Paediatric OSCE explanations

1. Paediatric OSCE explanations By Feon-Na Teh

2. Genetics counselling + screening tests • Infections • Developmental Issues Common explanation stations

3. Explain condition • What is it? • What causes it? • How common is it? • Explain test/procedure performed • What is it? • How is it done? • What does it tell you? • Discuss test result • What does the test result mean? • Discuss management • Biological • Psychological • Social • Address patient’s ICE • Check understanding • Address concerns (every explanation station has one) • Provide resources • Patient leaflets and websites • Non-governmental organisations e.g. associations, carer clubs, etc How to tackle an explanation station?

4. Down’s Syndrome • Cystic Fibrosis Genetic Counselling & Screening

5. Example station: You are a Foundation Doctor at the Antenatal Clinic. Tracy is currently 14 weeks pregnant and has just been screened for Down’s syndrome. The result was: 1 in 150 chance and would need further diagnostic tests. Explain the results and address her concerns.

6. Down’s Syndrome

7. Example station: You are a Foundation doctor in General Practice. Lisa, a new mother has just given birth to her son, Lucas 8 days ago. He had the heel prick test performed and was found to be positive for cystic fibrosis. Further tests were performed confirming the diagnosis of cystic fibrosis. Explain the condition and address her concerns.

8. Is an autosomal recessive disorder • 1 in 25 people in the UK are carriers of the gene. Carriers do not have the disease but carriers can pass the defective gene to their children. • When is it screened? • At newborn heel prick test – shows positive for CF • BUT, need diagnostic tests : sweat test or genetic testing • Fault in gene that controls salt and water in our cells. Mainly affects lung and digestive system. • In CF, mucus is thick and more sticky than normal resulting in increased risk of infections in lungs. In the pancreas, mucus is so thick it blocks digestive function. Cystic Fibrosis

10. Prognosis • No cure • Aim of treatment is ease symptoms and make condition easier to live with. To prevent/reduce long-term damage caused by infections • Management • Will be managed by a team of health care professionals at a CF centre • As each case of CF is different, they can receive tailored care for their child’s condition • Medication: Prophylactic antibiotics, bronchodilators, enzyme supplements, fat-soluble vitamins, mucus thinning enzymes • Chest physiotherapy and vaccinations • Refer to CF Trust which provides support and information for CF patients and their carers • Questions patient may ask: • Is it fatal? • Is there a cure? • How come my child has it but I do not? • I hear that people with CF die early? CF: other points to mention

11. Meningitis • Febrile Convulsions • HSP • Immunisations Infections

12. What? • Inflammation of the lining around brain and spinal cord • Signs/symptoms: fever, headache, poor feeding, lethargy, fever, seizures, bulging fontanelle, irritability, anorexia, N+V, rash, photophobia, • Management • IV antibiotics – IV ceftriaxone or cefotaxime + amoxicillin • Steroids • Prevention: childhood immunization • Ear assessment within 4 weeks • Concerns • Is it contagious? Meningitis

13. What? • Relatively common childhood condition. 1 in 20 children will have at least one febrile seizure at some point. Most occur between age 6 months and 5 years. • Refers to child having a fit when they have a high temperature. • Convulsions (fit) occur when electrical activities in the brain are disrupted – causing abnormal movement • Although febrile seizures can be frightening, most are harmless and do not threaten the child’s health • Why? • Cause of febrile seizure is unknown, although the condition appears to run in some families. Chances are higher if there is FH of febrile seizures • Usually the result of an infection • What can you do? (as a parent) • Give paracetamol + ibuprofen for fever • If another fit occurs, time the fit/video. Put child in recovery position. Avoid putting anything in mouth. • Dial 999 if – seizure >5 minutes, breathing difficulties, signs of dehydration, reduced consciousness, • 1/3 of children who had febrile seizures, will have another one often within a year of the first one Febrile Convulsions

14. What? • Inflammation of the blood vessels in the skin. Can also affect kidney, joints and intestine. • It is not contagious • Usually affects children age 2-10 years • Signs/symptoms: skin rash (red spots), joint pain/swelling, abdominal pain, blood in stool (red flag!), • Self-limiting disease, lasts around 6 weeks • How? • Cause of HSP is unknown • Often occurs after infection which triggers immune system • What can we do? • Urine dipstick (check if kidney affected) • Measure BP • What can you do? (Safety net) • No treatment – analgesia for pain, steroids • Rush to A&E if: blood in stool or urine, abdominal pain unresolved with paracetamol Henoch-Schonlein Purpura (HSP)

15. What? • MMR vaccine contains weakened version of measles, mumps and rubella viruses • MMR are diseases that have serious complications • Measles – ear infection, pneumonia, convulsion, brain damage • Mumps – main cause if viral meningitis. Deafness, swelling in testicles (orchitis) • Rubella – painful joints, blood disorder, swelling of the brain How? • The vaccine work by triggering immune system to produce antibodies against mumps, measles and rubella. If your child comes into contact with one of the disease, the immune system will recognize it and immediately produce antibodies to fight it When? • Given within a month of first birthday • A booster given before starting school Concerns • Does MMR cause autism? There is no evidence of such link. The research paper had results manipulated. Thus, your child should have the vaccine to protect him/her. • My child is allergic to eggs. Can she have MMR vaccine? Yes, MMR vaccine is grown on chick cells and not the egg white or yolk. Vaccinations (usually MMR)

16. Developmental delay • Nocturnal enuresis (bedwetting) Development

17. Developmental milestones

18. Points to cover: • Ask about antenatal + perinatal history – any hypoxic injury, infections • Vaccinations up-to-date? • Red flags: • Not sitting up by 9 months • Not standing by 12 months • Not walking by 18 months • Not babbling by 9 months • Differential diagnosis: • Motor delay – cerebral palsy • Social delay - autism • Language delay – hearing impairment, cleft palate • Global delay – Down’s syndrome Developmental delay station

19. What? • Involuntary urination at night while asleep, during which bladder control usually begins • >2 episodes per week for at least 3 consecutive months • Common in children <5 years and will often resolve with time • Can cause considerable psychological impact on self-esteem and confidence • Why? • Children have smaller sized bladder, they are more likely to need to pass urine during the night • In some children, the nerves attached to the bladder may not yet be fully developed, so they don’t generate a strong enough signal to send to brain • Can also be a sign that child is upset or worried e.g. starting new school, being bullied, arrival of new baby in the family • What can you do? (parent) • Restrict amount of fluids in the evening, avoid caffeine • Bedwetting alarm – over time, it helps train children to wake up once bladder is full • Medication – desmopressin • What else can it be? (screen) • Type 1 DM, constipation, UTI, damage to nerve which controls bladder Nocturnal Enuresis