While doing the weekend ward round I came across this list of local breastfeeding support groups pinned up on the back of the neonatal unit door. In the August GP Paediatric Pearls we wrote about tongue tie and feeding issues. The volunteers listed here are the lactation counsellors that Mr Patel at Kings likes to assess the babies prior to referral to him for possible division of tongue tie.
Monthly Archives: October 2010
Paediatric ECGs
Paediatric ECGs take a bit of getting used to. They change with age and I always have a crib sheet with me if looking at them formally. Well, can any non-cardiologists remember off the top of their head how many little squares are allowed to make up the R wave in V1 in a 1 week old compared to what is normal in a 15 year old? I like the crib sheet from the university of Chicago available at http://learnpediatrics.com/body-systems/cardiology/approach-to-pediatric-ecg/ although the first test is to fill in the lead numbers on the last 2 pages as they seem to have been left off! I also use “How to read Paediatric ECGs” by Park and Guntheroth (Mosby Elsevier) although it probably has more detail than is necessary for non-paediatricians. October’s ED version of Paediatric Pearls provides this same link to the Chicago crib sheet and also refers the reader to a recent paper on cardiac arrythmias which has some nice illustrative ECG strips. For those of you interested in such things, there is a course on paediatric ECGs run by cardiology registrars in central London twice a year. Their website is www.paeds.co.uk/ecg and the next course is early November 2010.
ED version of October’s Paediatric Pearls available
Click here for snippets on paediatric cardiac arrythmias, a link to a good site on how to read paediatric ECGs, NICE on coeliac disease and suggestions on how to look at paediatric elbow x-rays. Please leave any comments here.
October GP PDF has been published!
The October edition features eczema herpeticum, the 2009 NICE guideline on coeliac disease and a useful table of infant formulas suitable for cows’ milk protein allergic children. Click here!
Forthcoming child protection courses
All professionals who come into contact with children need Level 1 and 2 training. You can do both levels on-line; register at www.e-lfh.org.uk where the safeguarding courses are listed under “Projects”.
The Royal College of Paediatrics and Child Health holds a number of courses and advertises others, many of which are open to non-paediatricians. Have a look at http://www.rcpch.ac.uk/Policy/Child-Protection/Child-Protection-Training.
The Advanced Life Support Group also run child protection courses which have been developed with RCPCH. More information about this on- line course from http://www.alsg.org/en/?q=en/cpip.
There is a very good course for paediatricians run at the Hillingdon Hospital twice a year on child protection and court skills. They run in June and November each year. See http://www.acpcltd.co.uk/hillingdon_cp_course.html.
Do let me know of any other courses using the Comments feature below.
Safeguarding resources
Please find local safeguarding boards contact details below. Lots of information on what the LSCB is, training courses on offer, what to do if worried about a child, relevant local contact details etc.:
http://www.walthamforest.gov.uk/index/care/childrenandfamilies/childprotect/lscb.htm
Child Protection Handbook produced by Royal College of Paediatrics and Child Health (RCPCH) available to download in full from http://www.rcpch.ac.uk/Policy/Child-Protection/Child-Protection-Publications. Do peruse the continually updated list of downloadable documents at this link. For example the guidelines on when to suspect Fabricated and Induced Illness were updated in 2009 and quite substantially broadened.
NICE quick reference guideline on When to Suspect Child Maltreatment (July 2009) available at www.nice.org.uk/nicemedia/pdf/CG89QuickRefGuide.pdf
Working Together (2013) is a guide to inter-agency working to safeguard and promote the welfare of children https://www.gov.uk/government/publications/working-together-to-safeguard-children
In May 2010, after the election, the Department for Children, Schools and Families became the Department for Education. The safeguarding content is currently split between the 2 websites. Most of the Every Child Matters information is at www.dcsf.gov.uk/everychildmatters but some of the more up to date news on safeguarding issues is at http://www.education.gov.uk/childrenandyoungpeople/safeguardingandsocialworkreform.
A useful document on recognising physical abuse in children with fractures has just been published jointly by the NSPCC and Welsh Child Protection Systematic Review Group. Compulsory reading for GPs and ED physicians I should think. This Cardiff Core Info Group publish a number of excellent pamphlets on bites, head injury, burns, bruises and neglect.
Do use the comments box below to let me know about any other resources you would recommend.
Tinea capitis
I saw a 4 year old lad in A and E last week and noticed incidentally that he had scalp ringworm. Apparently his mum has been faithfully using an antifungal shampoo for 2 years and shaving his head intermittently but the scaliness and little spots keep coming back. Hence featuring the management of tinea capitis in September’s Paediatric Pearls as a reminder. Most of the infections in this area are caused by Tinea tonsurans, a dermatophyte which lives in the hair shaft and thus well protected from any shampoos people try to throw at it. Treatment is systemic, not topical, and the only licensed treatment in children is oral griseofulvin. There are a few new papers around documenting incidence and the different organisms that cause tinea but not much has changed from a management perspective since the 2000 guideline which is available in full from the British Association of Dermatologists’ website. Don’t be put off by its being listed under “BAD guidelines”… www.bad.org.uk/Portals/_Bad/Guidelines/Clinical%20Guidelines/Tinea%20Capitis.pdf