Paediatrics seminar: child in the family (readings)

Question 1

What is the family health service comprised of?

Answer 1

Health promotion and disease prevention services for children from birth-5 years, women below 65 years
31 Maternal and child health services (MCHCs)
3 Woman health centers (WHCs)

Question 2

What is the scope of services for maternal and child health centers (MCHCs)?

Answer 2

• Child health (0-5 years)
• Maternal health (antenatal and postnatal care)
• Family planning
• Cervical cancer screening
• Woman health package (in 10 MCHCs)

Question 3

What is the antenatal shared care progrma?

Answer 3

Pregnant ladies with following conditions will be FU by OG Dep: medical illness, obstretic complications, psychosocial risks
Psycho-social assessment: based on science of early child development
Comprehence child development service (CCDS) aims at early identification and management of high risk pregnant women: teenage mothers, substance abusers, women with mental health problems

Question 4

What is the collabaration between HA hospitals, MCHC and social welfare department in CCDS?

Question 5

What is the neonatal screening program?

Answer 5

Cord blood is collected and sent to neonatal screening unit of DH for screening: G6PD deficiency, congenital hypothyroidism.

Question 6

What is the integrated child health and development program?

Answer 6

• Health and developmental surveillance program
• Parenting program: physical health, psychosocial health
• Immunization program

Question 7

How is the identification and management of postnatal mothers with depression done?

Answer 7

Question 8

What is the triple P program?

Answer 8

Principles: understanding the causes of child behaviour problems, setting goals for changein parents own and childs behaviour, keeping track of parents own and childs behaviour, acquiring knowledge and skills

Positive parenting strategies
How to develop a positive relationship with your child: spend quality time with child, talk with child, show affection
How to encourage desirable behaviour: praise your child, give your child attention, provide engaging activities
How to teach your child new skills or behaviours: set a good example. use ask, say, do, use behaviour charts

Managing misbehaviours
* Establish ground rules
* Use directed discussion to deal with rule breaking
* Use planned ignoring to deal with minor problem behaviour
* Give clear, calm instructions
* Back up instructions with logical consequences
* Use quiet time to deal with misbehaviour
* Use timeout to deal with serious misbehaviour

Question 9

What is the immunization program in HK?

Answer 9

BCG vaccines to all newborn babies
BCG vaccines can be given to unvaccinated children aged <15 years without prior tuberculin testing

Question 10

What is the health and developmental surveillance program?

Answer 10

1. Newborn consultation: cogenital anomalies (congenital cataract, DDH)
2. Nutrition and growth monitoring: dietary history, body length/height, weight and head circumference, issues related to child feeding and growth
3. Developmental surveillance: leaflets, workshops, DSQ (Developmental surveillance questionnaires) administered by nurses
4. Hearing and vision screening: sensorineural hearing impairment, congenital cataract. Preschool vision screening at 4 years (detection of ambylopia and associated conditions (squint, anisometropia/severe refractive error): that can be corrected before irreversible condition

Question 11

What are the types of attachment?

Answer 11

Secure vs insecure attachment: avoidant, ambivalent, disorganized

Question 12

When will separation anxiety start and fade?
Who do babies attach to?

Answer 12

A baby can attach to several carers at the same time
Separation anxiety is a sign of close attachment. It oftne occurs from 6-8 months old onwards but will gradually fade out after 18 months
A child who is 8-18 months old will choose a particular carer to cling to when in distress
Good communication among carers is essential for consistency in childcare
* Parent strongly advised to have close interaction with the child even though he/she can spend only a short time with the child

Question 13

What are the effects of attachment?

Answer 13

Secure attachent established before age 1/2 were found to have more positive social skills and relationships with others in later childhood
More confident and social competent in adolescence
Intergenerational links into adulthood: more secure adult relationship, more stable emotional well being

Question 14

What is the emotional development of baby?

Answer 14

Question 15

What is separation anxiety a sign of?
When is it most obvious?

Answer 15

Sign of attachment
Most obvious at 8 months
if strong and good attachment may occur early and pass through it more quickly
Decline after 18 months

Question 16

What is the arousal state system: deep sleep, light sleep, semi awake, calm alert, active alert, upset signs and parental care?

Answer 16

Question 17

What is the goal of a baby crying?

Answer 17

Babys only way to communicate his needs explicitly
Around 8-12 months old: stage of purposeful goal directed chain of actions, overlapping with social referencing i.e. aware of others emotional expressions
Baby may start to be able to manipulate attention by crying

Question 18

What are the 4 parenting styles?

Answer 18

Question 19

What are the causes of child behaviour problems?

Answer 19

(1) Genetic Make-up
- temperament
(2) Family Environment
a) ineffective child management skills
 escalation traps
 ignoring desirable behaviour
 inappropriate ways of giving instructions
 ineffective use of punishment
b) imitation of bad habits
c) emotional messages
d) parents’ belief & expectations
e) other influences
 e.g. stress, parents’ emotions, parents’ relationship
(3) Influences Outside Home
- peers & friends
- school
- media & computer games

Question 20

What is planned ignoring?

Answer 20

Deal with minor behaviour problems or attention seeking behaviours that have no immediacy to handle.
Give absolutely no attention whatsoever inclu looking, talking, touching. Give attention once the behaviour stops no matter how brief. Initially behaviour is expected to escalate when ignored as child will be keen to get response from parents.
When planned ignoring persistent, behaviour will die down.

Question 21

CCDS targets which 3 at risk groups of mothers?

Answer 21

Mothers with mental illness: psychiatric medications
Mothers with drug abuse: heroin abuser, soft drug abusers (within 1 year from EDC)
Teenage mothers: mothers aged <16 years old by EDC, mothers aged 16-18yo with signficant AE e.g. no stable partner

Question 22

Who is involved in CCDS for antenatal and perinatal period?

Answer 22

• Antenatal period :
  – At risk expectant mothers are screened and seen by CCDS midwives
  – CCDS midwife has close liaison with CCDS Psychiatric nurses and Psychiatrist to monitor and treat the requiring expectant mothers.
  – CCDS Paediatrician regularly communicates with midwife and Psychiatrist for case monitoring, also collaborate with community partners (NGOs) for maternal and family support
• Postnatal period :
  – CCDS Paediatrician also works closely with hospital paediatric colleagues and IFSC/FCPSU workers for handling child welfare issues, play an significant role in child protection, participation in multidisciplinary case conference
  – CCDS Paediatrician provides on site consultation (match with child’s immunization schedule) and appropriate management for the child and family in MCHC aiming to provide a child focus, family centre and community based service

Question 23

What are the 4 components of comprehensive child development services?

Answer 23

1. Breastfeeding counselling and support
2. Identification and management of pregnant women and mothers with depression
3. Identification and management of families with psychosocial needs
4. Positive parenting program (triple P)
5. Identification (by preschool teachers) and referral of pre-school children who need special attention