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Childhood Immunisations and Development. By Dr Sarah Ramruttun-Mulcock GPVTS. Brief Overview. Introduction Practice AKT questions Revision of the diseases we vaccinate against Small group work More AKT questions Child development- Red Flags Even more AKT questions!! Summary and answers.

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childhood immunisations and development

Childhood Immunisations and Development

By Dr Sarah Ramruttun-Mulcock


brief overview
Brief Overview
  • Introduction
  • Practice AKT questions
  • Revision of the diseases we vaccinate against
  • Small group work
  • More AKT questions
  • Child development- Red Flags
  • Even more AKT questions!!
  • Summary and answers
  • Why learn about immunisations/child development?
  • Pass the AKT!! Area that is regularly tested and regularly deemed weak in exams
  • Condensed curriculum:
  • National immunisation programmes and the GPs role in promoting and organising immunisation.
  • Normal growth and development, management of delayed development and failure to thrive
  • Be able to talk confidently with parents about the immunisations (how many injections, after effects, what does it protect against)
  • Health promotion...herd immunity, reduce illnesses normally caused by the diseases
now for the practice
Now for the Practice!!
  • Have a go!!
  • Questions have been lifted from passmedicine
  • Gives an idea of what to expect.......
  • GUESS!!
overview of diseases
Overview of Diseases
  • Diphtheria (D): Corynebacteriumdiphtheriae. Throat and chest infection. Rare in UK.
  • Tetanus (T): Clostridium tetani (found in soil) Severe muscle contractions- fatal.
  • HaemophilusInfluenzae type b (Hib): causes pneumonia and meningitis. Most risk below age of 4.
  • Pertussis (aP): Whooping cough, Bordetellapertussis. Prolonged, distressing cough. Can lead to pneumonia and encephalitis
  • D/ aP/Hib/: fragmented vaccines, extracts of the organism/ virus used
  • Tetanus: detoxified exotoxins
overview of diseases1
Overview of Diseases
  • Poliomyelitis (IPV): infection through the gut, then on to cause meningitic type illness. Affects nerves resulting in muscle wasting which can cause paralysis of 1+ limbs. Affects breathing in some cases. Was given orally, now injected.
  • Pneumococcus (PCV): causes pneumonia, meningitis. Extremes of age are most vulnerable to this disease. Introduced in 2006.
  • Group C meningococcus (Men C): meningitis and septicaemia.
  • PCV/ Men C: fragmented vaccines
overview of diseases2
Overview of Diseases
  • Measles: miserable feverish illness with rash.

Koplik spots – white spots on buccal mucosa. Increasing incidence due to children not being immunised

  • Mumps: Inflammation and swelling of salivary glands. May cause permanent deafness in one ear.
  • Rubella: mild illness with rash, starts on the face and then spreads.
  • MMR and BCG are live attenuated vaccines ( also oral polio, yellow fever and oral typhoid)
overview of diseases3
Overview of Diseases
  • Human Papillomavirus (HPV):
  • affects skin and mucosa
  • HPV 16 & 18 involved in most cases of cervical cancer
  • Cervarix (endorsed by government) 3 injections; 2nd given 1-2 months, 3rd at 6m
  • Gardasil: protects against viral warts, covers HPV 6, 11, 16 and 18
group work
Group Work
  • 2 small groups to devise imms schedule
  • Match the corresponding ages to the relevant vaccines
  • Each vaccine at the correct time scores a point
  • Winning group gets a treat!!
correct schedule
Correct Schedule
  • At Birth: BCG/Hep B (if high risk)
  • 2 months: DTaP/ IPV/ Hib+ PCV
  • 3 months: DTaP/ IPV/ Hib+ Men C
  • 4 months: DTaP/ IPV/ Hib+ PCV + Men C
  • 12-13m: MMR+ Hib/Men C + PCV
  • 3-5yrs: MMR +DTaP/ IPV
  • 12-13yrs: HPV
  • 13-18yrs: DT/IPV
  • DT always given with IPV, given with aP apart from 1yr/18yr
  • Hib not given after age of 4 yrs
  • 2 lots of MMR back to back
  • PCV/Men C given up to the age of 1 yr
more akt questions
More AKT questions
  • Re- answer previous AKT questions
  • Added some “curve- ball” questions
  • Answers revealed at the end
child development
Child Development
  • Not something that is easily taught or learnt
  • Even as a parent.....each child is different
  • Development is most rapid during the first four years of life
  • Key is to notice the abnormal from the normal
  • May be useful to split the periods of development:

- The newborn baby

- The supine infant (6-8 wks)

- The sitting infant (6- 9 m)

- The mobile toddler (18- 24m)

- The communicating child (3-4 yrs)

red flags in development
Red flags in Development
  • Does not roll over in either direction by the end of 4 months of age

yellow flag

  • Does not respond to sounds or turns head to locate sound by age

7 months

red flag

  • Cannot stand when unsupported age 12 months

yellow flag

  • Does not speak at least 15 words and begin to use 2 word sentences by age 2 years

red flag

  • Does not walk by 18 months or walks exclusively on tiptoes

red flag

  • Cannot build a tower of more than 6-8 blocks by the age of 3 years

yellow flag

red flags in development1
Red flags in Development
  • Not jumping by the age of 30 months

red flag

  • Not feeding themselves with finger food by the age of 14 months

red flag

  • Not smiling by 1 month

yellow flag

  • Not interested in pretend play by 2-3 years of age

red flag

  • Doesn’t pass objects from one hand to another by age 9 months

red flag



  • (b) Mumps is a live attenuated vaccine
  • (e) Hib/ Men C, MMR, PCV
  • (c) 5
  • (a) Clean wound and IM tetanus Ig
  • (d) MMR with repeat dose at 3 months
  • (a) Child can have the vaccine

Child development:

  • (e) 4 years
  • (b) 9 months
  • (c) 6 weeks

(see handout on developmental milestones)

  • Gone through and (hopefully) learnt the immunisation schedule
  • Learnt about some of the red flags in child development
  • Answered AKT questions along the way
  • Wow the examiners with our impressive knowledge at the AKT exam!
thank you for listening
Thank you for listening!!

Any Questions.....

Ask the Boss!!