Child Health

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

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10. Eight week check

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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

17. 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

18. 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

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

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

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

22. 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

24. 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

26. Vision

33. Vision

34. 8 week vision • Fixing and following

35. Hips

36. Hips

37. Hips

38. Hips • Video / DVD

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

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

41. 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

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