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?
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 ."
Aims of this session:
• Assessment in a child friendly approach
• 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
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
Checklist
• behaviour / colour
• 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
Normal Values
Age
Respiratory Heart rate
Systolic BP
Rate / min
/ min
Neonate
60
160
70
<1
35-45
110-160
75
1-5
25-35
95-140
80-90
5-12
20-25
80-120
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.