Domain – Child and youth health (Guiding topics)

General Health Issues, Including Context of Care and Specific Populations

Developmental Assessment of a Child or Young Person

• History and Examination:
  • Detailed History: Prenatal and birth history, family history, milestones, social and environmental factors.
  • Physical Examination: Growth parameters (height, weight, head circumference), motor skills, language development, social interaction.
• Psychological Wellbeing:
  • Screen for behavioral and emotional problems using validated tools (e.g., Strengths and Difficulties Questionnaire (SDQ)).
  • Assess family dynamics and stressors.

Communication Skills with Young Patients and Parents/Carers

• Building Rapport:
  • Use age-appropriate language and engage the child directly.
  • Show empathy and active listening to both the child and parents.
  • Provide clear and concise explanations, and confirm understanding.

Healthy Lifestyle Advice and Immunisation

• Current Guidelines:
  • Healthy Lifestyle: Encourage balanced diet, regular physical activity, adequate sleep, and screen time limits.
  • Immunisation: Follow national immunisation schedule; provide evidence-based information to address vaccine concerns.
• Counseling:
  • Respectfully address concerns about vaccination; provide reliable resources and support informed decision-making.

Principles of Prescribing Medication in Children

• Guidelines:
  • Follow age and weight-based dosing guidelines.
  • Use pediatric formulary resources like the Australian Medicines Handbook Children’s Dosing Companion.
  • Monitor for side effects and interactions.

Early Intervention/Support for Vulnerable Children and Young Patients

• Specific Populations:
  • Aboriginal or Torres Strait Islander Background: Culturally appropriate care, involve Aboriginal healthcare workers.
  • Out-of-Home Care: Ensure stability, address trauma, coordinate with social services.
  • Refugee Background: Screen for infectious diseases, PTSD, and provide language support.
  • LGBTIQ+: Provide a safe and supportive environment, address mental health concerns, respect identity.

Screening for Abuse and Carer Stress

• Signs of Abuse:
  • Physical (bruises, fractures), behavioral (fearfulness, withdrawal), and emotional (depression, anxiety) indicators.
• Carer Stress:
  • Assess for signs of burnout, depression, and inadequate support.
• Mandatory Reporting:
  • Know local laws and procedures for reporting suspected abuse.

Medico-Legal Issues

• Consent and Confidentiality:
  • Understand Gillick competence for assessing minor’s capacity to consent.
  • Maintain confidentiality while balancing the need for parental involvement.
  • Be aware of laws regarding medical power of attorney and guardianship.

Identifying an Acutely Unwell Child

• Assessment:
  • Take a thorough history, looking for red flags (e.g., high fever, lethargy, rapid breathing).
  • Perform a focused examination to assess hydration, consciousness, and vital signs.
• Management:
  • Immediate referral to emergency services if necessary.
  • Provide clear follow-up instructions and ensure timely re-evaluation.

Nutrition and Feeding

Common Feeding Issues

• Breastfeeding and Formula Problems:
  • Assess latch and feeding techniques, provide lactation support, address formula tolerance.
• Constipation:
  • Encourage fiber-rich diet, adequate hydration, and regular toileting habits.
• Dietary Deficiency:
  • Screen for and treat deficiencies (e.g., iron supplementation for anemia).
• Failure to Thrive:
  • Comprehensive evaluation of dietary intake, growth patterns, and potential underlying conditions.
• Food Intolerances and Allergies:
  • History of symptoms related to food intake, elimination diets, and allergy testing.
• Introduction of Solids:
  • Start at around 6 months, introduce one new food at a time, watch for allergies.
• Food Fussiness and Refusal:
  • Establish routine meal times, offer a variety of foods, avoid force-feeding.

Overweight and Obesity

• Holistic Approach:
  • Assess diet, physical activity, family history, and psychological factors.
  • Develop a family-centered management plan that includes dietary changes, increased activity, and behavioral support.

Serious Underlying Conditions

• Screening:
  • Rule out conditions like cow’s milk protein intolerance, coeliac disease, and inflammatory bowel disease through history, examination, and appropriate testing.

Behaviour and Development

Early Identification and Intervention

• Developmental Delays:
  • Early screening for conditions like ADHD, autism spectrum disorder, cerebral palsy, and intellectual delay.
  • Use tools like ASQ (Ages and Stages Questionnaire) for early detection.
• Premature Birth:
  • Monitor for delayed milestones, respiratory issues, and growth concerns.

Common Behavioral Presentations

• Excessive Crying and Temper Tantrums:
  • Evaluate for underlying medical issues, provide strategies for parents to manage behaviors.
• School Refusal and Separation Anxiety:
  • Identify triggers, provide support strategies, involve school counselors if needed.
• Challenging Temperament and Parenting Styles:
  • Offer guidance on positive parenting techniques, consistent routines, and behavioral reinforcement.

Sleep Problems and Toilet Training

• Sleep Issues:
  • Encourage consistent bedtime routines, address any underlying medical issues.
• Toilet Training:
  • Provide age-appropriate guidance, address enuresis and encopresis with behavioral and medical interventions if necessary.

Parental or Carer Medical/Mental Health History

• Impact on Child:
  • Recognize that parental mental health issues can manifest as behavioral problems in the child.
  • Provide support and referrals for parents’ mental health as part of the child’s care plan.

Summary

For effective pediatric care, conduct thorough developmental assessments, build strong communication with families, follow evidence-based guidelines for healthy lifestyle and immunization, understand medication prescribing principles, support vulnerable populations, screen for abuse and stress, manage medico-legal issues, and provide appropriate follow-up and referrals. Address common feeding issues, manage overweight and obesity holistically, and identify serious conditions early. Support developmental and behavioral health through early identification, appropriate intervention, and parental guidance.