By Dr Sarah Ramruttun-Mulcock GPVTS Childhood Immunisations and Development

Brief Overview Introduction Practice AKT questions Revision of the diseases we vaccinate against Small group work More AKT questions Child development- Red Flags Even more AKT questions!! Summary and answers

Introduction Why learn about immunisations/child development? Pass the AKT!! Area that is regularly tested and regularly deemed weak in exams Condensed curriculum: - National immunisation programmes and the GPs role in promoting and organising immunisation. - Normal growth and development, management of delayed development and failure to thrive Be able to talk confidently with parents about the immunisations (how many injections, after effects, what does it protect against) Health promotion...herd immunity, reduce illnesses normally caused by the diseases

Now for the Practice!! Have a go!! Questions have been lifted from passmedicine Gives an idea of what to expect GUESS!!

Overview of Diseases Diphtheria (D): Corynebacterium diphtheriae. Throat and chest infection. Rare in UK. Tetanus (T): Clostridium tetani (found in soil) Severe muscle contractions- fatal. Haemophilus Influenzae type b (Hib): causes pneumonia and meningitis. Most risk below age of 4. Pertussis (aP): Whooping cough, Bordetella pertussis. Prolonged, distressing cough. Can lead to pneumonia and encephalitis D/ aP/Hib/: fragmented vaccines, extracts of the organism/ virus used Tetanus: detoxified exotoxins

Overview of Diseases Poliomyelitis (IPV): infection through the gut, then on to cause meningitic type illness. Affects nerves resulting in muscle wasting which can cause paralysis of 1+ limbs. Affects breathing in some cases. Was given orally, now injected. Pneumococcus (PCV): causes pneumonia, meningitis. Extremes of age are most vulnerable to this disease. Introduced in Group C meningococcus (Men C): meningitis and septicaemia. PCV/ Men C: fragmented vaccines

Overview of Diseases Measles: miserable feverish illness with rash. Koplik spots – white spots on buccal mucosa. Increasing incidence due to children not being immunised Mumps: Inflammation and swelling of salivary glands. May cause permanent deafness in one ear. Rubella: mild illness with rash, starts on the face and then spreads. MMR and BCG are live attenuated vaccines ( also oral polio, yellow fever and oral typhoid)

Overview of Diseases Human Papillomavirus (HPV): - affects skin and mucosa - HPV 16 & 18 involved in most cases of cervical cancer - Cervarix (endorsed by government) 3 injections; 2 nd given 1-2 months, 3 rd at 6m - Gardasil: protects against viral warts, covers HPV 6, 11, 16 and 18

Group Work 2 small groups to devise imms schedule Match the corresponding ages to the relevant vaccines Each vaccine at the correct time scores a point Winning group gets a treat!!

Correct Schedule At Birth:BCG/Hep B (if high risk) 2 months:DTaP/ IPV/ Hib + PCV 3 months:DTaP/ IPV/ Hib + Men C 4 months:DTaP/ IPV/ Hib + PCV + Men C 12-13m:MMR+ Hib/Men C + PCV 3-5yrs:MMR +DTaP/ IPV 12-13yrs:HPV 13-18yrs:DT/IPV DT always given with IPV, given with aP apart from 1yr/18yr Hib not given after age of 4 yrs 2 lots of MMR back to back PCV/Men C given up to the age of 1 yr

Correct Schedule At BirthBCG/ Hep B (if risk factors) 2 monthsDTaP/ IPV/ Hib + PCV 3 monthsDTaP/ IPV/ Hib + Men C 4 monthsDTaP/IPV/ Hib + PCV + Men C monthsHib/ Men C + PCV + MMR 3-5 years (pre- school)MMR + DTaP/ IPV years (girls)HPV yearsDT/ IPV

More AKT questions Re- answer previous AKT questions Added some “curve- ball” questions Answers revealed at the end

Child Development Not something that is easily taught or learnt Even as a parent.....each child is different Development is most rapid during the first four years of life Key is to notice the abnormal from the normal May be useful to split the periods of development: -The newborn baby -The supine infant (6-8 wks) -The sitting infant (6- 9 m) -The mobile toddler (18- 24m) -The communicating child (3-4 yrs)

Red flags in Development Does not roll over in either direction by the end of 4 months of age yellow flag Does not respond to sounds or turns head to locate sound by age 7 months red flag Cannot stand when unsupported age 12 months yellow flag Does not speak at least 15 words and begin to use 2 word sentences by age 2 years red flag Does not walk by 18 months or walks exclusively on tiptoes red flag Cannot build a tower of more than 6-8 blocks by the age of 3 years yellow flag

Red flags in Development Not jumping by the age of 30 months red flag Not feeding themselves with finger food by the age of 14 months red flag Not smiling by 1 month yellow flag Not interested in pretend play by 2-3 years of age red flag Doesn’t pass objects from one hand to another by age 9 months red flag

Even more AKT questions!

Answers Immunisations: 1) (b) Mumps is a live attenuated vaccine 2) (e) Hib/ Men C, MMR, PCV 3) (c) 5 4) (a) Clean wound and IM tetanus Ig 5) (d) MMR with repeat dose at 3 months 6) (a) Child can have the vaccine

Answers Child development: 1) (e) 4 years 2) (b) 9 months 3) (c) 6 weeks (see handout on developmental milestones)

Summary Gone through and (hopefully) learnt the immunisation schedule Learnt about some of the red flags in child development Answered AKT questions along the way Wow the examiners with our impressive knowledge at the AKT exam!

Thank you for listening!! Any Questions..... Ask the Boss!!