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 u Preventative Medicine u Developmental Surveillance u Family Health u Common diseases of Childhood u Common problems in children

Department of General Practice Queen’s University, Belfast Preventative Medicine in Child Care u Ante-natal care l ante-natal screening l folate supplements and nutrition u Neonatal care l environment l feeding u Immunisations

Department of General Practice Queen’s University, Belfast The Old Childhood Immunisation Schedule u Primary immunisations at 8, 12 and 16 weeks l Diphtheria, Tetanus, Pertussis HIB and Polio (5 in one injection) l Meningitis C (single component injection) u Measles mumps and rubella vaccine (MMR) in second year of life (1 injection) – usually about 15 months. u Pre-school boosters l Diphtheria, Tetanus, Pertussis and Polio (4 in one injection) l MMR

Department of General Practice Queen’s University, Belfast Changes to the Schedule u Addition of a pneumococcal conjugate vaccine (PCV) at 2,4 and 15 mths of age u One dose of Men C vaccine at 3 & 4 Mths u Booster dose of combined Hib & MenC 1t 12 Mths of age

Department of General Practice Queen’s University, Belfast Immunisation Schedule 2006 AGEImmunisations to be GivenHow 2 mths Diphtheria, Tetanus, Pertusis, Polio and Haemophilus influenzae type b Pneumococcal (PCV) 1 injection 3 mths Diphtheria, Tetanus, Pertusis, Polio and Haemophilus influenzae type b Meningitis C (Men C) 1 injection 4 mths Diphtheria, Tetanus, Pertusis, Polio and Haemophilus influenzae type b Pneumococcal (PCV) Meningitis C (Men C) 1 injection

Department of General Practice Queen’s University, Belfast Immunisation Schedule 2006 AGEImmunisations to be GivenHow 12 mths Haemophilus influenzae type b and Meningitis C (Men C) 1 injection 15 mths Measles Mumps and Rubella (MMR) Pneumococcal (PCV) 1 injection mths Diphtheria, Tetanus, Pertusis and Polio Measles Mumps and Rubella (MMR) 1 injection 14 – 18 yrs Tetanus. Diphteria and polio1 injection

Department of General Practice Queen’s University, Belfast Effect of the changes to the old schedule u Infants will be offered different combinations of vaccines at the 2,3 and 4 mth visits u Three injections will be offered to infants at 4 mths of age u A new 12 Mth vaccine will be introduced.

Department of General Practice Queen’s University, Belfast

Things not to miss u Phenylketonuria u Hypothyroidism u Congenital dislocation of the hip u Retinoblastoma u Down’s Syndrome

Department of General Practice Queen’s University, Belfast Developmental Surveillance u Periodic assessment of a child’s developmental progress with the aim of detecting pre-symptomatic disability u Screening procedures should be brief, simple, cheap and reliable u 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? u Normal growth pattern l Height, weight, head circumference u Achievement of developmental milestones (indicating neurological development) l Gross motor function l Fine motor function and vision l Hearing and speech u Social behaviour and play

Department of General Practice Queen’s University, Belfast How do we carry out developmental screening u Often in a clinic u GP and Health visitor u Direct observation u Listening to parents / carers l History is important - we want to find out what the child can and cannot do u Specific tests

Department of General Practice Queen’s University, Belfast Developmental Screening Tests 6 weeks u Head Control l usually achieved by 6 weeks u Moro response l present at 6 weeks, gone by 6 months u Gaze fixes in mother’s face, follows a brightly coloured object past the midline u Rattle or bell, 15cm at ear level - quietens or turns to sound.

Department of General Practice Queen’s University, Belfast Family Health Family Life Cycle Stages u The new couple u Birth of first child u School age family u Adolescent family u Launching family u Empty nest u Ageing family

Department of General Practice Queen’s University, Belfast Group Tasks u List the commonest diseases in childhood. u List the commonest presenting symptoms in childhood.

Department of General Practice Queen’s University, Belfast Common diseases in Childhood u Nappy rash u Upper Respiratory Tract Infection u Infectious Diseases u Urinary tract infection u Asthma u Eczema and other rashes u Trauma

Department of General Practice Queen’s University, Belfast Infectious diseases and common infections u Measles u Mumps u Rubella u Pertussis u Chickenpox u URTI u Otitis media u Tonsillitis u UTI u Gastro-enteritis u Herpes stomatitis u Meningitis

Department of General Practice Queen’s University, Belfast Common Problems u Sore tummy u Headaches u Rashes and fevers u Bed wetting - enuresis u Behavioural problems / school refusal u Cough u Diarrhoea and vomiting

Department of General Practice Queen’s University, Belfast Group tasks (2) u Discuss how you might manage the following scenarios: l A six month old baby presenting with a fever l A five year old presenting with a cough l A nine year old with an itchy rash on her trunk. l 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 u Who is the patient? u What is the reason for the consultation? u What opportunities does this consultation present? u Is the consultation structured any differently from an adult consultation?

Department of General Practice Queen’s University, Belfast Summary u Child health is an integral part of GP. u It embraces prevention, diagnosis and treatment. u A knowledge of the family is an important key to the understanding of child health problems. u 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