CH HS Flashcards
(198 cards)
1
Q
role of school in managing mental health
A
> Tackling/preventing stigma
- Education on mental health topics
- Tackling/preventing bullying
2
Q
role of HV in managing MH
A
- Promotion of health and prevention of illness in all age groups
- Advise mother about physical and emotional development in all aspects of health
- Help overcome difficulties people may face if there are disabilities/illness
3
Q
Role of social svcs in MH
A
- Assess childs’ needs
- Provide services which support people in their own homes
- Assess any possibility of abuse in the household
4
Q
Role of educational psychologists in MH
A
- Tackle learning difficulties, social or emotional problems
- Enhance child’s learning
- Enable teachers to be aware of social factors affecting teaching and learning
5
Q
Neonatal mortality rate
A
deaths that occur within the first 28 days of life following a live birth. I
6
Q
what is the neonatal mortality rate in 2018
A
2.8/1000 live births
7
Q
still birth =
A
: when a foetus is delivered after 24 weeks of gestation without showing any signs of life. I
8
Q
Still birth rate in the UK 2018
A
4.1/1000 live births
9
Q
Perinatal mortality rate
A
deaths occurring within 7 days of life (this rate includes still births).
10
Q
infant mortality rate =
A
the number of deaths occurring within the first year of life per every 1000 live births. This does not include still births
11
Q
Low birth weight =
A
baby weighig less than 2.5kg at birth
12
Q
which 3 counteies have the lowest neonatal mortality rates
A
Monaco then Japan then Iceland
13
Q
highest neonatal mortality rates =
A
Afghanistan, Somalia, central African republic
14
Q
lowest still birth rates in
A
Iceland, the Andorra thrn denmark
15
Q
countries w highest still birth rate
A
PK nigreia and chad
16
Q
Risk factors for perinatal mortality
A
- Premature delivery (most common risk factor)
● Congenital abnormalities
● Low socio-economic status
● Late pregnancy registration
● Low birth weight
● Intra-uterine growth restriction
● Maternal diseases (gestational HTN, gestational diabetes, intrapartum complications such as abruption)
17
Q
how to reduce perinatal mortality
A
- improve antenetal care in low and MIC
> skilled care at birth
> ensured postnatal care for mother and baby
> ensure mother and baby not discharged from hosp too early
18
Q
Maternal Characteristics that increase risk of preterm birth (
A
- Fhx of preterm birth
- low SES, low education attainment
- maternal age - low or high
- ethnicity - non white rase
- stress, depression, tobacco use
- low or high BMI
- Hx of cervical surgeries
19
Q
reproductive RF for preterm birth
A
- prior preterm birth
- prior stillbirth
- induced abortion
- cervical insufficiency
20
Q
current pregnancy characteristics for preter birth
A
> vg bleeding
use of assisted reproductive tech
multiple gestation
polyhydramnios/ oligohydramnios
pre-ecla,psia
GD
21
Q
Method of predicting preterm labour
A
> Transvaginal USS of the cervix
- Measurement of foetal fibronectin (if positive from
cervical secretions between 22-34 weeks there is
increased risk of premature birth within 7 days)
22
Q
predicting low birth weight
A
- inadeq weight gain by mother (<8.9kg)
- inadequate proteins in diet
- prev preterm baby
- anaemic mother
- smoker
23
Q
mx of a preterm infant
A
- stabilise at borth
- body T control - incubators, clothing, extremely preT should be placed in a plastic bag for resus to minimise fluid loss
- avoid infection - handwashing
24
Q
Nutrition in a preterm baby
A
> if over 34 weeks, usually able to take oral feeds - breast usually better tolerated then artificial
Preterm infants’ sucking and swallowing reflexes may be ineffective so feeds may need
to be delivered through a small bore nasogastric or orogastric tube
If enteral feeds by mouth or NG tube are not tolerated then more prolonged
maintenance of nutrition is achieved using TPN
25
preterm infants require supplements of
phosphate and vitamin D to ensure adequate bone deminieralisation - iron may also be given from 4 weeks
26
Mx of preterm infant < 28 weeks
> - Assess for need for resuscitation and PPV/CPAP
- 40% oxygen
- Temperature maintenance
- Umbilical vascular access
- Dextrose 10% to avoid hypoglycemia
27
drugs given to a preterm infant <28 weeks
> empirical IV ab after blood cultures - 1st line ampicillin and gentamicin
> if cultures negative discontinue
> methylaxanthine is the 1st line caffiene - Tx recurrent apnoea
> surfactatnt
> crystalloids/ hydrocortisone for reg BP
28
what should be given for congenital HD
prost
29
short term comps of preterm birth and low birth weight
> resp disorders - surfactant def, apnoeic attacks
> PDA
> intrcranial lesions - haemorrhage into germinal matrix of ventricles
> GI - bowel perforation, NEC
30
LT comps from preterm birth and low birth weight
> retinopathy of prematurity
> CLD of prematurity
> neurodevelopmebtal e.g. CP, cognitive delay, visual impairment, seizures
31
common congenital anomalies
> CHD
> chromosomal e.g. DS
> neural tube defects - high AFP in antenatal blood test
> cleft lip/ palate
> club foot
32
neonatal screening physical exam is performed…
by dr within 72 hrs and again by GP at 6-8 week baby check
33
what is looked at in the neonatal screen physical exam
> Weight
2. General inspection (pallor, cyanosis, jaundice, posture)
3. Tone
4. Head (size, shape, fontanelles)
5. Skin (birthmarks, bruising/lacerations, vernix)
6. Face (dysmorphic features, asymmetry, trauma, nasal passages)
7. Eyes (discharge, discolouration, fundal reflex)
8. Ears (inspect pinna)
9. Mouth (cleft lip and palate, tongue tie)
10. Neck and clavicles (webbing, lumps, evidence of #)
11. Upper limbs (symmetry, fingers, palmar creases, brachial pulse)
12. Chest (RR, Work of breathing, deformity, auscultate lungs and heart)
13. Preductal and postductal pulse oximetry
14. Abdomen (distension, umbilicus appearance, palpation for organomegaly)
15. Genitalia (Males: urethral meatus position, size of penis, hydrocele, presence of testes Females: labia, clitorus, vaginal discharge)
16. Lower limbs (Symmetry, oedema, talipes, missing digits, hypermobility, femoral pulses)
17. Hips (Barlow’s manoeuvre and Ortolani’s manoeuvret)
18. Back and spine (scoliosis, hair tufts, naevi, birthmarks, sacral pits)
19. Anus (patency, passage of meconium)
20. Reflexes (suckling, stepping, palmar grasp, rooting, moro)
34
neonatal heel prick is done at
5-9 days
35
when can the heel prick be done up to
1 yr if missed except CF which is up to 8 weeks
36
what does the heel prick screen for
* sickle cell
- CF
- congenital hypothyroidism
- PKU
- McAO deficiency
- maple syrup urine disease
- Isovaleric acidaemia
- Glutaric aciduria type 1
- Homocystinuria
37
when do SIDS deaths peak
1-3 m. Can occur up to 1y
38
what is the leading cause of death beyond the neonatal period in the UK
SIDS
39
RF for SIDS
- Tobacco smoke (antenatally and postnatally)
- Prone and side sleeping
- Bed-sharing
- Soft mattress and/or sleeping surface (including sofa or ar chair)
- Over bundling/Overheating
- Prematurity
- Exposure to alcohol and illicit drugs
- Viral infection
40
Protective factors for SIDS
* Dummy during sleep
- Immunisation
- Breastfeeding
- Room sharing
41
reducing SIDS guide for parents
- Always place your baby on their back to sleep
- Place your baby in the “feet to foot” position - with their feet touching the end of the cot, moses basket
or pram
- Keep your baby’s head uncovered - their blanket should be tucked in no higher than their shoulders
- Let your baby sleep in a cot or moses basket in the same room as you for the first 6 months
- Use a mattress that’s firm, flat, waterproof and in good condition
- Breastfeed your baby, if you can
- Make sure to use a sling or baby carrier safely
- Do not smoke during pregnancy or let anyone smoke in the same room as your baby before and after
birth
- Do not sleep on a bed, sofa or armchair with your baby
- Do not share a bed with your baby if you or your partner smoke or take drugs, have recently drunk
alcohol or if your baby was born prematurely or weighed under 2.5kg when they were born
- Do not let your baby get too hot or too cold (16C-20C) w/ light bedding or a lightweight sleeping bag
42
epidemiology of asthma in the UK
> 8 M ppl - 160k diagnosed each year
> incidence higher in children than adults
43
most common industrial lung disease in the developed world
Occupational asthma accounts for 9-15% of adult-onset asthma - most common industrial lung disease in the developed world
44
sex ratios in asthma
- More common in boys than girls however in adulthood the sex ratio is reversed
45
how do we screen for DDH
as part of routine examination of newborn - Barlow and Ortlani
46
who does DDH affect more
Girls
47
When should USS be perfomed even if Barlows and Ortlanis are negative:
- Breech presentation at or after 36 weeks or at delivery, regardless of whether ECV was done
* ** 1st degree FHx of hip dysplasia or dislocation**
- Congenital deformity of the feet
- Clicky or unstable hips
- Limited abduction in flexion
- Apparent shortening of one/ both legs
48
imaging for DDH
- Pelvic X R if over 4 m
- USS if under
49
Methods of reducing childhood infection
- Chemoprophylaxis - administration of a medications for the purpose of preventing disease or infection e.g. Vaccination or antibiotic prophylaxis
- Hand washing in between patients
- PPE - gloves and gown
- Isolating infected pts on ward to limit spread
50
methods of reducing childhood infection - referral
> Increase awareness of symptoms of disease
- Notify Public Health England if disease is notifiable disease to help identify cause and prevent
spread
51
general priciples of vaccination
> Active immunity can be acquired by natural disease or by vaccination
- Vaccines induce active immunity and provide immunological memory by stimulating the production of antibodies
involved in the immune response
52
live attenuated vaccines
MMR and BCG
53
inactive prep of virus vaccines
meningococcal vacine
54
inactivated toxin vaccines
DPT
55
Microorganism extract vaccine
pneumoccoal or hep B
56
viral bector vaccine
astrazeneca COVID-19 vaccone
57
Nucleic acif of an antigen from the virus
Pfizer/BioNTech or Moderna COVID-19 vaccines or bacter
58
8 week vaccines
6-in-1*, Rotavirus,, MenB
59
12 week vaccines
6-in-1 (2nd dose), Pneumococcal (PCV), Rotavirus (2nd dose)
60
16 week vaccies
6-in-1 (3rd dose), MenB (2nd dose)
61
1 yr vaccines
Hib/MenC, MMR, PCV (2nd dose), MenB (3rd dose)
62
2-10 yrs vaccines
Flu vaccine yearly (6 months-17 years old if long-term health conditions present)
63
3y and 4 m vaccines
MMR (2nd dose), 4-in-1 pre-school booster*
64
12-13 yrs vaccines
HPV vaccine (types 16, 18, 6 and 11)
65
14 yrs vaccine
3-in-1 teenage booster***, MenACWY
66
whicch vaccines do 65y get
PCV, Flu vaccine yearly
67
Which vaccines do 70y get
shingles
68
pregnant women vaccines
> During flu season - Flu vaccine
- 16 weeks - Whooping cough (pertussis) vaccine
69
babies at risk of hep B vaccines
- Babies born to mothers with hepatitis B - HepB vaccine at birth, 4 weeks and 12 months
70
TB vaccinaion - kids
Children born in areas of the country with higher numbers of TB cases or whose parents/grandparents were born in a country with many cases of TB - BCG tuberculosis vaccine
71
who gets the CP vaccine
Adults children who are in regular contact with someone with weakened immune system or ar serious risk if they catch chickenpox AND have not has chickenpox previously- chicken pox (Varicella) vaccine
72
HC worker vaccines
> HepB vaccine (3 doses or 2 doses depending on manufacturer) w/ anti-Hbs serologic tests 1-2 months after final dose
- Annual flu vaccine
- 2 dose MMR if not had during childhood schedule
- Chicken pox (Varicella) vaccine if blood test shows you are not immune
73
travel to endemic areas - vaccines free on the NHS
Available free on NHS: polio, typhoid, hepatitis A, cholera
74
TRAVE TO ENDEMIC AREAS - PAID FOR VACCINES
t: hepatitis B, japanese encephalitis, meningitis vaccines, rabies, tick-borne encephalitis, BCG (TB), yellow fever
75
Types of localised reaction to vaccines
> Soreness, redness, itching or swelling at injection site - apply cold compress to injection site, consider analgesia or antihistamines
- Slight bleeding - pressure and an adhesive compress over injection site
- Continuous bleeding - thick layer of gauze pads over site, maintain direct and firm pressure, raise bleeding injection site above lev
76
psychological reaction to injection
> anxiety B4 - sit/lie down
> Paleness, sweating, cold peripheries, nausea, light-headedness, dizziness, weakness, visual disturbances - have patient lie flat, loosen any tight
clothing, maintain open airway, apply cool damp cloth to pt’s face and neck, keep under close observation until full recovery
- Fall, no LOC - examine pt to determine if injury is present before attempting to move pt, then place pt on back with feet elevated
- LOC - check to determine if injury is present before attempting to move pt, then place pt flat on back with feet elevated, call 999 if they do not
immediately recover
77
anaphylaxis presentation
generalised hives, itching/flushing, swelling of lips/face/throat/eyes, nasal congestion, change in voice, stridor, dyspnoea, wheeze,
cough, N/V, diarrhoea, abdominal pain, collapse, dizziness, tachycardia, hypotension
78
mx of anaphylaxis
Mx- adrenaline (dose dependent on child’s weight) autoinjector or 0.01mg/kg up to maximum single dose of 0.5mg - can repeat every 5-15 minutes until ambulance arrives
79
what can be given alongside adrenaline for anaphylaxis
Chlorphenamine to relieve itching and urticaria
- Steroids (hydrocortisone) to reduce inflammation
80
CI for vaccination
: previous anaphylaxis to vaccine with same antigen, acute febrile illness, egg anaphylaxis (no influenzae or yellow fever unless controlled environment), immunodeficiencyforlivevaccines
81
common concerns abt vaccines
> They wear out child’s immune system/concern about having several at once
- They don’t work
- Bad side effects
- Causes autism or other developmental disorders
- Causes SIDS
- The vaccine gives you the disease it is supposed to prevent
- Additives in the vaccine
82
childhood to adult care for chronic condition
> involve young people and carers
> Ensure it’s developmentally appropriate taking into account: maturity, cognitive ability, social and personal circumstances,
communication needs
> - Start discussion about process of transition young when possible
- Aim to allow as much independence as possible
- Share important clinical details and aim for no disruption to care
- Crossover/joint appointments involving both child and adult practitioner
- Support continues after transfer (minimum 6 months before and after)
83
impact of chronic condition on a child
> time off school/ difficulty comp scholl work
> feeling diff to friends
> needing to plan day around meals/ medications
> impact on employmenr
> increase dependence on parents compared to peers
84
cognitive effects of altered life expectancy on a child
> Over-acceptance - letting illness take over, level of impairment above what would be expected
- Denial - symptoms and advice ignored, treatment poorly adhered to
85
emotional effects of altered life expectancy on a child
May similar to normal/abnormal bereavement
86
behaviour effects of altered life expectancy on a child
> Maturing
- Could cause regression - act younger, including reduced school performance, nocturnal enuresis
87
family effects of altered life expectancy ona a child
> May suppress feeling to try and support child
- Can create tension/long-term issues
88
social effects of altered life expectancy on a child
* rebeillien - increased autonomy and independence
* peer relationship and self image - don’t want to be seen as diff to others or become labelled
* skewed assessmsnt - risk of social disregard > risk of not taking medication
* Side effects of medication may effect appearance - delayed puberty, short stature
89
what is safeguarding
the action that is taken to promote the welfare of children and prevent harm
90
what is child protection
- What is in place to protect children who have already experience harm, abuse, neglect, sexual exploitation or have otherwise been harmed
91
working together to safeguard children
> 2018
> Key statutory guidance for anyone working with children in England
- Sets out how organisations and individuals should work together and how practitioners should conduct the assessment of children
92
what does working together to safeguard children state
- States a co-ordinated approach between agencies and practitioners is crucial as safeguarding children is everyone’s responsibility
- Practitioners should be alert to sharing important information as early as possible to help identify, assess and respond to risks or
concerns about the safety and welfare of children
93
who might attend a child case conference
> social worker
> GP/ HCP
> teacher
> HV
> police
94
role of HCP
If a child discloses abuse to you then you have a statutory obligation to tell an appropriate agency, often
discuss with senior/child protection doctor then inform:
1. Social services, Police, NSPCC = child at risk will have case conference
2. School, relevant doctors (paediatrician or GP) and family members
3. MDT to share concerns and identify risk and what to do to protect the child - draw up Child Protection Plan
95
Children’s Act 1989 -
- Allocates duties to local authorities, courts, parents and other agencies in the UK to ensure children are safeguarded and their welfare is promoted
96
Children act 2004
- Amended 1989 act to state there is an obligation to share information and to co-operate to safeguard and promote the welfare of children
97
what does the childrens act 2004 stipulate
> If there are concerns about sharing information with others they should obtain advice from designated
professionals for safeguarding children
- This should be undertaken as soon as possible to ensure little delay to the safety of the children or young
person
- If concerns are based on information given by a child, healthcare professionals should explain to the child why
they are unable to maintain confidentiality (reassure them they’ll be kept in the loop)
98
under 16- decision making
> may consent if gillick competent
> if not: consent from parent/ legal guardian
99
if parents fail to consent in best interest
> take to court
> in emergency: tx
100
gillick competence
parental rights yield if child reaches sufficiency understanding and intelligence assessed with fraser guidelines
101
16-17 consent
Presumed comp to consent when > 16 - if doctor thinks it in their best interest they can take to court to ovverule even if the parents support the resusal
102
under 18s are not comp to refuse
Tx
103
parental autonomy and child welfare
> grounded in assumption that parents know their childs best interest and the close parental bond motivates them to do what is best for kids
> e.g. antivaxx parents
104
health child programme 2009
* Gives comprehensive advice on screening tests (antenatal, neonatal and beyond), immunisations, developmental reviews and information and guidance to support parenting
and healthy choices
- Encourages early identification of families which might have factors which put child health and well-being at risk and specifies extra supportive measure on top of the universal approach at each stage
105
what does the health child programme aim to do
- help parents and carers develop a strong bond with kids
> support parents in keeping the child healthy and to reach their full potential
* protect children from serious disease, through screening and immunisation
* reduce childhood obesity by promoting healthy eating and physical activity
* promote oral health
106
Health promotion programmes help to educate parents to
prevent disease/ illness/ death and form good attitudes to health
107
the healthy child progamme provides info on: to parents
smoking, alc, nutrition, dental health ad hazards
108
Start4Life
e is Public Health England’s national programme that delivers NHS advice and practical guidance to parents-to-be and families with babies and young children under 5
109
primary ptevention for diabetic eye
- optimal glycaemic control
- BP control - under 140/80
- healthy diet and exercise
- stop smoking
110
secondary prevention of diabetic eye disease
>diabetic eye screenng
111
who gets diabetic eye screening
> Offered to anyone with DM who is 12+ years old
- Offered annual check w/ retinal imaging performed by optometrist
112
follow on actions from diabetic eye screening
> routine recall in 1y
> earlier review
> refer to opthalmologist
113
when is emergency opthalmologist review indicated from diabetic eye sccreen
> Sudden loss of vision
- Rubeosis iridis
- Pre-retinal or vitreous haemorrhage
- Retinal detachment
114
squint (Stabismus)
> one eye is misaligned in relation to the other
- Can occur in children who are otherwise well but more likely to develop in children with associated conditions
e.g. Cerebral palsy, Down’s Syndrome, hydrocephalus and SOL
- They are also much more common in children with treated or regressed retinopathy of prematurity
115
causes of squint in adults
Stroke (most common), other neurological problems, Graves’ disease and trauma
116
RF for squint
> FHx
> prematurity
> neonatal jaundice
> encephalitis
> CP
> craniofacial abn
> FAS, LD,
117
Referral for quint
> refer any neonate to opthalmolosist w constant squit worsening from 2m of age
> refer any older child routinely with a suspected squint to the paeds eye clinic - the earlier the better
> refer under 2www if any serious underlying cause suspected
118
most common countries with blindness
south Asia and Sub-saharan africa
119
blindness is sig associated with
LIC - 90% of the worlds blind population live in LIC
120
Causes of blindness worldwide
> unconrrected refractive errors
> cataracts
> glaucoma
> age related macular degen
> diabetic retinopathy
121
most common cause of blindness in the UK
1. . Age-related macular degeneration
2. Glaucoma
3. Cataract
122
Registred blinf
> Every local authority keeps a register of blind and partially blind individuals
- Registration is through a consultant ophthalmologist
> After registration social services arrange an assessment to assess their needs and what they require to remain independent
123
benefits of being registered blind
- Help with any costs relating to your disability/illness (Disability Living Allowance, Incapacity benefit, Income support)
- Reduction in the TV licence fee
- Help with NHS costs
- Help with council tax and tax allowances
- Reduced fees on public transport
- Parking concessions (Blue Badge parking permit)
- Bus and rail ticket concessions
124
Role of optometrists in the NHS
> HCP’s that provide primary vision care ranging from sight testing and correction
to the diagnosis, treatment and management of vision changes
- Trained to recognise abnormalities in the eye
125
How often should people visit the optometsits
every 2 yrs
126
deafness rates in the UK
> half are born deaf - either acquired perinatally or congenital
> temprary deafness e.g. glue ear, ET blockage
127
RF for deadness - childhood
- FHx deafness
- Infection: mumps, measles, congenital infections e.g. rubella
- Ototoxic medications (in utero or postnatally)
- Low birth weight, prematurity, low birth APGAR scores, prolonged mechanical ventilation
- Craniofacial anomalies or any syndrome associated with sensorineural hearing loss
128
intrauterine causes of child deafness
> 8% of childhood infections
> congenital - toxoplasmosis, rubella, CMV, HS2
> maternal drugs and toxins
129
genetic causes of child deafness
e.g. turners or klinfelters. Accounts for 50%
130
Perinatal mortality rate
> 12%
> prematurity, low birth weight, birth asphyxia, severe hyperpibilirunaemia
131
post natal causes of deafness
> 30%
> childhood infections - meningitis, encephalitis, head injury
132
When is newborn hearing performed
Ideally performed in the first 4-5 weeks after birth but can be done up to 3 months of age
133
what test is done to check a newborns hearing
AUTOMATED ATOACOUSTIC EMISSIONS TEST
134
what if there is hearing loss on automated autoacoustic emission test
do auditory brainstem response test
135
Babies excluded from hearing screening programme:
- Microtia and external ear canal atresia
- Neonatal bacterial meningitis or meningococcal septicaemia
- Programmable ventriculo-peritoneal shunts in place
- Confirmed congenital CMV infection
136
birth - heairng milestone
startles and blinks at sudden noise e.g. door slam
137
4 months hearing milestone
Quietens or smiles to sound of voice, even if can’t see, may turn towards sound
138
7,9,12 months heatig milestoen
> 7 months - turns immediately to your voice
- 9 months - listens attentively
- 12 months - responds to own name and familiar words
139
outline approaches to prevention of deafness
> avoid loid noises - over 85 dB
> Listening to loud music through headphones/earphones is one of the biggest dangers
to your hearing
- Protect hearing during loud events and activities
- Take precautions at work - employers are obliged to make changes to reduce your
exposure
- Get your hearing tested - early it is picked up the earlier something can be done
- Avoid insertion of foreign body into the ears (e.g. cotton buds, hair pains)
- Vaccination - vs measles, meningitis, rubella and mumps
> avoid ototoxic drugs
140
most common cause of death in >1
injury. More common in males>females
141
causes of death in babies
burns, being dropped
142
causes of death in toddlers
burns, poisioning
143
causes of death in older kids
falls
144
Preventing falls in kids
> Stair gates up to 2, preferably not at top of steep stairs as if they do get over there is serious
consequences
- Don’t leave babies unattended
- Don’t change nappies on raised surface
145
prevention of poisoning in kids
> Child resistant containers
- Keep things out of reach
- Child resistant packaging
146
scalds In kids
Peak age for injury with this mechanisms is 1 year - lots of admissions but
death is rare
- Age of exploration and just achieved ability to grab things but no cognitive
development to know not to do it
147
prevention of scalds in kids
* Hot drinks out of reach/ don’t hold baby whilst drinking hot drink
- Teach child not to climb on things
- Keeping saucepan handles turned away from hob or back burners out of
reach
- Thermostatic mixing valves fixed to taps to prevent water being too hot
148
Charities for people with visual impairment
- royal national institue of blind people
- guide dogs UK
- sight support centers
149
NHS audiology svs
> provided by GP referral or direct access
> includes hearing tests, provision and fitting of NHS hearing aids, ENT referrals for management
150
communication support for deaf people
BSL interpreters, speech to text reportsers, lip readers
151
charities for hearing impairment
> royal nat insitute for deaf people
> deafblind UK
152
which infants require screening for DDH
> routine US for:
> first-degree family history of hip problems in early life
breech presentation at or after 36 weeks gestation, irrespective of presentation at birth or mode of delivery
multiple pregnancy
153
how are all infants screened for DDH
all infants are screened at both the newborn check and also the six-week baby check using the Barlow and Ortolani tests
154
MDT in paeds LTC
> GP - long term meds and monitoring
> paeds consultant - diagnosis, Tx
> specialist nurses - disease specific support e.g. diabetes
> CAHMS
> physio, OT, S< - max physical independence
155
MDT - education for paeds LTC
> school nurse or health advisor - liase between school and HT team
> SENCO - supports access for kids w mediccal needs
> educational psychologist
156
impact of a childs HP on the family
> parents: stress, self blame, employment challeges, financial cost - travel, lost income
> siblings: feeling of neglect or resentment, emotional impacy, disrupted routines
> burnout in caregivers
157
signs of neglects in kids
> FTT
> poor denral health
> poor hygeine
> untreated lice or scabies
> withdrawn or hypervigilant child
> freq school absences
158
features of non accidental injuries
> story inconsistent with injuries
repeated attendances at A&E departments
delayed presentation
child with a frightened, withdrawn appearance - 'frozen watchfulness'
159
CHD identification
antenatal vaia fetal anomaly scan
160
difficulties with compliance in paediatric populations
> developmental stage - teens & autonomy
> fear of misunderstanding
> complex regimes
> family or social issue
161
motivational interviewing for difficult compliance
- express empathy
- develop discrepany between current behav and health goals
- avoid arguments
- support self efficacy
162
Physical abuse
> Deliberate use of force that results in injury or physical harm.
> Bruises in unusual areas, burns, fractures, inconsistent explanations for injuries.
163
psychological abuse
> Persistent emotional maltreatment that affects emotional development or self-worth.
> signs: Low self-esteem, developmental delay, overly compliant or withdrawn behaviour.
164
sexual abuse
Signs: Sexualized behaviour, STIs, difficulty walking/sitting, fear of specific people.
165
neglect
> Persistent failure to meet a child’s basic physical or emotional needs.
> Signs: Failure to thrive, poor hygiene, untreated medical issues, developmental delay.
166
financial abuse
> common in vulnerable adults
> misuse of money or property
> e.g. fraud or coercion, stealing possessions
167
MDT approach to child protection
> involves healthcare, social care, education, police
> provides a more comprehensive understanding
> improved DM and risk assessmwnt
> earlt recognition and intervention
> Protects professionals by ensuring responsibility is shared and decisions are not made in isolation.
168
raising safeguaridng concerns ->
- immediate danger: call 999
- otherwise inform designated safeguarding lead or hild protection team, inform social care
- do not wait for proof if u suspect abuse
169
GMC guidance on rasing a safeguarding concern
> document concerns in the childs medical records
170
Section 17 -
child in need
171
section 47 =
child protection
172
UN Convention on the Rights of the Child,
> The right to be heard
The right to health
The right to protection from harm
The right to education
173
advocating for a child - areas
> healthy lifestyle
> young mental health, access to CAHMS
> child protection
174
Consent in children summary
* under 16: can consent if gillick competent
* 16-17: can consent like an adult
* < 18: cannoy refuse treatment if parents or courts ovveride in their best interests
175
gillick competence
* A child under 16 can consent to their own medical treatment if they have sufficient understanding and intelligence to:
* Understand the nature, purpose, and possible consequences of the treatment
* weigh up the risks and benefits
* Make an informed decision
176
fraser guidelines
Specifically relate to contraceptive advice/treatment to under-16s without parental knowledge.
177
when is parental consent valid
if child is not competent
178
when should we maintain confidentiality
> The young person is competent and understands the implications
> They have not given permission to share
> There is no risk of significant harm to them or others
179
when to break confidentiality
> There is risk of significant harm (e.g., abuse, self-harm, substance misuse)
> Safeguarding concerns arise
> It’s in the public interest (rare in paediatrics)
180
Ciriteria for fraser guidelines
- A clinician can give contraceptive advice/treatment to under-16s without parental knowledge if:
- The young person understands the advice.
- They can’t be persuaded to tell their parents.
- They’re likely to have sex regardless.
- Their health is at risk without it.
- It’s in their best interests.
181
Healthy child programme - antenatal
- screening for maternal conditions e.g. HIV, hep B
- screening for genetic conditions - downs
- antenatal US
182
early years HCP
- Newborn blood spot - PKU, CF
- hearing screen
- newborn physical exam
- developmental assessment
- vision screening - 4-5 yrs
- screening for 6-8 weeks PP
183
adolescence HCP
- sexual health education
- MH support
- HPV at 12-13, meningitis ACWY - 14
184
Section 17 of the childrens act 1989
places duty on local authorities to provide support and services for children in need
185
section 47 of the chilkdrens act 1989
places duty on LA to make enquires in cases where there is reasoanable cause to suspect a child is suffering/ likely to suffer sig harm
186
toxic trio - RF fot abuse
> parental MH
> parentl substance mIsuse
> Domestic abuse
187
what does cervical screening lok for
HPV
188
If screening is + for HPV then
cytology
189
abnormal cytology ->
colposcopy
190
if HPV + normal cytology ->
follow up in 12 m
191
Cervical screening invitations
- People aged 25 to 49 receive invitations every 3 years. People aged
- 50 to 64 receive invitations every 5 years.
192
After action reviews =
- gets stakeholders together
- asks questions: what happened, what was
- supposed to happen, why was there a difference, what actions are there to be taken
193
3 things there needs to be in order for negligence to have occurred
> Duty of Care +
Breach of Duty +
Causation of loss or damage
194
standard of care -
the doctor has to have acted to a required standard that a responsible body of medical opnion woild find acceptable
195
vicarious liability
> emo resp for actions of employees
> NHS litigation authority
196
negligence = quantifying loss
> - General Damages = Pain Suffering and Loss of Amenity
- Special Damages = Actual loss until date of trial.
- Future Loss = Predicted future loss
- Bereavement award
197
gross negligence - manslaughter
> common law offence
> max penalty of life imprisonment
198
5 ekements which need to be proved for a claim of gross negligence manslaughter
- the defendant owed an existing duty of care to the deceased
- the defendant negligently breached that duty of care
- the breach of duty caused the death of the deceased
- at the time of the negligence, there was an obvious risk of death
- the nature of the defendant’s negligence was so “gross”, it amounts to a criminal offence
- The prosecution needs to establish ALL 5 elements to secure a conviction
