What you should be able to do
Stimulus questions in relation to outcomes
Competence in Clinical Skills
What features in the history might help you
determine the likely cause of the respiratory
distress a) in neonates b) in infants and older
children?
Be able to perform full paediatric and neonatal
history and examination
Be able to recognise the signs of respiratory
distress in neonates and older children
Know how the age of the child affects the likely
pathology
Know the radiographic appearances of the
various causes of respiratory distress
Competence in practical procedures
Be aware of the way blood is taken from
neonates, infants, and older children
Be aware of how blood gases are obtained
Competence in Patient Investigation
Know the appropriate investigations in a neonate
and child with respiratory distress
Be able to interpret blood gas results
Competence to manage a patient
Know the role of surfactant and antibiotics in
neonates with respiratory distress
Know how to use clinical findings, X-rays, blood
gas and other blood test results to guide patient
management
Know the appropriate management for the
common causes of respiratory distress
What are the clinical features of bronchiolitis, and
which age group is most vulnerable to this
condition?
What are the radiographic features associated
with respiratory distress syndrome?
How can children be prepared for practical
procedures? How does their age affect this
preparation?
In what circumstances should a chest X-ray be
performed, and when is this unnecessary?
What further information can be obtained from
blood tests?
Should all children with respiratory distress have
blood gases checked?
What infections are
checked for using a pernasal swab and a
nasopharyngeal aspirate?
Which neonates should receive surfactant?
How should patients be monitored, and how will
you know if they are improving?
Which patients should receive antibiotics?
Is outpatient follow-up necessary?
What factors would make you decide to admit a
child to hospital?
Know when to involve other members of the
healthcare team in management
Competence to offer advice in health promotion
and disease prevention
Be able to offer advice to parents on measures to
control asthma symptoms
Be able to explain to parents of asthmatic
children the importance of ‘preventer’ therapy
What measures can be taken to reduce the
severity of chronic asthmatic symptoms?
What is the role of the asthma nurse in asthma
management?
What factors affect patient compliance with their
treatment?
Know the effects of exposure to cigarette smoke
on respiratory symptoms
Understand the role of antenatal steroids in
preventing respiratory distress in preterm infants
Competence in communication
Know how and when to contact members of the
multidisciplinary team
How long before delivery do steroids have to be
given to be effective in reducing the incidence of
respiratory distress syndrome?
When would it be important to contact the health
visitor or GP?
How could you explain the nature of respiratory
distress syndrome to parents?
Be able to communicate effectively with parents
about their child’s condition
Competence to retrieve and handle information
Be able to search the literature and interpret
information obtained on respiratory problems in
childhood
Are there any Cochrane reviews on the
management of respiratory distress in neonates?
Are there any national Guidelines on the
management of asthma in children?
Be able to obtain information on children’s health
from all appropriate sources
How you should approach your practice
Understanding the social, basic and
clinical sciences
Know the common causes of respiratory distress,
and understand the pathophysiological processes
by which each results in the clinical entity of
respiratory distress
Stimulus questions in relation to outcomes
How does respiratory distress syndrome cause
respiratory distress, and why is surfactant an
effective treatment?
What are the mechanisms of action of the drugs
used in asthma?
At what level does airway narrowing occur in
asthma?
Appropriate attitudes, ethical understanding and
legal responsibilities
Behave with kindness and sympathy towards
parents and children where possible, and allow
them to express any anxiety and questions they
may have
Be aware of the ethical issues surrounding
treatment of extremely premature infants
What feelings may parents of infants admitted to
hospital with respiratory distress experience?
What is the role of the doctor in deter-mining how
actively extremely preterm infants with severe
respiratory distress should be treated?
Clinical decision making
Be able to identify differential diagnoses, select
appropriate
investigations,
and
initiate
appropriate treatment for patients with respiratory
distress
Is it necessary to do a chest X-ray on a 6 month
old infant with bronchiolitis, who is not requiring
any supplemental oxygen?
A four hours old preterm neonate with respiratory
distress syndrome has a pH of 7.18 and a pCO2
of 8.8,on nasal CPAP. What further interventions
may be necessary?
A 2 year-old boy with lobar pneumonia has a
rising oxygen requirement despite intra-venous
antibiotic treatment. What simple intervention
may help his ventilation?
How you should present yourself
professionally
Stimulus questions in relation to outcomes
Role of the doctor
Be aware of the different professions that should
be involved in the detection and management of
respiratory distress in children, and how the
doctor should interact with these people
What is the role of the General Practitioner in
managing children with respiratory distress?
Personal development
Be aware of the knowledge and skills you should
possess in relation to respiratory distress, and
seek to gain knowledge and experience in order
to attain this standard
Outside the Child Health block, where else can
you gain knowledge about respiratory distress?
(Primary care, medicine blocks?)
Be able to assess your own knowledge and
progress, and aim to correct any weaknesses you
identify
Who else might be involved in managing asthma
in children?