Childhood Immunisations and
Development
By Dr Sarah Ramruttun-Mulcock
GPVTS
Brief Overview
 Introduction
 Practice AKT questions
 Revision of the diseases we vaccinate against
 Small group work
 More AKT questions
 Child development- Red Flags
 Even more AKT questions!!
 Summary and answers
Introduction
 Why learn about immunisations/child development?
 Pass the AKT!! Area that is regularly tested and regularly deemed
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weak in exams
Condensed curriculum:
National immunisation programmes and the GPs role in
promoting and organising immunisation.
Normal growth and development, management of delayed
development and failure to thrive
Be able to talk confidently with parents about the immunisations
(how many injections, after effects, what does it protect against)
Health promotion...herd immunity, reduce illnesses normally
caused by the diseases
Now for the Practice!!
 Have a go!!
 Questions have been lifted from passmedicine
 Gives an idea of what to expect.......
 GUESS!!
Overview of Diseases
 Diphtheria (D): Corynebacterium diphtheriae. Throat and chest
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infection. Rare in UK.
Tetanus (T): Clostridium tetani (found in soil) Severe muscle
contractions- fatal.
Haemophilus Influenzae type b (Hib): causes pneumonia and
meningitis. Most risk below age of 4.
Pertussis (aP): Whooping cough, Bordetella pertussis. Prolonged,
distressing cough. Can lead to pneumonia and encephalitis
D/ aP/Hib/: fragmented vaccines, extracts of the organism/
virus used
Tetanus: detoxified exotoxins
Overview of Diseases
 Poliomyelitis (IPV): infection through the gut, then on to
cause meningitic type illness. Affects nerves resulting in
muscle wasting which can cause paralysis of 1+ limbs. Affects
breathing in some cases. Was given orally, now injected.
 Pneumococcus (PCV): causes pneumonia, meningitis.
Extremes of age are most vulnerable to this disease.
Introduced in 2006.
 Group C meningococcus (Men C): meningitis and
septicaemia.
 PCV/ Men C: fragmented vaccines
Overview of Diseases
 Measles: miserable feverish illness with rash.
Koplik spots – white spots on buccal mucosa. Increasing
incidence due to children not being immunised
 Mumps: Inflammation and swelling of salivary glands. May
cause permanent deafness in one ear.
 Rubella: mild illness with rash, starts on the face and then
spreads.
 MMR and BCG are live attenuated vaccines ( also oral polio,
yellow fever and oral typhoid)
Overview of Diseases
 Human Papillomavirus (HPV):
- affects skin and mucosa
- HPV 16 & 18 involved in most cases of cervical cancer
- Cervarix (endorsed by government) 3 injections; 2nd given
1-2 months, 3rd at 6m
- Gardasil: protects against viral warts, covers HPV 6, 11, 16
and 18
Group Work
 2 small groups to devise imms schedule
 Match the corresponding ages to the relevant vaccines
 Each vaccine at the correct time scores a point
 Winning group gets a treat!!
Correct Schedule
 At Birth:
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BCG/Hep B (if high risk)
2 months:
DTaP/ IPV/ Hib + PCV
3 months:
DTaP/ IPV/ Hib + Men C
4 months:
DTaP/ IPV/ Hib + PCV + Men C
12-13m:
MMR+ Hib/Men C + PCV
3-5yrs:
MMR +DTaP/ IPV
12-13yrs:
HPV
13-18yrs:
DT/IPV
DT always given with IPV, given with aP apart from 1yr/18yr
Hib not given after age of 4 yrs
2 lots of MMR back to back
PCV/Men C given up to the age of 1 yr
Correct Schedule
At Birth
BCG/ Hep B (if risk factors)
2 months
DTaP/ IPV/ Hib + PCV
3 months
DTaP/ IPV/ Hib + Men C
4 months
DTaP/IPV/ Hib + PCV + Men C
12-13 months
Hib/ Men C + PCV + MMR
3-5 years (pre- school)
MMR + DTaP/ IPV
12-13 years (girls)
HPV
13-18 years
DT/ IPV
More AKT questions
 Re- answer previous AKT questions
 Added some “curve- ball” questions
 Answers revealed at the end
Child Development
 Not something that is easily taught or learnt
 Even as a parent.....each child is different
 Development is most rapid during the first four years of life
 Key is to notice the abnormal from the normal
 May be useful to split the periods of development:
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The newborn baby
The supine infant
The sitting infant
The mobile toddler
The communicating child
(6-8 wks)
(6- 9 m)
(18- 24m)
(3-4 yrs)
Red flags in Development
 Does not roll over in either direction by the end of 4 months of age
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yellow flag
Does not respond to sounds or turns head to locate sound by age
7 months
red flag
Cannot stand when unsupported age 12 months
yellow flag
Does not speak at least 15 words and begin to use 2 word sentences by age 2
years
red flag
Does not walk by 18 months or walks exclusively on tiptoes
red flag
Cannot build a tower of more than 6-8 blocks by the age of 3 years
yellow flag
Red flags in Development
 Not jumping by the age of 30 months
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red flag
Not feeding themselves with finger food by the age of 14 months
red flag
Not smiling by 1 month
yellow flag
Not interested in pretend play by 2-3 years of age
red flag
Doesn’t pass objects from one hand to another by age 9 months
red flag
Even more AKT questions!
Answers
Immunisations:
1) (b) Mumps is a live attenuated vaccine
2) (e) Hib/ Men C, MMR, PCV
3) (c) 5
4) (a) Clean wound and IM tetanus Ig
5) (d) MMR with repeat dose at 3 months
6) (a) Child can have the vaccine
Answers
Child development:
1) (e) 4 years
2) (b) 9 months
3) (c) 6 weeks
(see handout on developmental milestones)
Summary
 Gone through and (hopefully) learnt the immunisation
schedule
 Learnt about some of the red flags in child development
 Answered AKT questions along the way
 Wow the examiners with our impressive knowledge at the
AKT exam!
Thank you for listening!!
Any Questions.....
Ask the Boss!!