rattle or bell, 15cm at ear level - quietens or turns to sound.
Department of General Practice Queen’s University, Belfast
Family HealthFamily Life Cycle Stages
The new couple Birth of first child School age family Adolescent family Launching family Empty nest Ageing family
Department of General Practice Queen’s University, Belfast
Group Tasks
List the commonest diseases in childhood.
List the commonest presenting symptoms in childhood.
Department of General Practice Queen’s University, Belfast
Common diseases in Childhood
Nappy rash Upper Respiratory Tract Infection Infectious Diseases Urinary tract infection Asthma Eczema and other rashes Trauma
Department of General Practice Queen’s University, Belfast
Infectious diseases and common infections
Measles Mumps Rubella Pertussis Chickenpox
URTI Otitis media Tonsillitis UTI Gastro-enteritis Herpes stomatitis Meningitis
Department of General Practice Queen’s University, Belfast
Common Problems
Sore tummy Headaches Rashes and fevers Bed wetting - enuresis Behavioural problems / school refusal Cough Diarrhoea and vomiting
Department of General Practice Queen’s University, Belfast
Group tasks (2)
Discuss how you might manage the following scenarios: A six month old baby presenting with a
fever A five year old presenting with a cough A nine year old with an itchy rash on her
trunk. A ten year old child with recurrent
headaches
Department of General Practice Queen’s University, Belfast
On observing a consultation with a child - questions to ask yourself
Who is the patient? What is the reason for the
consultation? What opportunities does this
consultation present? Is the consultation structured any
differently from an adult consultation?
Department of General Practice Queen’s University, Belfast
Summary
Child health is an integral part of GP. It embraces prevention, diagnosis and
treatment. A knowledge of the family is an important
key to the understanding of child health problems.
Flexibility of approach, attention to detail, observation and listening to children and parents are of crucial importance.
Department of General Practice Queen’s University, Belfast