Child Health

Eight week check Elaine Burfitt July 2010

Child Health

 Eight week check  Check list  Referral information  DVD  Pitfalls

Schedule

Screen  Newborn  6-8 weeks SHO or midwife GP or HV Non screen status  2 year check nursery nurse

Eight week check

 Newborn & Infant Physical Examination Standards and Competencies March 2008 UK National Screening committee  Local referral information  Awaiting Public Health oversight

Eight week checklist

 Examine in appropriate surroundings, preferably with calm, fed baby  Take opportunities to discuss health promotion messages along the way e.g. smoking, back to sleep, careful handling, etc.  Brief review of birth history, general health and feeding.  Review red book information to date including hearing screening data Sets context of examination and growth assessment. May have missed hearing screen or not had a clear response.  Ask carer if they think baby can see and hear  Ask carer if any concerns about baby

Eight week checklist

 Head to toe examination All areas of skin must be seen at some point during the examination. May carry out some parts of examination when babe is dressed or partially dressed in order not to disturb ie when auscultating the heart but still need to carry out examination appropriately. Including general handling, demeanour, skin, head shape and size, fontanelles, dysmorphism, eyes including red reflex and visual fixation and behaviour, palate, neck, heart, abdomen, genitalia, spine, anus, hips, limbs including hands and feet.

Eight week check

Eight week check

Eight week checklist

 Plot and assess growth  Complete red book  Discuss outcomes with parent/carer  Immunisation as appropriate Send in return slip Make any referrals needed With appropriate consent

Eight week check

Eight week check

Eight week check

 Sacral dimple is simple if:  < 5mm diameter  Lying in midline  <25 mm from anus

Heart defects

 Screen all by 72 hours  Refer all screen positive within 24 hours of examination for pulse oximetry and expert consultation  Review by 10 days if considered at risk of clinical deterioration  1 st appointment within 4 weeks if no significant clinical risk

Heart defects

 6-8 week check  Refer by phone if symptomatic at that time  No other timescales recommended at present

Hearing

 Universal neonatal screening  Oto acoustic emissions  Normal   Abnormal - further diagnostics Normal but in high risk group – 8 month FU  Incomplete test or not done

Hearing

 Check parental concerns  Check neonatal screening page  Encourage attendance at further screen or diagnostic appointments  If unclear ring neonatal screeners for information on child on pathway  Fill in slip appropriately

Hearing

 Several missed in recent years Presented May 2008 by Hilary Smith  Jan 2008 – Dec 2009 78 babies recorded on 8 week slip as normal hearing when had NCR in one or both ears on neonatal screen

Hearing

 Pre screening average age of aiding 22 months  i.e. huge loss of developmental window for learning language  Recent good examples of successes

Vision

 Neonatal check no concerns  8 weeks parental concerned about visual behaviour  Reported to HV/ GP at time of 8 w check

Vision

 Referred to paediatrician by letter  Seen by paediatrician at 12 weeks  Concern regarding red reflex

Congenital cataract

 Tel ref to ophthalmologist  Operation at 13 weeks (despite anaesthetic risk re URTI at the time)  17 m no detectable VI problem over and above lens limitation

Congenital cataract survey

 1995-1996 12 months  Data on 235 children  35% detected at newborn  12% detected at 6-8 week check  By 3 months 47% had been detected by screening and 57% of these had seen an ophthalmologist

Vision

Neonatal

Inspect external eye structures and red reflex Referral to ophthalmologist see below National recommendation to be seen within 2 weeks of birth Retinopathy of prematurity, < 31 weeks and/ or < 1500g then should be in ophthalmology screening pathway at neonatal unit.

6-8 week check

 Establish if any concerns of parents and check relevant family history  Observe visual behaviour  Observe visual fixing and following  Inspect external eye structures  Check red reflexes Abnormal red reflexes are to be referred urgently to ophthalmology at Manchester Eye Hospital. Urgent means including phone contact ASAP with paediatric ophthalmology, via switch 0161 2761234 Retinoblastoma can be life threatening Congenital cataracts need to be operated upon by 12 weeks of age to prevent loss of vision development.

Other vision concerns include

possible severe vision impairment or parental concern of such.

Refer to Mr Simon Wallis, Bolton Royal, does weekly Thursday Pendleton Gateway clinic and

will see with low threshold urgently. Urgent fax

referrals 01204 390051, Confirm by Tel 01204 390390 ext 3935

Squint, family history of squint or any vision concerns/reduced vision will be seen by orthoptists via chose and book and liase with Mr Wallis accordingly

Vision

4-5 years Universal screen by orthoptist. Orthoptists available for discussion of concerns. Work closely with ophthalmology, based in Sandringham 0161 2124128 or [email protected]

8 week vision

 Fixing and following

Hips

Neonatal examination

Universal Ortolani and Barlow screen in hospital Dislocated or dislocatable hips for urgent referral to orthopaedics and hip ultrasound Ultrasound arranged for high risk babies, screen positive as above or clinical concern, particularly marked limited abduction. Referrals are made directly to orthopaedics from neonatology and Dr Jill Carling, paediatric radiologist at SRFT

Hips

8 week check

Universal Ortolani and Barlow screen (Not if already seeing orthopaedics for such/ in harness!) Confirm US appointment has been attended if high risk National Screening Committee March 2008 definition of high risk:  Clinical diagnosis of breech presentation at any time, even if cephalic birth  Family history of DDH (Developmental Dysplasia of the Hip) Locally Talipes or other lower limb abnormality is also considered to indicate a high risk baby Screen positive, clinical concern or high risk baby not already in the system at SRFT or elsewhere then referral for urgent hip ultrasound at SRFT. Urgent fax number at SRFT is 0161 2065494 Note that asymmetrical thigh creases with no other positive findings or history are not an indication for referral.

Hips

Older ages

Refer if needed because of clinical concern at any later date direct to Mr Henry orthopaedic surgeon at RMCH Refer via fax to 0161 7015421 Tel confirmation of receipt is requested on 0161 7015352 Referral will be triaged clinically Weekly hips clinic is at RMCH

Hips

 Video / DVD

Testes Neonatal check

 Bilateral undescended – 100% to see paediatrician within 24 hours  Unilateral – make parent aware and review at 6-8 weeks

Testes 8 weeks

 Bilateral undescended  Refer to surgeons C&B  Appointment by 1 year old  Operation by 2 years old

Testes 8 weeks

 Unilateral  All reviewed by GP at 22-26 weeks Child Health computer can notify  Refer to surgeon at review if needed  All seen by 1 year and all operated on by 2 years of age

Eight week check

Be thorough Check slips and send in returns Thank you very much DVD