Community Perspectives On Early Childhood Development

26.4.06

There was also a handout to go with. The notes below are just the slides that weren't included on the handout.

Why screen children?
• To detect remedial condition.
• To check growth.
• To check developmental milestones reached.
• To support parents - give information, address concerns.
• To address public health issues.

Neonatal examination
• Hospital-based, within first 24 hours.
• Check weight and head circumference.

Major disorders
• Down's syndrome (1 per 600).
• Congenital hypothyroidism (1 per 5,000).
• Phenylketonurea (1 per 13,000).
• Congenital heart disease (7 per 1,000).
• Congenital dislocation of the hip (1 per 1,000).
• Undescended testes (60 per 10,000).

6-8 week check
• Done by GP in specific baby clinics.
• Developmental milestones.
• Measure and plot weight, length and head circumference.
• Top-to-toe examination.
• Ask about parental concerns and address issues.
• Discuss feeding, parental coping, smoking, prevention of cot death, immunisations.
• Screen for post-natal depression.

6-9 month check
• Done by health visitor.
• GP only involved if problems.
• Looking for:
-growth;
-squint - cover test;
-hearing - distraction test;
-developmental milestones.
• Check for parental concerns.
• Ask specifically about hearing and vision concerns.

3 year check often by questionnaire.

5 year check
• Done by school nurse.
• Children with special educational needs - followed up annually.


Growth problems
Failure to thrive:
• Failure to gain weight at normal rate.
• Commonest cause: inadequate dietary intake.
• Further investigation - CF, coeliac disease.

Short stature:
• Short parents = constitutional short stature.
• Height below 3rd centile.
• Causes: chromosomal abnormalities, poor gestational nutrition etc.

Normal hearing
• Not turning to sound <6 months old.
• Ignoring being called at 3-4 years.

Walking
• Normal late walking up to 18 months.
• Often familial.
• Bottom shufflers - 10% of population - often familial.
• Hypotonia.

Referrals to community paediatric units
• Hearing problems.
• Speech and language problems.
• Visual problems.
• Developmental delay.
• Behavioural/psychological problems.

Important issues to cover in child health promotion clinics
1. Immunisations
• Explore parental attitude to immunisations.
• Address parental concerns.
• Check immunisations up-to-date.

2. Universal advice
• Cot death prevention.
• Smoking cessation etc.

3. Parental issues
• Contraceptive advice.
• Post-natal depression screening.
• Support of good parenting skills.
• Parental concerns.

4. Child protection issues.
• Four types of abuse:
(i) physical;
(ii) emotional;
(iii) neglect;
(iv) sexual.
• Watch out for:
-mental health problems of carers;
-previous history of neglect;
domestic violence.

If child abuse suspected
• Consider whether child needs immediate removal.
• Other cases: refer to social services.
• Patient confidentiality can be breached in child's best interests.