SPOTTING THE SICK CHILD Dr James Thomas

Spotting the sick child introduction: • Paediatric training?

• Where will you pick these skills up?

• What learning resources do you know to help you spot the sick child?

RCGP : Care of children and young people & Care of acutely ill • "Recognise and evaluate acutely ill patients" people • "manage conditions which may present early and in an undifferentiated way, and recognise a seriously ill child and intervene urgently when necessary ."

• Spotting the ill child.

• Look at physiological changes in children due to acute serious illnesses and how this helps us with assessing ill children.

• • Look at scenarios of serious illness in childhood : breathing difficulties,rashes and fever.

• Summarise your findings • Reflect on your future learning needs.

Assessment in a child friendly approach • Why is this important?

• How do we achieve this child friendly environment?

• What general principals do you use to examine children?

• How do you make your examination child friendly?

Rapid assessment toolkit for paediatrics • 3 minute paediatric toolkit • Demonstration videos

•GENERAL • behaviour / colour Checklist •AIRWAY • Stridor / noisy breathing / drooling •BREATHING • Recession/accessory muscles/respiratory rate/auscultation/sats •CIRCULATION • Peripheral tempre & colour / pulse/ capillary refill/BP - video •DISABILITY • Alert / Voice only/ Pain only/ Unresponsive •ENT

Normal Values Age Neonate Respiratory Rate / min Heart rate / min Systolic BP 60 160 70 <1 1-5 5-12 35-45 25-35 20-25 110-160 95-140 80-120 75 80-90 90-110

Clinical scenarios: small group work • History and examination of common causes and how you would differentiate the ill child in these cases.

• Difficulty in breathing • Rashes • Fever

Difficulty in breathing • Common causes • Key history points • Examination points - video • Case history 1-5 year old -video

Rashes • Common causes • History ?

• Examination?

• Tumbler test - video • Serious causes - video

Fever • History • General examination • Specific examination • Case history - video

Summary • Child friendly environment and examination technique.

• 3 minute toolkit • Check physiology and know age related normal values.

• Use this information to allow you to be confident in your further management.

Reflection • What will you do now?

• Look at other resources - eGP / CKS /PALS course • AKT - look at NICE guidance • CSA - no sick child but might be a telephone consultation scenario and make sure aware of NICE guidance for fever management.