Hands-on Guide to Practical Paediatrics

Rebecca Hewitson is Paediatrics Specialist Trainee, London Deanery, The Whittington Hospital and Royal Free Hospital, London  Caroline Fertleman is Consultant Paediatrician, The Whittington HospitalSite Sub-Dean and Honorary Senior Lecturer, University College London Medical SchoolTraining Programme Director, School of Paediatrics, London DeaneryHonorary Consultant, Great Ormond Street Hospital, London

• Preface xiAcknowledgements xiiAbout the Companion Website xiii1 Getting started 1Who’s who? 1Breastfeeding advisor 1Child protection nurse 1Clinical support worker 1Dietitian 1Health visitor 2Healthcare assistant 2Midwife 2Nursery assistant 2Nursery nurse 3Occupational therapist 3Orthoptist 3Pharmacist 3Pharmacy technician 3Physician assistant 3Physiotherapist 4Play specialist 4Psychologist 4School teacher 4Specialist nurse 5Social worker 5Speech and language therapist 5Staff nurse 5Ward clerk 6Ward sister 6What happens where? 6Playroom 6Teenage room 6Treatment room 6School room 7Parents’ room 7Sensory room 7Day care unit 7Milk room 7Postnatal ward 7Paediatric emergency department 7Be prepared 8Jargon buster 92 Child development 19What can a child of this age normally do? 19Six weeks 20Six to eight months 21Twelve months 21Eighteen months 21Two years 22Three years 22School 22Developmental delay and children with disabilities 22Support for children with disabilities and their families 25Growth 26Obesity 28Immunisations 29The UK vaccination schedule 313 Communication with children and their parents 37How to communicate with a baby or toddler 39How to communicate with an infant school child (4–6 years) 40How to communicate with a school-age child (7–12 years) 40How to communicate with a teenager 41How to communicate with a child using alternative communication 45How to communicate with anxious parents 46How to communicate with an expert parent or patient 47Breaking bad news 49Cultural sensitivity 54Illiteracy 56Consent 56Parental responsibility 57At what age can children consent for themselves? 574 Child protection and safeguarding 60Different forms of abuse 60Physical abuse 60Fabricated or induced illness (FII) 62Emotional abuse 64Neglect 66Sexual abuse 66Maternal substance abuse in pregnancy 69Female genital mutilation 70Forced marriage and honour violence 70Which children are most vulnerable to abuse? 72What to do if you suspect child abuse 73What should I say to the parents? 75What to do if you suspect sexual abuse 75Child protection medicals 77Working with social care, education and the police 77Social care 78Police 78I’ve made a referral to social services; what happens next? 83What if you are worried about the immediate safety of the child? 83What is a section 17 investigation? 84Who is a child in need? 84Who is a looked-after child? 84What happens after it is decided that a child is in need? 84What is a strategy discussion? 84What is a section 47 enquiry? 85What is a child protection conference? 85What is a child protection plan? 85What is a child protection review conference? 85What is the child protection register? 85What stops us from considering the possibility of abuse? 855 Common paediatric emergencies 88Basic Life Support 88Danger 88Response 88Shout for help 88Airway 90Breathing 91Circulation 91Choking child 92History 93Symptoms 93Signs 93Immediate management 93Advanced Life Support 95Airway management 97Breathing management 97Circulation management 99Emergency drugs 99ABCDE approach 101A – Airway 101B – Breathing 105c – Circulation 108d – Disability 110E – Exposure 112Reassess 113Take a brief history 113Anaphylaxis 113History 113Symptoms 114Signs 114Immediate management 114Further management 115Long-term management 115Acute asthma 115History 116Symptoms 116Signs 116Immediate management 116Further management 118Long-term management 118Drowning 119History 119Signs 119Immediate management 119Further management 120Sepsis 121History 121Symptoms and signs 121Immediate management 122Further management 122Meningococcal septicaemia 123History 123Symptoms 123Signs 123Initial management 124Burns and scalds 124History 124Symptoms 124Signs 125Immediate management 125Further management 126Ongoing management 126Seizures 128History 128Immediate management 128Further management 130Poisoning 131History 131Symptoms and signs 131Immediate management 131Further management 132Diabetic ketoacidosis 135History 135Symptoms 135Signs 135Immediate management 135Further management 136Trauma 138Catastrophic external haemorrhage 138Airway and cervical spine control 138Breathing 139Circulation with haemorrhage control 140Disability and assessment of head injury 141Critical care transfer services 141North West England 141North East England 142West Midlands 142East Midlands 142South East England and London 142South Central and South West England 142North Wales 142East Scotland 143West Scotland 143Northern Ireland 1436 Practical procedures 144Setting up 144Cannulation 145Taking blood (including heel prick sampling) 148Heel prick sampling 148Venepuncture in babies 151Capillary blood gas 152How to measure a spun bilirubin (SBR) 153How to measure packed cell volume 154Intraosseous access 154Nasogastric tube 158Lumbar puncture 161Urinary catheter insertion 166Suprapubic urine sample 169Mantoux test 171Injecting tuberculin 171‘Reading’ the Mantoux test results 173Peak flow 173Hand-held spirometry 174Setting up a nebuliser 175Inhaler technique and using a spacer 175Intramuscular injections (for immunisations) 176How to use an Epipen/Anapen 177Changing a nappy 1777 Prescribing in children 179General principles 179Getting children to actually take what you prescribe 181Fluids 181Maintenance fluids 182Replacement therapy 182Analgesia 186Step 1 – mild pain 187Step 2 – moderate pain 187Step 3 – severe pain 188Controlled drugs 188Blood products 188When to give CMV-negative products 188When to give gamma-irradiated products 189Packed red cells 189Platelets 189Fresh frozen plasma (FFP) 190Drug level monitoring 1908 Teenagers 192Taking a history from a teenager 192Mental health problems 193Deliberate self-harm and suicide 193Eating disorders 196Substance abuse 197Sexual health 1989 Neonates 200Neonatal life support at birth 200Stimulate and airway manoeuvre 204Reassess 204Give five inflation breaths 205Reassess 205Consider oxygen saturation monitoring 205Further inflation breaths or regular breaths 205Calculating Apgar scores 206Newborn baby checks 207Newborn examination 210Prematurity 210Resuscitation at birth for premature babies 211Extreme prematurity and resuscitation decisions 213The law in the United Kingdom 214Best interests 214Parental responsibility 214Euthanasia is illegal 214Intending relief of distress is normally legal 214Withdrawing or withholding treatment is the same in the eyes of the law 215Some useful ethical frameworks and guidance 215Intravenous fluids in infants 215Neonatal nurses 21610 Looking after yourself 218Dealing with upsetting situations 218Short-term coping mechanisms 218Long-term coping mechanisms 221Bullying and harassment 223Practising paediatrics when you have your own children 224Emotional impact 224Not enough hours in the day 224Feeling isolated 225Nobody’s perfect: dealing with mistakes 226Avoiding making mistakes 227Pitfall 1: Communication 227Pitfall 2: Being distracted at a critical moment 229Pitfall 3: Failure to follow protocol 230Pitfall 4: Acting beyond your competence 230Organisation 231Night shifts 23211 Developing your career 234Specialist training structure for paediatrics 234Opportunities for research 237Academic training programme 237Out-of-programme research (OOPR) 237Completing research projects alongside regular training 237College exams 238Written papers 238Clinical exam 239How to boost your CV 240CV building for medical students 241CV building for Foundation trainees 243CV building for specialist trainees 245Clinical governance – more than just audit 246Service improvement projects 246Patient safety 249Less than full-time training 250Teaching and training 252Work-based assessments and e-portfolios 254Index 257