Child Health in General
Practice
Dr. Kieran McGlade
Department of General Practice
Queen’s University, Belfast
Child Health Issues
 Preventative
Medicine
 Developmental Surveillance
 Family Health
 Common diseases of Childhood
 Common problems in children
Department of General Practice
Queen’s University, Belfast
Preventative Medicine in Child
Care
 Ante-natal
care
ante-natal screening
 folate supplements and nutrition

 Neonatal
care
environment
 feeding

 Immunisations
Department of General Practice
Queen’s University, Belfast
The Old Childhood Immunisation
Schedule

Primary immunisations at 8, 12 and 16 weeks
 Diphtheria, Tetanus, Pertussis HIB and Polio
(5 in one injection)
 Meningitis C (single component injection)

Measles mumps and rubella vaccine (MMR) in second year of life (1
injection) – usually about 15 months.

Pre-school boosters
 Diphtheria, Tetanus, Pertussis and Polio
(4 in one injection)
 MMR
http://www.immunisation.nhs.uk/
Department of General Practice
Queen’s University, Belfast
Changes to the Schedule
 Addition
of a pneumococcal conjugate
vaccine (PCV) at 2,4 and 15 mths of age
 One dose of Men C vaccine at 3 & 4
Mths
 Booster dose of combined Hib & MenC
1t 12 Mths of age
Department of General Practice
Queen’s University, Belfast
Immunisation Schedule 2006
AGE
Immunisations to be Given
2 mths Diphtheria, Tetanus, Pertusis , Polio and
Haemophilus influenzae type b
Pneumococcal (PCV)
Haemophilus influenzae type b
Meningitis C (Men C)
1 injection
1 injection
4 mths Diphtheria, Tetanus, Pertusis, Polio and
Department of General Practice
1 injection
1 injection
3 mths Diphtheria, Tetanus, Pertusis, Polio and
Haemophilus influenzae type b
Pneumococcal (PCV)
Meningitis C (Men C)
How
1 injection
1 injection
1 injection
Queen’s University, Belfast
Immunisation Schedule 2006
AGE
12 mths
Immunisations to be Given
Haemophilus influenzae type b and
Meningitis C (Men C)
How
1 injection
15 mths Measles Mumps and Rubella (MMR)
Pneumococcal (PCV)
1 injection
1 injection
40 - 60
mths
Diphtheria, Tetanus, Pertusis and Polio
Measles Mumps and Rubella (MMR)
1 injection
1 injection
14 – 18
yrs
Tetanus. Diphteria and polio
1 injection
Department of General Practice
Queen’s University, Belfast
Effect of the changes to the old
schedule
 Infants
will be offered different combinations
of vaccines at the 2,3 and 4 mth visits
 Three injections will be offered to infants at 4
mths of age
 A new 12 Mth vaccine will be introduced.
http://www.immunisation.nhs.uk/
Department of General Practice
Queen’s University, Belfast
Department of General Practice
Queen’s University, Belfast
Department of General Practice
Queen’s University, Belfast
Department of General Practice
Queen’s University, Belfast
Things not to miss
 Phenylketonuria
 Hypothyroidism
 Congenital
dislocation of the hip
 Retinoblastoma
 Down’s Syndrome
Department of General Practice
Queen’s University, Belfast
Developmental Surveillance
 Periodic
assessment of a child’s
developmental progress with the aim of
detecting pre-symptomatic disability
 Screening procedures should be brief,
simple, cheap and reliable
 May be combined with immunisation
visits - if so, screening should be done
first
Department of General Practice
Queen’s University, Belfast
What do we look for in
developmental screening?
 Normal
growth pattern
 Height, weight, head circumference
 Achievement of developmental milestones
(indicating neurological development)
 Gross motor function
 Fine motor function and vision
 Hearing and speech
 Social behaviour and play
Department of General Practice
Queen’s University, Belfast
How do we carry out
developmental screening
 Often
in a clinic
 GP and Health visitor
 Direct observation
 Listening to parents / carers

History is important - we want to find out
what the child can and cannot do
 Specific
tests
Department of General Practice
Queen’s University, Belfast
Developmental Screening
Tests 6 weeks
 Head
Control
 usually achieved by 6 weeks
 Moro response
 present at 6 weeks, gone by 6 months
 Gaze fixes in mother’s face, follows a brightly
coloured object past the midline
 Rattle or bell, 15cm at ear level - quietens or
turns to sound.
Department of General Practice
Queen’s University, Belfast
Family Health
Family Life Cycle Stages
 The
new couple
 Birth of first child
 School age family
 Adolescent family
 Launching family
 Empty nest
 Ageing family
Department of General Practice
Queen’s University, Belfast
Group Tasks
 List
the commonest diseases in
childhood.
 List
the commonest presenting
symptoms in childhood.
Department of General Practice
Queen’s University, Belfast
Common diseases in
Childhood
 Nappy
rash
 Upper Respiratory Tract Infection
 Infectious Diseases
 Urinary tract infection
 Asthma
 Eczema and other rashes
 Trauma
Department of General Practice
Queen’s University, Belfast
Infectious diseases and
common infections
 Measles
 URTI
Mumps
 Rubella
 Pertussis
 Chickenpox


Department of General Practice
Otitis media
 Tonsillitis
 UTI
 Gastro-enteritis
 Herpes stomatitis
 Meningitis
Queen’s University, Belfast
Common Problems
 Sore
tummy
 Headaches
 Rashes and fevers
 Bed wetting - enuresis
 Behavioural problems / school refusal
 Cough
 Diarrhoea and vomiting
Department of General Practice
Queen’s University, Belfast
Group tasks (2)
 Discuss
how you might manage the
following scenarios:
A six month old baby presenting with a
fever
 A five year old presenting with a cough
 A nine year old with an itchy rash on her
trunk.
 A ten year old child with recurrent
headaches

Department of General Practice
Queen’s University, Belfast
On observing a consultation with
a child - questions to ask yourself
 Who
is the patient?
 What is the reason for the consultation?
 What opportunities does this
consultation present?
 Is the consultation structured any
differently from an adult consultation?
Department of General Practice
Queen’s University, Belfast
Summary
 Child
health is an integral part of GP.
 It embraces prevention, diagnosis and
treatment.
 A knowledge of the family is an important
key to the understanding of child health
problems.
 Flexibility of approach, attention to detail,
observation and listening to children and
parents are of crucial importance.
Department of General Practice
Queen’s University, Belfast
Department of General Practice
Queen’s University, Belfast