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 injection3 mths

Diphtheria, Tetanus, Pertusis, Polio and Haemophilus influenzae type bMeningitis C (Men C)

1 injection

1 injection4 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