Description
Book SynopsisAbout to start a paediatrics rotation? Working with children for the first time? Thinking about a career in paediatrics? This is a practical guide for medical students encountering paediatrics for the first time, junior doctors thinking about working with children, and new paediatric trainees.
Table of ContentsPreface xi
Acknowledgements xii
About the Companion Website xiii
1 Getting started 1
Who’s who? 1
Breastfeeding advisor 1
Child protection nurse 1
Clinical support worker 1
Dietitian 1
Health visitor 2
Healthcare assistant 2
Midwife 2
Nursery assistant 2
Nursery nurse 3
Occupational therapist 3
Orthoptist 3
Pharmacist 3
Pharmacy technician 3
Physician assistant 3
Physiotherapist 4
Play specialist 4
Psychologist 4
School teacher 4
Specialist nurse 5
Social worker 5
Speech and language therapist 5
Staff nurse 5
Ward clerk 6
Ward sister 6
What happens where? 6
Playroom 6
Teenage room 6
Treatment room 6
School room 7
Parents’ room 7
Sensory room 7
Day care unit 7
Milk room 7
Postnatal ward 7
Paediatric emergency department 7
Be prepared 8
Jargon buster 9
2 Child development 19
What can a child of this age normally do? 19
Six weeks 20
Six to eight months 21
Twelve months 21
Eighteen months 21
Two years 22
Three years 22
School 22
Developmental delay and children with disabilities 22
Support for children with disabilities and their families 25
Growth 26
Obesity 28
Immunisations 29
The UK vaccination schedule 31
3 Communication with children and their parents 37
How to communicate with a baby or toddler 39
How to communicate with an infant school child (4–6 years) 40
How to communicate with a school-age child (7–12 years) 40
How to communicate with a teenager 41
How to communicate with a child using alternative communication 45
How to communicate with anxious parents 46
How to communicate with an expert parent or patient 47
Breaking bad news 49
Cultural sensitivity 54
Illiteracy 56
Consent 56
Parental responsibility 57
At what age can children consent for themselves? 57
4 Child protection and safeguarding 60
Different forms of abuse 60
Physical abuse 60
Fabricated or induced illness (FII) 62
Emotional abuse 64
Neglect 66
Sexual abuse 66
Maternal substance abuse in pregnancy 69
Female genital mutilation 70
Forced marriage and honour violence 70
Which children are most vulnerable to abuse? 72
What to do if you suspect child abuse 73
What should I say to the parents? 75
What to do if you suspect sexual abuse 75
Child protection medicals 77
Working with social care, education and the police 77
Social care 78
Police 78
I’ve made a referral to social services; what happens next? 83
What if you are worried about the immediate safety of the child? 83
What is a section 17 investigation? 84
Who is a child in need? 84
Who is a looked-after child? 84
What happens after it is decided that a child is in need? 84
What is a strategy discussion? 84
What is a section 47 enquiry? 85
What is a child protection conference? 85
What is a child protection plan? 85
What is a child protection review conference? 85
What is the child protection register? 85
What stops us from considering the possibility of abuse? 85
5 Common paediatric emergencies 88
Basic Life Support 88
Danger 88
Response 88
Shout for help 88
Airway 90
Breathing 91
Circulation 91
Choking child 92
History 93
Symptoms 93
Signs 93
Immediate management 93
Advanced Life Support 95
Airway management 97
Breathing management 97
Circulation management 99
Emergency drugs 99
ABCDE approach 101
A – Airway 101
B – Breathing 105
c – Circulation 108
d – Disability 110
E – Exposure 112
Reassess 113
Take a brief history 113
Anaphylaxis 113
History 113
Symptoms 114
Signs 114
Immediate management 114
Further management 115
Long-term management 115
Acute asthma 115
History 116
Symptoms 116
Signs 116
Immediate management 116
Further management 118
Long-term management 118
Drowning 119
History 119
Signs 119
Immediate management 119
Further management 120
Sepsis 121
History 121
Symptoms and signs 121
Immediate management 122
Further management 122
Meningococcal septicaemia 123
History 123
Symptoms 123
Signs 123
Initial management 124
Burns and scalds 124
History 124
Symptoms 124
Signs 125
Immediate management 125
Further management 126
Ongoing management 126
Seizures 128
History 128
Immediate management 128
Further management 130
Poisoning 131
History 131
Symptoms and signs 131
Immediate management 131
Further management 132
Diabetic ketoacidosis 135
History 135
Symptoms 135
Signs 135
Immediate management 135
Further management 136
Trauma 138
Catastrophic external haemorrhage 138
Airway and cervical spine control 138
Breathing 139
Circulation with haemorrhage control 140
Disability and assessment of head injury 141
Critical care transfer services 141
North West England 141
North East England 142
West Midlands 142
East Midlands 142
South East England and London 142
South Central and South West England 142
North Wales 142
East Scotland 143
West Scotland 143
Northern Ireland 143
6 Practical procedures 144
Setting up 144
Cannulation 145
Taking blood (including heel prick sampling) 148
Heel prick sampling 148
Venepuncture in babies 151
Capillary blood gas 152
How to measure a spun bilirubin (SBR) 153
How to measure packed cell volume 154
Intraosseous access 154
Nasogastric tube 158
Lumbar puncture 161
Urinary catheter insertion 166
Suprapubic urine sample 169
Mantoux test 171
Injecting tuberculin 171
‘Reading’ the Mantoux test results 173
Peak flow 173
Hand-held spirometry 174
Setting up a nebuliser 175
Inhaler technique and using a spacer 175
Intramuscular injections (for immunisations) 176
How to use an Epipen/Anapen 177
Changing a nappy 177
7 Prescribing in children 179
General principles 179
Getting children to actually take what you prescribe 181
Fluids 181
Maintenance fluids 182
Replacement therapy 182
Analgesia 186
Step 1 – mild pain 187
Step 2 – moderate pain 187
Step 3 – severe pain 188
Controlled drugs 188
Blood products 188
When to give CMV-negative products 188
When to give gamma-irradiated products 189
Packed red cells 189
Platelets 189
Fresh frozen plasma (FFP) 190
Drug level monitoring 190
8 Teenagers 192
Taking a history from a teenager 192
Mental health problems 193
Deliberate self-harm and suicide 193
Eating disorders 196
Substance abuse 197
Sexual health 198
9 Neonates 200
Neonatal life support at birth 200
Stimulate and airway manoeuvre 204
Reassess 204
Give five inflation breaths 205
Reassess 205
Consider oxygen saturation monitoring 205
Further inflation breaths or regular breaths 205
Calculating Apgar scores 206
Newborn baby checks 207
Newborn examination 210
Prematurity 210
Resuscitation at birth for premature babies 211
Extreme prematurity and resuscitation decisions 213
The law in the United Kingdom 214
Best interests 214
Parental responsibility 214
Euthanasia is illegal 214
Intending relief of distress is normally legal 214
Withdrawing or withholding treatment is the same in the eyes of the law 215
Some useful ethical frameworks and guidance 215
Intravenous fluids in infants 215
Neonatal nurses 216
10 Looking after yourself 218
Dealing with upsetting situations 218
Short-term coping mechanisms 218
Long-term coping mechanisms 221
Bullying and harassment 223
Practising paediatrics when you have your own children 224
Emotional impact 224
Not enough hours in the day 224
Feeling isolated 225
Nobody’s perfect: dealing with mistakes 226
Avoiding making mistakes 227
Pitfall 1: Communication 227
Pitfall 2: Being distracted at a critical moment 229
Pitfall 3: Failure to follow protocol 230
Pitfall 4: Acting beyond your competence 230
Organisation 231
Night shifts 232
11 Developing your career 234
Specialist training structure for paediatrics 234
Opportunities for research 237
Academic training programme 237
Out-of-programme research (OOPR) 237
Completing research projects alongside regular training 237
College exams 238
Written papers 238
Clinical exam 239
How to boost your CV 240
CV building for medical students 241
CV building for Foundation trainees 243
CV building for specialist trainees 245
Clinical governance – more than just audit 246
Service improvement projects 246
Patient safety 249
Less than full-time training 250
Teaching and training 252
Work-based assessments and e-portfolios 254
Index 257
