The Hands-on Guide to Practical Paediatrics

281 Pages·2014·1.331 MB·English

by  Rebecca Hewitson, Caroline Fertleman

The Hands-on Guide tT
oh
to Practical Paediatrics Pe
r H
a
About to start a paediatrics rotation? Working with children for the fi rst time? ca
Thinking about a career in paediatrics? ticnd The
The Hands-on Guide to Practical Paediatrics is the ultimate practical guide for medical as
students encountering paediatrics for the fi rst time, junior doctors thinking about l -o
working with children, and new paediatric trainees. It’s full of vital information on Pan Hands-on Guide
practical procedures, prescribing for young patients, and communicating with children eG
and young people, as well as guidance on the paediatric training programme and du
paediatrics as a career. iaid to Practical
te
Full of clinical tips, and covering key information on developmental stages, common ri
ethical dilemmas, and child protection, The Hands-on Guide to Practical Paediatrics is cs Paediatrics
also supported by online resources including practice prescribing scenarios and video
content at www.wileyhandsonguides.com/paediatrics.

Take the stress out of paediatrics with The Hands-on Guide!
Titles of Related Interest
H
Paediatrics and Child Health, 3rd edition e Rebecca Hewitson
Rudolf, Lee & Levene 2011 9781405194747 w
Avoiding Errors in Paediatrics its Caroline Fertleman
Raine, Williams, & Bonser 2013 9780470658680 o
n
Paediatrics at a Glance, 3rd edition a
Miall, Rudolf & Smith 2012 9780470654521 n
d
Essential Neonatal Medicine 5th, edition
F
Sinha, Miall & Jardine 9780470670408 e
r
t
l
e
m
All content reviewed by students for students
a
Wiley Blackwell Medical Education books are designed exactly for their intended n
audience. All our books are developed in collaboration with students. This means
that our books are always published with you, the student, in mind.
If you would like to be one of our student reviewers, go to
www.reviewmedicalbooks.com to fi nd out more.
Also available as an e-book,
on CourseSmart and as a Wiley E-Text ISBN 978-1-118-46352-9

9 781118 463529
www.wiley.com/go/medicine

The
Hands-on Guide
to Practical Paediatrics
To my family and friends and most of all to Nick, for your endless
support, patience and encouragement.
Rebecca Hewitson
I would like to dedicate this book to my paediatric colleagues
Heather Mackinnon and Mervyn Jaswon.
Caroline Fertleman
The
Hands-on Guide
to Practical Paediatrics
Rebecca Hewitson
Paediatrics specialist trainee, London Deanery
the whittington Hospital and Royal Free Hospital
caRoLine FeRtLeman
consultant Paediatrician, the whittington Hospital
site sub-Dean and Honorary senior Lecturer,
University college London medical school
training Programme Director, school of Paediatrics, London Deanery
Honorary consultant, Great ormond street Hospital, London
This edition first published 2014 © John Wiley & Sons, Ltd
Registered Office
John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial Offices
350 Main Street, Malden, MA 02148–5020, USA
9600 Garsington Road, Oxford, OX4 2DQ, UK
The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
For details of our global editorial offices, for customer services, and for information about how
to apply for permission to reuse the copyright material in this book please see our website at
www.wiley.com/wiley-blackwell.
The right of Rebecca Hewitson and Caroline Fertleman to be identified as the authors of this work has been
asserted in accordance with the UK Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise,
except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of
the publisher.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not
be available in electronic books.
Designations used by companies to distinguish their products are often claimed as trademarks. All brand
names and product names used in this book are trade names, service marks, trademarks or registered
trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned
in this book.
Limit of Liability/Disclaimer of Warranty: While the publisher and author(s) have used their best efforts
in preparing this book, they make no representations or warranties with respect to the accuracy or
completeness of the contents of this book and specifically disclaim any implied warranties of merchantability
or fitness for a particular purpose. It is sold on the understanding that the publisher is not engaged in
rendering professional services and neither the publisher nor the author shall be liable for damages arising
herefrom. If professional advice or other expert assistance is required, the services of a competent
professional should be sought.
Library of Congress Cataloging-in-Publication Data
Hewitson, Rebecca, author.
The hands-on guide to practical paediatrics / Rebecca Hewitson, Caroline Fertleman.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-118-46352-9 (paper. : alk. paper) – ISBN 978-1-118-46357-4 (eMobi) –
ISBN 978-1-118-46358-1 (ePub) – ISBN 978-1-118-46359-8 (ePDF) – ISBN 978-1-118-79386-2 –
ISBN 978-1-118-79408-1
I. Fertleman, Caroline, author. II. Title.
[DNLM: 1. Pediatrics. WS 100]
RJ61
618.92–dc23
2013024995
A catalogue record for this book is available from the British Library.
Cover images: iStock photo, file #3313409, reproduced from iStock © slovegrove; iStock photo, file
#18250395, reproduced from iStock © kajakiki; iStock photo, file #10579373, reproduced from
iStock © yumiyum; iStock photo, file #1262714, reproduced from iStock © zoomstudio;
iStock photo, file #11395745, reproduced from iStock © naumoid.
Cover design by Grounded Design
Set in 8/10pt Gill Sans by SPi Publisher Services, Pondicherry, India
1 2014
Contents
Preface xi Teenage room 6
Acknowledgements xii Treatment room 6
About the companion website xiii School room 7
Parents’ room 7
1 Getting started 1 Sensory room 7
Day care unit 7
Who’s who? 1 Milk room 7
Breastfeeding advisor 1 Postnatal ward 7
Child protection nurse 1 Paediatric emergency
Clinical support worker 1 department 7
Dietitian 1 Be prepared 8
Health visitor 2 Jargon Buster 9
Healthcare assistant 2
Midwife 2 2 Child development 19
Nursery assistant 2
Nursery nurse 3 What can a child of this age
Occupational therapist 3 normally do? 19
Orthoptist 3 Six weeks 20
Pharmacist 3 Six to eight months 21
Pharmacy technician 3 Twelve months 21
Physician assistant 3 Eighteen months 21
Physiotherapist 4 Two years 22
Play specialist 4 Three years 22
Psychologist 4 School 22
School teacher 4 Developmental delay and
Specialist nurse 5 children with disabilities 22
Social worker 5 Support for children with
Speech and language disabilities and
therapist 5 their families 25
Staff nurse 5 Growth 26
Ward clerk 6 Obesity 28
Ward sister 6 Immunisations 29
What happens where? 6 The UK vaccination
Playroom 6 schedule 31
Contents v
3 Communication with Forced marriage and
children and their honour violence 70
parents 37 Which children are most
vulnerable to abuse? 72
How to communicate with a What to do if you suspect
baby or toddler 39 child abuse 73
How to communicate with an What should I say to
infant school child the parents? 75
(4–6 years) 40 What to do if you suspect
How to communicate with a sexual abuse 75
school-age child Child protection medicals 77
(7–12 years) 40 Working with social care,
How to communicate with education and the police 77
a teenager 41 Social care 78
How to communicate with a Police 78
child using alternative I’ve made a referral to
communication 45 social services; what
How to communicate with happens next? 83
anxious parents 46 What if you are worried
How to communicate with about the immediate
an expert parent or patient 47 safety of the child? 83
Breaking bad news 49 What is a section 17
Cultural sensitivity 54 investigation? 84
Illiteracy 56 Who is a child in need? 84
Consent 56 Who is a looked-after child? 84
Parental responsibility 57 What happens after it
At what age can children is decided that a child is
consent for themselves? 57 in need? 84
What is a strategy
4 C hild protection and discussion? 84
safeguarding 60 What is a section 47
enquiry? 85
Different forms of abuse 60 What is a child protection
Physical abuse 60 conference? 85
Fabricated or induced What is a child protection
illness (FII) 62 plan? 85
Emotional abuse 64 What is a child protection
Neglect 66 review conference? 85
Sexual abuse 66 What is the child protection
Maternal substance abuse register? 85
in pregnancy 69 What stops us from considering
Female genital mutilation 70 the possibility of abuse? 85
vi Contents
5 Common paediatric Drowning 119
emergencies 88 History 119
Signs 119
Basic Life Support 88 Immediate management 119
Danger 88 Further management 120
Response 88 Sepsis 121
Shout for help 88 History 121
Airway 90 Symptoms and signs 121
Breathing 91 Immediate management 122
Circulation 91 Further management 122
Choking child 92 Meningococcal septicaemia 123
History 93 History 123
Symptoms 93 Symptoms 123
Signs 93 Signs 123
Immediate management 93 Initial management 124
Advanced Life Support 95 Burns and scalds 124
Airway management 97 History 124
Breathing management 97 Symptoms 124
Circulation management 99 Signs 125
Emergency drugs 99 Immediate management 125
ABCDE approach 101 Further management 126
A – Airway 101 Ongoing management 126
B – Breathing 105 Seizures 128
C – Circulation 108 History 128
D – Disability 110 Immediate management 128
E – Exposure 112 Further management 130
Reassess 113 Poisoning 131
Take a brief history 113 History 131
Anaphylaxis 113 Symptoms and signs 131
History 113 Immediate management 131
Symptoms 114 Further management 132
Signs 114 Diabetic ketoacidosis 135
Immediate management 114 History 135
Further management 115 Symptoms 135
Long-term management 115 Signs 135
Acute asthma 115 Immediate management 135
History 116 Further management 136
Symptoms 116 Trauma 138
Signs 116 Catastrophic external
Immediate management 116 haemorrhage 138
Further management 118 Airway and cervical
Long-term management 118 spine control 138
Contents vii
Breathing 139 Peak flow 173
Circulation with Hand-held spirometry 174
haemorrhage control 140 Setting up a nebuliser 175
Disability and assessment Inhaler technique and using
of head injury 141 a spacer 175
Critical care transfer services 141 Intramuscular injections
North West England 141 (for immunisations) 176
North East England 142 How to use an Epipen/Anapen 177
West Midlands 142 Changing a nappy 177
East Midlands 142
South East England 7 P rescribing in children 179
and London 142
South Central and General principles 179
South West England 142 Getting children to actually
North Wales 142 take what you prescribe 181
East Scotland 143 Fluids 181
West Scotland 143 Maintenance fluids 182
Northern Ireland 143 Replacement therapy 182
Analgesia 186
6 Practical procedures 144 Step 1 – mild pain 187
Step 2 – moderate pain 187
Setting up 144 Step 3 – severe pain 188
Cannulation 145 Controlled drugs 188
Taking blood (including heel Blood products 188
prick sampling) 148 When to give CMV-
Heel prick sampling 148 negative products 188
Venepuncture in babies 151 When to give gamma-
Capillary blood gas 152 irradiated products 189
How to measure a spun Packed red cells 189
bilirubin (SBR) 153 Platelets 189
How to measure packed Fresh frozen plasma (FFP) 190
cell volume 154 Drug level monitoring 190
Intraosseous access 154
Nasogastric tube 158 8 Teenagers 192
Lumbar puncture 161
Urinary catheter insertion 166 Taking a history from a teenager 192
Suprapubic urine sample 169 Mental health problems 193
Mantoux test 171 Deliberate self-harm and suicide 193
Injecting tuberculin 171 Eating disorders 196
‘Reading’ the Mantoux Substance abuse 197
test results 173 Sexual health 198
viii Contents