• Manage primary contact with children and their families - and, with older children, on their own
• Understand the importance of multi-agency working (working across professional and agency boundaries)
• Co-ordinate care with other primary care professionals, paediatricians and other appropriate specialists, leading to effective and appropriate care provision, taking an advocacy position for the patient or family when needed:
• Deal effectively with child abuse. Safeguarding children, understanding that:
o the welfare of the child must be the paramount consideration and can help to justify actions that challenge ethical and professional norms.
o as GPs we are usually family focused, but in dealing with child protection and other vulnerable children (such as domestic violence) if we focus on the family we risk losing sight of the child.
o often children in special circumstances are ‘invisible’ to the system because they live in the shadow of their parents' problems
o dealing effectively with child abuse involves, recognising the clinical features, knowing about local arrangements for child protection, referring effectively and playing a part in assessment and continuing management including prevention of further abuse in the patient and family.
• Understand the principles of clinical governance and risk management
o clinical governance systems do not always explicitly recognise children and young people as a separate and vulnerable client group. It is essential that the care of children is given a specific focus within the clinical governance arrangements in primary care.
o the components of clinical governance strategies in primary care will include: safety of treatment and care; safeguarding; the use of evidence-based practice; clinical audit; effective prescribing and referrals, and continuing professional development.
• Ensure that parents or carers, children and young people receive information, advice and support to enable them to:
o manage minor illnesses themselves, using community pharmacists and triage services where appropriate
o Access appropriate services when necessary
• Prescribe and advise appropriately about the use of medicines in children, being competent at:
o calculating drug doses
o understanding the risks and benefits of medicines in relation to children;
o understanding the needs of ethnic minorities, and cultural differences in beliefs about illness and the use of medicines
• Understanding the welfare of the unborn baby by:
o being aware of the impact of parental problems including domestic violence, substance misuse and mental health problems.
o being able to recognise the symptoms and presentations of such problems and being able to make a sensitive enquiry if concerned
o providing information about, or referral to, local services for women who have substance misuse problems as they are at greater risk of problem pregnancies and their care should be provided by an integrated multi-disciplinary and multi-agency team
The knowledge base
Symptoms
• vomiting, fever, drowsiness, developmental delay, infantile colic, ‘Failure to Thrive’ and growth disorders, behavioural problems
Common and/or important conditions
• neonatal problems: birthmarks, feeding problems, heart murmur, sticky eye, jaundice
• constipation, abdominal pain (acute and recurrent)
• pyrexia ,febrile convulsions
• cough/dyspnoea, wheezing including respiratory infections, bronchiolitis
• otitis media
• sensory deficit especially deafness
• gastroenteritis
• viral exanthems,
• urinary tract infection,
• meningitis
• epilepsy
• chronic disease: asthma, diabetes, arthritis, learning disability
• child abuse, deprivation
• mental health problems such as attention deficit hyperactivity disorder, depression, eating disorders, substance misuse and self-harm, autistic spectrum disorder and related conditions
• psychological problems: enuresis, encopresis, bullying, school refusal, behaviour problems including tantrums
• child and young person development (physical and psychological);
Prevention
Areas where healthy choices make a big difference in children’s and young people’s lives include:
• pre-natal diagnosis
• breastfeeding;
• healthy diet and exercise for children and young people;
• social and emotional well-being;
• keeping children and young people safe; child protection, accident prevention
• immunisation
• avoiding smoking, using volatile substances and other drugs and minimising alcohol intake,
• reducing the risk of teenagers getting pregnant or acquiring sexually transmitted infections.
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The knowledge base
Symptoms
• vomiting, fever, drowsiness, developmental delay, infantile colic, ‘Failure to Thrive’ and growth disorders, behavioural problems
Common and/or important conditions
• neonatal problems: birthmarks, feeding problems, heart murmur, sticky eye, jaundice
• constipation, abdominal pain (acute and recurrent)
• pyrexia ,febrile convulsions
• cough/dyspnoea, wheezing including respiratory infections, bronchiolitis
• otitis media
• sensory deficit especially deafness
• gastroenteritis
• viral exanthems,
• urinary tract infection,
• meningitis
• epilepsy
• chronic disease: asthma, diabetes, arthritis, learning disability
• child abuse, deprivation
• mental health problems such as attention deficit hyperactivity disorder, depression, eating disorders, substance misuse and self-harm, autistic spectrum disorder and related conditions
• psychological problems: enuresis, encopresis, bullying, school refusal, behaviour problems including tantrums
• child and young person development (physical and psychological);
Prevention
Areas where healthy choices make a big difference in children’s and young people’s lives include:
• pre-natal diagnosis
• breastfeeding;
• healthy diet and exercise for children and young people;
• social and emotional well-being;
• keeping children and young people safe; child protection, accident prevention
• immunisation
• avoiding smoking, using volatile substances and other drugs and minimising alcohol intake,
• reducing the risk of teenagers getting pregnant or acquiring sexually transmitted infections.
Specific problem-solving skills
By the end of training, the GP Registrar should be able to:
• Use a decision-making process determined by the prevalence and incidence of illness in the community and the specific circumstances of the patient and family:
o being aware of normal growth and development
o being aware of neonatal problems including jaundice and feeding problems, breast feeding and nutrition
• Manage conditions which may present early and in an undifferentiated way, and to recognize a seriously ill child and intervene urgently when necessary by:
o having a thorough understanding of normal development, and being able to recognise delayed development
o recognising normal growth, and dealing with faltering growth and failure to thrive
o recognising children at risk
o being aware that consultations about children may be a presentation of a mother’s post-natal depression; and being aware of the effect that post-natal depression may have on her children
o recognising the significance of non-attending
o understanding that children failing to attend appointments (in primary or secondary care) may trigger concern, given that they are reliant on their parent or carer to take them to the appointment.
o failure to attend can be an indicator of a family’s vulnerability, potentially placing the child’s welfare in jeopardy.
o Acknowledging that failure to attend can be an indicator that services are difficult for families to access or considered inappropriate, and need reviewing.
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