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Child Health

Child Health . Eight week check Elaine Burfitt July 2010 . Child Health. Eight week check Check list Referral information DVD Pitfalls. Schedule . Screen Newborn - SHO or midwife 6-8 weeks - GP or HV Non screen status

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Child Health

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  1. Child Health Eight week check Elaine Burfitt July 2010

  2. Child Health • Eight week check • Check list • Referral information • DVD • Pitfalls

  3. Schedule Screen • Newborn - SHO or midwife • 6-8 weeks - GP or HV Non screen status • 2 year check - nursery nurse

  4. Eight week check • Newborn & Infant Physical Examination Standards and Competencies March 2008 UK National Screening committee • Local referral information • Awaiting Public Health oversight

  5. Eight week checklist

  6. Eight week checklist

  7. Eight week check

  8. Eight week check

  9. Eight week checklist

  10. Eight week check

  11. Eight week check

  12. Eight week check • Sacral dimple is simple if: • < 5mm diameter • Lying in midline • <25 mm from anus

  13. Heart defects • Screen all by 72 hours • Refer all screen positive within 24 hours of examination for pulse oximetry and expert consultation • Review by 10 days if considered at risk of clinical deterioration • 1st appointment within 4 weeks if no significant clinical risk

  14. Heart defects • 6-8 week check • Refer by phone if symptomatic at that time • No other timescales recommended at present

  15. Hearing • Universal neonatal screening • Oto acoustic emissions • Normal • Abnormal - further diagnostics • Normal but in high risk group – 8 month FU • Incomplete test or not done

  16. Hearing • Check parental concerns • Check neonatal screening page • Encourage attendance at further screen or diagnostic appointments • If unclear ring neonatal screeners for information on child on pathway • Fill in slip appropriately

  17. Hearing • Several missed in recent years Presented May 2008 by Hilary Smith • Jan 2008 – Dec 2009 78 babies recorded on 8 week slip as normal hearing when had NCR in one or both ears on neonatal screen

  18. Hearing • Pre screening average age of aiding 22 months • i.e. huge loss of developmental window for learning language • Recent good examples of successes

  19. Vision • Neonatal check no concerns • 8 weeks parental concerned about visual behaviour • Reported to HV/ GP at time of 8 w check

  20. Vision • Referred to paediatrician by letter • Seen by paediatrician at 12 weeks • Concern regarding red reflex

  21. Congenital cataract • Tel ref to ophthalmologist • Operation at 13 weeks (despite anaesthetic risk re URTI at the time) • 17 m no detectable VI problem over and above lens limitation

  22. Congenital cataract survey • 1995-1996 12 months • Data on 235 children • 35% detected at newborn • 12% detected at 6-8 week check • By 3 months 47% had been detected by screening and 57% of these had seen an ophthalmologist

  23. Vision

  24. Vision

  25. 8 week vision • Fixing and following

  26. Hips

  27. Hips

  28. Hips

  29. Hips • Video / DVD

  30. Testes Neonatal check • Bilateral undescended – 100% to see paediatrician within 24 hours • Unilateral – make parent aware and review at 6-8 weeks

  31. Testes 8 weeks • Bilateral undescended • Refer to surgeons C&B • Appointment by 1 year old • Operation by 2 years old

  32. Testes 8 weeks • Unilateral • All reviewed by GP at 22-26 weeks Child Health computer can notify • Refer to surgeon at review if needed • All seen by 1 year and all operated on by 2 years of age

  33. Eight week check Be thorough Check slips and send in returns Thank you very much DVD

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