Paediatrics & Child Health: General and Community Paediatrics

Care of well children

Presentations

• Normal child behaviour
• Normal development
• Normal growth

Child maltreatment

Presentations

• Child vulnerability and suspected maltreatment
• Family dysfunction:
  
  • family violence
• Non-accidental injuries

Child protection

Presentations

• Family dysfunction:
  
  • poverty and disadvantage

Developmental-behavioural paediatrics

Presentations

• Adolescent risk-taking
• Crying baby
• Dysmorphic appearance
• Eating disturbances
• Fears, anxiety, and phobias
• Grief and bereavement
• Learning and communication difficulties
• Oppositional behaviour and conduct behaviour
• School refusal
• Separation anxiety
• Sibling rivalry and inter-sibling hostility
• Sleep problems
• Social skills concern
• Soiling and wetting
• Temper tantrums

Conditions

• Attention deficit hyperactivity disorder (ADHD)
• Autistic spectrum disorder
• Developmental delay
• Developmental regression
• Hypotonia
• Intellectual disability
• Language delay and impairment
• Learning disorders
• Oppositional defiant disorder
• Poor mobility, acquired and congenital

Multisystem and undifferentiated

Presentations

• Abdominal or groin mass
• Abdominal pain, acute and chronic
• Abnormal gait
• Bleeding
• Bruising
• Chest pain
• Diarrhoea
• Dysuria
• Encopresis
• Enuresis
• Faints or funny turns
• Fatigue
• Haematuria
• Headache
• Hearing loss
• Jaundice
• Joint pain
• Lethargy
• Murmur or abnormal pulses
• Oedema
• Pallor
• Pubertal delay or abnormal puberty
• Rash
• Short or tall stature
• SIDS or SUDI
• Skin lesions
• Visual disturbance
• Weight loss

Conditions

• Constipation
• Dental caries
• Gastroenteritis
• Hypertension
• Obesity
• Poor growth
• Sleep disorders and upper airway obstruction

Palliative care

Presentations

• Constipation
• Dyspnoea
• Excessive secretions
• Nausea and vomiting
• Pain
• Restlessness

Pharmacology

Presentations

• Acute presentations associated with addiction, such as withdrawal and overdose

Conditions

• Adverse drug reaction, such as severe cutaneous reactions, interactions, and drug overdose
• Poisoning
• Polypharmacy

Rehabilitation

Presentations

• Dysphagia and aspiration

Conditions

• Acquired brain injury, such as traumatic brain injury and non-accidental brain injury
• Cerebral palsy
• Hydrocephalus
• Pressure areas

Routine care of neonates

Presentations

• Neonatal feeding problems
• Neonatal respiratory distress
• Neonatal sepsis
• Neonatal vomiting
• Neonate with jaundice
• Premature neonate
• Unsettled or irritable neonate
• Unwell term neonate
• Well neonate

 

Urgent presentations and conditions

Presentations

• Altered level of consciousness
• Brief resolving unresponsive episode (BRUE)
• Cough
• Cyanosis
• Eye abnormalities
• Fever
• Injury
• Shortness of breath
• Stridor
• Vomiting
• Wheeze

Conditions

• Orbital and periorbital cellulitis
• Seizure
• Shock

For each presentation and condition, Basic Trainees will know how to:

Synthesise

• recognise the clinical presentation
• identify relevant epidemiology, pathophysiology, and clinical science
• take a relevant clinical history
• conduct an appropriate examination
• establish a differential diagnosis
• plan and arrange appropriate investigations
• consider the impact of illness and disease on patients¹ and their quality of life

Manage

• provide evidence-based management
  For less common or more complex presentations and conditions the trainee must also seek expert opinions
• prescribe therapies tailored to patients’ needs and conditions
• recognise potential complications of disease and its management, and initiate preventative strategies
• involve multidisciplinary teams

Consider other factors

• identify individual and social factors and the impact of these on diagnosis and management

Conditions

• Autonomic dysreflexia
• Baclofen withdrawal
• Coma
• Complex neurodisability
• Developmental disorders:
  
  • conduct disorders
  • hearing impairment
  • other sensory impairments
  • visual impairment
• Dysautonomia
• Osteoporosis
• Sequelae following brain injury, such as physical, cognitive, speech, and psychosocial sequelae
• Spina bifida and spinal cord injury:
  
  • neurogenic bladder
  • neurogenic bowel
• Status dystonicus
• Strokes
• Urinary retention

For each presentation and condition, Basic Trainees will know how to:

Synthesise

• recognise the clinical presentation
• identify relevant epidemiology, pathophysiology, and clinical science
• take a relevant clinical history
• conduct an appropriate examination
• establish a differential diagnosis
• plan and arrange appropriate investigations
• consider the impact of illness and disease on patients¹ and their quality of life

Manage

• provide evidence-based management
  For less common or more complex presentations and conditions the trainee must also seek expert opinions
• prescribe therapies tailored to patients’ needs and conditions
• recognise potential complications of disease and its management, and initiate preventative strategies
• involve multidisciplinary teams

Consider other factors

• identify individual and social factors and the impact of these on diagnosis and management

• Muscle anatomy, including specific muscle actions in the setting of spasticity
• Epidemiology of obesity
• Pathophysiology of pain
• Physiological, social, and psychological factors influencing child development
• Spinal levels, including myotome and dermatome distributions

Investigations

• Barium studies
• Basic neonatal imaging, such as chest x-ray and abdominal imaging
• Bone densitometry scan
• Bone scan
• CT
• MRI
• Modified barium swallow
• Ultrasound
• X-rays:
  
  • chest
  • pelvis
  • spine

Procedures

• Bowel wash out protocol
• Cannulation
• Lumbar puncture
• Peripheral intravenous catheters
• Pleural aspiration and drainage

Clinical assessment tools

• Behavioural questionnaires, such as Conners Early Childhood Screen
• Common Approach to Assessment Referral and Support (CAARS)
• Developmental screening tools for focused assessment of development and behaviour
• Gait examination
• Growth charts
• Hip surveillance in cerebral palsy
• Investigation of inflicted injury
• Post-traumatic amnesia diagnosis and management
• Recognition, differentiation, and treatments of spasticity and dystonia

• Awareness of behavioural modification techniques in children, adolescents and young adults
• Awareness of personal reactions to childhood illness, behaviour, disability and family situations, and the impact these may have on professional practice
• Best practice for patients’ self-monitoring in established chronic disease, such as diabetes, hypertension, and respiratory disease
• Cerebral palsy classifications:
  • difference between spasticity and dystonia when assessing hypertonia
  • functional scores, such as:
    • gross motor function classification system (GMFCS)
    • manual ability classification system (MACS)
    • communication function classification system (CFCS)
  • physical classifications
  • topographical classifications
• Child maltreatment issues:
  • fabrication, falsification, exaggeration, or induction of illness or symptoms in a child
  • legislative requirements
  • special consideration of all injuries in non-ambulatory infants
  • unexplained or repeated incidents of injury
• Child protection issues:
  • child vulnerability and family adversity and its relationship to child protection
  • referral pathways and community and hospital services for vulnerable children and their families

• Chronic and complex care:
  
  • access to care and cost implications
  • coordination of care
  • health system resourcing and patients’ insurance status
  • impact of physical, cognitive, and intellectual disabilities in management of chronic disorders
  • management of complex or multiple comorbidities
  • primary, emergency, and after hours care
• Cultural and psychosocial needs of complex patients and their families being discharged from hospital
• Death and dying:
  
  • compassion towards those who can no longer be ‘cured’
  • ethical principles involved in care of dying patients
  • evaluation of length and depth of coma
  • impact that dealing with death and dying has on one’s self
  • importance of assessing needs of families and carers and
    respecting their wishes
  • importance and meaning of resuscitation orders
  • medicolegal aspects of end-of-life care
  • recognition of the dying phase
  • respect for dignity at the end of life
  • responding to the questions of a dying child
• Role of immunisation, nutrition, and sleep in the care of well children
• Prevalence and impact of obesity across the life course and associated prevention measures, such as:
  
  • awareness of potential obesity prejudice and weight bias amongst health professionals, and methods for reducing bias
  • childhood antecedents to obesity in adulthood
  • clinical practice guidelines and management options for childhood obesity
  • health impacts of obesity in childhood
  • impacts of maternal obesity on fetuses
  • education, support, health promotion, and advocacy options for working with patients, families, and carers to manage obesity
  • sociocultural factors and their impact on obesity, including incidence, outcome, and management
• Patient-centred care:
  
  • impact of patients’ background on their health or health behaviours,
    such as:
    
    • Māori and Aboriginal and Torres Strait Islander patients
    • adolescent and young adult patients
    • patients from culturally and linguistically diverse backgrounds
    • patients with disability, including cognitive, intellectual, and
      physical impairment
    • patients with diverse socioeconomic backgrounds
    • patients with mental health issues
    • vulnerable patients
  • principles of patient-centred care
• Potential impacts of dealing with distressing situations on the health and wellbeing of self and colleagues
• Rehabilitation:
  
  • assessment of patients following brain injury, including assessment of the severity of injury and the need for ongoing therapy and follow up
  • assessment of degree of impairment, disability, and activity limitation or participation restriction, and potential for rehabilitation
  • basic strategies used by other members of the multidisciplinary
    team
  • biopsychosocial model and its application to patient care
  • indications for referral to physiotherapy, occupational therapy, speech therapy, psychology, orthotics, and child life therapy
  • pain and irritability assessment in children with severe disability who are non-verbal
  • sequelae following brain injury, and appreciation of executive dysfunction and its impact on learning
• Role of and interaction with the developmental multidisciplinary assessment team
• Transitions in care:
  
  • transitions between practitioners
  • transitions between settings:
    
    • acute settings
    • community care
    • inpatient settings
    • metropolitan hospital care
    • outpatient settings
    • rural or remote healthcare settings
    • subacute and rehabilitation settings