My RCPCH 2016- Day 1 and 2

Day 1

This year, the RCPCH conference coincided with that historical day that junior doctors took emergency strike action for the first time. The Royal College President Neena Modi kicked the whole thing off with a strong message of support for the action, expressing her trust in junior doctors.


After that it was business as usual as the college got down to what it does best: discussing how we can best meet the needs of the children and young people of the UK. Aptly, the first speakers were four confident brilliant young women from the

‘RCPCH and us’ advisory group. All had been paediatric patients in the UK and had a thing or two to tell us about the big issues for young people in healthcare today.

To summarise, their priorities were redefining the school nurse role and school curriculum to empower young people to seek health care, improving transition services and better engagement with young people in planning services. They also highlighted the staggering impact of child poverty and inequality. No child’s opportunities should be determined by their post code!

They were then followed by the impressive Professor Terry Stephenson (current chair of the GMC). Interestingly he was also the dean of my medical school for a short period amongst many other achievements…

He highlighted the major public health issues facing the children of the UK today and the progress that paediatricians had made in influencing political policy in conjunction with other medical colleges. In particular he mentioned the ‘car smoking ban’ of 2015 and the recent evolution of the sugar tax. Interestingly although this tax is nationwide, only the English government plan to fund primary school sport with the proceeds. We’re still waiting to hear what the other nations will do with the extra money!

He briefly touched on the fact that the UK government spends significantly less per capita on healthcare than any other G7 nation, despite their ongoing push for increased services; as well as stressing the role of paediatricians in the development of consultant delivered care (even on weekends, would you believe…) He finished on the important theme of patient safety, comparing the NHS not to the aviation industry but to the Shell oil company, who seem to have a fairly insane, although foolproof safety culture.

Next, a number of Royal College Vice Presidents informed us about the many roles of our college and what they do for us (more than I’d previously thought). These vary from influencing political policy, providing educational resources and promoting science and research. Useful resources mentioned were Paediatric Care Online and online learning modules on topics including female genital mutilationspotting the sick child and mental health in children (MindEd). All of these are available through the RCPCH website and I’ve made a promise to myself to get around to doing them this year. Professor Anne Greenough (vice president for science and research) talked about the new UK Child Health Research Collaboration, working in partnership with paediatricians, research providers and patients to increase and strengthen paediatric research in the UK.

After a very brief interlude for coffee, it was time for the workshops and symposiums. After much deliberation I decided to attend a work shop entitled ‘To Play or GA’ run by the National Association Health Play Specialists (NAHPS). This was an eye-opener to not only the therapeutic benefits but also the possible cost-saving benefits of play therapy. The speakers stressed how a hospitalised child is emotionally and developmentally vulnerable and how play can be the ‘bridge’ between normality and the strange hospital environment. Most impressive were the talks from play therapists working in oncology and radiology across the UK who brought new evidence to the table showing the specific benefits that play therapy can have in reducing the need for general anaesthetic for procedures such as MRI and radiotherapy. In one study involving children as young as four years: 93% of children were successful in undergoing MRI without anaesthetic. This in turn could lead to massive cost savings for any trust and we were encouraged to collaborate with our play specialists to create similar pilot trials of play therapy locally and further expand the evidence base. Specific resources mentioned included a specially made DVD for children undergoing radiotherapy- ‘One of a Kind’ and the use of a system called ‘Beads of Courage’ in which children are given an extra bead for their string/necklace every time they undergo an unpleasant procedure.

The afternoon for me was filled by a symposium (series of talks) on ‘Hot Topics in Developmental and Behavioural Paediatrics’ . I was torn between this and the Young Persons Health Special Interest Group. The first talk was about Down’s Syndrome and was deliberately provocative, causing the room to reflect on whether we were doing everything we could as a nation for these children who now live well into their 60’s. Although we are generally good at the developmental stuff, there is a very obvious lack of research on the long term medical outcomes of these children as well as a lack of NICE guidelines for their care. Considering 1 in 1000 children have an extra chromosome 21, that’s pretty significant. If you’re looking for guidelines, a very comprehensive set can be found on the Downs Syndrome Medical Interest group website (http://www.dsmig.org.uk/) although I’m sure the group would appreciate the extra backing of NICE.

Following this was a talk on the prevention of neurodisability. I learnt that John F Kennedy (of American President Fame) had had a younger sister named Rose with significant behavioural problems who sadly was made to undergo a lobotomy at 23 years of age, which incapacitated her for life. John F Kennedy who was greatly affected by this tragedy formed the Presidents Committee on Mental Retardation to investigate the history and causation of neurodevelopment problems and his team identified the association with deprivation still evident today. Deprivation also correlates with preterm delivery, in itself a risk factor for neurodevelopmental problems. The WHO ‘Born Too Soon’ report released in 2012 helped identify global actions to be taken in reducing this risk, targeting areas like smoking cessation, birth planning and maternal health.

An audience member asked about the correlation between screen time and developmental problems and I was shocked to here that the college recommends that children under 2 should have ‘zero’ screen time…Yes zero! This is secondary to a study published by the American Academy of Paediatrics in 1999 suggesting that it displaces other developmentally important interactions. I feel a bit guilty about distracting all those toddlers with Peppa Pig cartoons now….

Our president Neema Modi then briefly talked about the significant increased risk of ADHD and ASD in preterm infants and debated whether we should be following their development beyond the age of 2 as currently recommended. Next followed a talk on Cows Milk Protein Allergy. Apparently the latest trend is not to use the word ‘intolerance’ at all but to define it as IgE or non-IgE mediated allergy. I learnt that the recommendation for the use of extensively hydrolysed formulas (e.g. Nutramigen) over amino acid formulas (e.g. Neocate) is not purely on a financial basis as it also accelerates milk tolerance acquisition in the later stages.

Finally, the great Prof Stephenson gave another talk on the ethical dilemmas associated with young people and decision making; We all squirmed in our seats as we thought about how to manage a 15 year old pregnant female with learning difficulties and cancer who was refusing chemotherapy because she didn’t want to harm her baby. Essentially children over 16 years are presumed to have capacity to consent to treatment and those under 16 may be deemed to if they are found Gillick competent. However in situations when a young person is refusing treatment under the age of 18 years and this is likely to have a significant impact on life, their ability to refuse consent can be challenged on the grounds that they lack sufficient understanding and maturity, although this may require a court order. The guidance is all there on the GMC website (http://www.gmc-uk.org/guidance/ethical_guidance/children_guidance_contents.asp). He also emphasised the importance of not presuming that a young person does not have capacity if learning disabled or unable to speak and doing everything in our power to help them communicate their wishes. 

I think that’s quite enough for now. All this learning is making me exhausted! Time to sleep and recuperate ready for day 2….

‘RCPCH and us’ advisory group. All had been paediatric patients in the UK and had a thing or two to tell us about the big issues for young people in healthcare today.

To summarise, their priorities were redefining the school nurse role and school curriculum to empower young people to seek health care, improving transition services and better engagement with young people in planning services. They also highlighted the staggering impact of child poverty and inequality. No child’s opportunities should be determined by their post code!

They were then followed by the impressive Professor Terry Stephenson (current chair of the GMC). Interestingly he was also the dean of my medical school for a short period amongst many other achievements…

He highlighted the major public health issues facing the children of the UK today and the progress that paediatricians had made in influencing political policy in conjunction with other medical colleges. In particular he mentioned the ‘car smoking ban’ of 2015 and the recent evolution of the sugar tax. Interestingly although this tax is nationwide, only the English government plan to fund primary school sport with the proceeds. We’re still waiting to hear what the other nations will do with the extra money!

He briefly touched on the fact that the UK government spends significantly less per capita on healthcare than any other G7 nation, despite their ongoing push for increased services; as well as stressing the role of paediatricians in the development of consultant delivered care (even on weekends, would you believe…) He finished on the important theme of patient safety, comparing the NHS not to the aviation industry but to the Shell oil company, who seem to have a fairly insane, although foolproof safety culture.

Next, a number of Royal College Vice Presidents informed us about the many roles of our college and what they do for us (more than I’d previously thought). These vary from influencing political policy, providing educational resources and promoting science and research. Useful resources mentioned were Paediatric Care Online and online learning modules on topics including female genital mutilationspotting the sick child and mental health in children (MindEd). All of these are available through the RCPCH website and I’ve made a promise to myself to get around to doing them this year. Professor Anne Greenough (vice president for science and research) talked about the new UK Child Health Research Collaboration, working in partnership with paediatricians, research providers and patients to increase and strengthen paediatric research in the UK.

After a very brief interlude for coffee, it was time for the workshops and symposiums. After much deliberation I decided to attend a work shop entitled ‘To Play or GA’ run by the National Association Health Play Specialists (NAHPS). This was an eye-opener to not only the therapeutic benefits but also the possible cost-saving benefits of play therapy. The speakers stressed how a hospitalised child is emotionally and developmentally vulnerable and how play can be the ‘bridge’ between normality and the strange hospital environment. Most impressive were the talks from play therapists working in oncology and radiology across the UK who brought new evidence to the table showing the specific benefits that play therapy can have in reducing the need for general anaesthetic for procedures such as MRI and radiotherapy. In one study involving children as young as four years: 93% of children were successful in undergoing MRI without anaesthetic. This in turn could lead to massive cost savings for any trust and we were encouraged to collaborate with our play specialists to create similar pilot trials of play therapy locally and further expand the evidence base. Specific resources mentioned included a specially made DVD for children undergoing radiotherapy- ‘One of a Kind’ and the use of a system called ‘Beads of Courage’ in which children are given an extra bead for their string/necklace every time they undergo an unpleasant procedure.

The afternoon for me was filled by a symposium (series of talks) on ‘Hot Topics in Developmental and Behavioural Paediatrics’ . I was torn between this and the Young Persons Health Special Interest Group. The first talk was about Down’s Syndrome and was deliberately provocative, causing the room to reflect on whether we were doing everything we could as a nation for these children who now live well into their 60’s. Although we are generally good at the developmental stuff, there is a very obvious lack of research on the long term medical outcomes of these children as well as a lack of NICE guidelines for their care. Considering 1 in 1000 children have an extra chromosome 21, that’s pretty significant. If you’re looking for guidelines, a very comprehensive set can be found on the Downs Syndrome Medical Interest group website (http://www.dsmig.org.uk/) although I’m sure the group would appreciate the extra backing of NICE.

Following this was a talk on the prevention of neurodisability. I learnt that John F Kennedy (of American President Fame) had had a younger sister named Rose with significant behavioural problems who sadly was made to undergo a lobotomy at 23 years of age, which incapacitated her for life. John F Kennedy who was greatly affected by this tragedy formed the Presidents Committee on Mental Retardation to investigate the history and causation of neurodevelopment problems and his team identified the association with deprivation still evident today. Deprivation also correlates with preterm delivery, in itself a risk factor for neurodevelopmental problems. The WHO ‘Born Too Soon’ report released in 2012 helped identify global actions to be taken in reducing this risk, targeting areas like smoking cessation, birth planning and maternal health.

An audience member asked about the correlation between screen time and developmental problems and I was shocked to here that the college recommends that children under 2 should have ‘zero’ screen time…Yes zero! This is secondary to a study published by the American Academy of Paediatrics in 1999 suggesting that it displaces other developmentally important interactions. I feel a bit guilty about distracting all those toddlers with Peppa Pig cartoons now….

Our president Neema Modi then briefly talked about the significant increased risk of ADHD and ASD in preterm infants and debated whether we should be following their development beyond the age of 2 as currently recommended. Next followed a talk on Cows Milk Protein Allergy. Apparently the latest trend is not to use the word ‘intolerance’ at all but to define it as IgE or non-IgE mediated allergy. I learnt that the recommendation for the use of extensively hydrolysed formulas (e.g. Nutramigen) over amino acid formulas (e.g. Neocate) is not purely on a financial basis as it also accelerates milk tolerance acquisition in the later stages.

Finally, the great Prof Stephenson gave another talk on the ethical dilemmas associated with young people and decision making; We all squirmed in our seats as we thought about how to manage a 15 year old pregnant female with learning difficulties and cancer who was refusing chemotherapy because she didn’t want to harm her baby. Essentially children over 16 years are presumed to have capacity to consent to treatment and those under 16 may be deemed to if they are found Gillick competent. However in situations when a young person is refusing treatment under the age of 18 years and this is likely to have a significant impact on life, their ability to refuse consent can be challenged on the grounds that they lack sufficient understanding and maturity, although this may require a court order. The guidance is all there on the GMC website (http://www.gmc-uk.org/guidance/ethical_guidance/children_guidance_contents.asp). He also emphasised the importance of not presuming that a young person does not have capacity if learning disabled or unable to speak and doing everything in our power to help them communicate their wishes. 

I think that’s quite enough for now. All this learning is making me exhausted! Time to sleep and recuperate ready for day 2….

‘RCPCH and us’ advisory group. All had been paediatric patients in the UK and had a thing or two to tell us about the big issues for young people in healthcare today.

To summarise, their priorities were redefining the school nurse role and school curriculum to empower young people to seek health care, improving transition services and better engagement with young people in planning services. They also highlighted the staggering impact of child poverty and inequality. No child’s opportunities should be determined by their post code!

They were then followed by the impressive Professor Terry Stephenson (current chair of the GMC). Interestingly he was also the dean of my medical school for a short period amongst many other achievements…

He highlighted the major public health issues facing the children of the UK today and the progress that paediatricians had made in influencing political policy in conjunction with other medical colleges. In particular he mentioned the ‘car smoking ban’ of 2015 and the recent evolution of the sugar tax. Interestingly although this tax is nationwide, only the English government plan to fund primary school sport with the proceeds. We’re still waiting to hear what the other nations will do with the extra money!

He briefly touched on the fact that the UK government spends significantly less per capita on healthcare than any other G7 nation, despite their ongoing push for increased services; as well as stressing the role of paediatricians in the development of consultant delivered care (even on weekends, would you believe…) He finished on the important theme of patient safety, comparing the NHS not to the aviation industry but to the Shell oil company, who seem to have a fairly insane, although foolproof safety culture.

Next, a number of Royal College Vice Presidents informed us about the many roles of our college and what they do for us (more than I’d previously thought). These vary from influencing political policy, providing educational resources and promoting science and research. Useful resources mentioned were Paediatric Care Online and online learning modules on topics including female genital mutilationspotting the sick child and mental health in children (MindEd). All of these are available through the RCPCH website and I’ve made a promise to myself to get around to doing them this year. Professor Anne Greenough (vice president for science and research) talked about the new UK Child Health Research Collaboration, working in partnership with paediatricians, research providers and patients to increase and strengthen paediatric research in the UK.

After a very brief interlude for coffee, it was time for the workshops and symposiums. After much deliberation I decided to attend a work shop entitled ‘To Play or GA’ run by the National Association Health Play Specialists (NAHPS). This was an eye-opener to not only the therapeutic benefits but also the possible cost-saving benefits of play therapy. The speakers stressed how a hospitalised child is emotionally and developmentally vulnerable and how play can be the ‘bridge’ between normality and the strange hospital environment. Most impressive were the talks from play therapists working in oncology and radiology across the UK who brought new evidence to the table showing the specific benefits that play therapy can have in reducing the need for general anaesthetic for procedures such as MRI and radiotherapy. In one study involving children as young as four years: 93% of children were successful in undergoing MRI without anaesthetic. This in turn could lead to massive cost savings for any trust and we were encouraged to collaborate with our play specialists to create similar pilot trials of play therapy locally and further expand the evidence base. Specific resources mentioned included a specially made DVD for children undergoing radiotherapy- ‘One of a Kind’ and the use of a system called ‘Beads of Courage’ in which children are given an extra bead for their string/necklace every time they undergo an unpleasant procedure.

The afternoon for me was filled by a symposium (series of talks) on ‘Hot Topics in Developmental and Behavioural Paediatrics’ . I was torn between this and the Young Persons Health Special Interest Group. The first talk was about Down’s Syndrome and was deliberately provocative, causing the room to reflect on whether we were doing everything we could as a nation for these children who now live well into their 60’s. Although we are generally good at the developmental stuff, there is a very obvious lack of research on the long term medical outcomes of these children as well as a lack of NICE guidelines for their care. Considering 1 in 1000 children have an extra chromosome 21, that’s pretty significant. If you’re looking for guidelines, a very comprehensive set can be found on the Downs Syndrome Medical Interest group website (http://www.dsmig.org.uk/) although I’m sure the group would appreciate the extra backing of NICE.

Following this was a talk on the prevention of neurodisability. I learnt that John F Kennedy (of American President Fame) had had a younger sister named Rose with significant behavioural problems who sadly was made to undergo a lobotomy at 23 years of age, which incapacitated her for life. John F Kennedy who was greatly affected by this tragedy formed the Presidents Committee on Mental Retardation to investigate the history and causation of neurodevelopment problems and his team identified the association with deprivation still evident today. Deprivation also correlates with preterm delivery, in itself a risk factor for neurodevelopmental problems. The WHO ‘Born Too Soon’ report released in 2012 helped identify global actions to be taken in reducing this risk, targeting areas like smoking cessation, birth planning and maternal health.

An audience member asked about the correlation between screen time and developmental problems and I was shocked to here that the college recommends that children under 2 should have ‘zero’ screen time…Yes zero! This is secondary to a study published by the American Academy of Paediatrics in 1999 suggesting that it displaces other developmentally important interactions. I feel a bit guilty about distracting all those toddlers with Peppa Pig cartoons now….

Our president Neema Modi then briefly talked about the significant increased risk of ADHD and ASD in preterm infants and debated whether we should be following their development beyond the age of 2 as currently recommended. Next followed a talk on Cows Milk Protein Allergy. Apparently the latest trend is not to use the word ‘intolerance’ at all but to define it as IgE or non-IgE mediated allergy. I learnt that the recommendation for the use of extensively hydrolysed formulas (e.g. Nutramigen) over amino acid formulas (e.g. Neocate) is not purely on a financial basis as it also accelerates milk tolerance acquisition in the later stages.

Finally, the great Prof Stephenson gave another talk on the ethical dilemmas associated with young people and decision making; We all squirmed in our seats as we thought about how to manage a 15 year old pregnant female with learning difficulties and cancer who was refusing chemotherapy because she didn’t want to harm her baby. Essentially children over 16 years are presumed to have capacity to consent to treatment and those under 16 may be deemed to if they are found Gillick competent. However in situations when a young person is refusing treatment under the age of 18 years and this is likely to have a significant impact on life, their ability to refuse consent can be challenged on the grounds that they lack sufficient understanding and maturity, although this may require a court order. The guidance is all there on the GMC website (http://www.gmc-uk.org/guidance/ethical_guidance/children_guidance_contents.asp). He also emphasised the importance of not presuming that a young person does not have capacity if learning disabled or unable to speak and doing everything in our power to help them communicate their wishes. 

I think that’s quite enough for now. All this learning is making me exhausted! Time to sleep and recuperate ready for day 2….

Day 2

So day two….definitely a day to my taste with a focus on global and public health. Also sadly my final day at the conference so tomorrow I’m hoping my lovely colleague Darshana might be kind enough to fill in the gaps.

The Windemere Lecture given by New Zealand based Peter Gluckmann, provided an informative start to the day on the very relevant topic of childhood obesity, the most prevalent non-communicable disease affecting children today. In fact so prevalent that the World Health Organisation has now set up a commission to end childhood obesity.

For a while now, there has been evidence that low birth weight can correlate with the so called ‘metabolic syndrome’ but he highlighted that other factors can also play a part in obesity causation such as being large for gestational age, excessive gestational weight gain and maternal obesity, increased blood glucose in pregnancy and reduced breast feeding duration. He discussed the evidence that epigenetic changes occur in early life after exposure to the above leading to a increased susceptibility to obesity in our ever ‘obesogenic’ environment. This does not detract from the importance of environmental

factors but instead implies that we should be approaching obesity prior to

conception, concentrating on maternal factors. The recommendations made by the World Health Organisation were to make nutrition and food information accessible as well as increasing access to healthy food, a sugar tax, to restrict marketing of unhealthy foods and the development of healthy food environments in schools, nurseries and other public locations. He also emphasised the importance of pre-conceptual nutrition advice, avoidance of toxins (smoking in particular) and identified a need for further consideration of what drives our early food preference and satiety as this is likely to have implications for weaning/food introduction.

The next lecture by Christine Cassar was on the the needs of unaccompanied minors in the UK with the key message that ‘children are vulnerable, developing and have a voice’ regardless of their asylum status. This is an ever increasing issue with a recent 56% increase in unaccompanied minors seeking asylum in the UK. High rates of physical and psychological illnesses as well as incomplete immunisation were identified, with >75% children showing evidence of mental health problems. These children are here to stay and to uphold their rights, we need to support research into their specific needs, vulnerabilities and life trajectories. 

This was followed by a talk on the evidence for maternal micronutrient supplementation, a measure that the WHO are considering in addition to their current recommendation of folic acid and iron. To sum it up after a systemic review, there is very little evidence except for a small reduction in reduced birth weight and a possible small reduction in still births (although the evidence is a bit dodgy…) The overwhelming message; That a negative result may be dull but is often no less important than a positive.

An energetic Felicity Fitzgerald from ‘Save the Children’ gave an inspiring talk about the approaches to cohorting used during the recent Ebola epidemic in Sierra Leone and the specific difficulties encountered within paediatrics. I had appreciated that PPE (personal protective equipment) may be terrifying for small children but hadn’t appreciated the risks that the destructive qualities of small boys might harbour to health care workers. She described the frustrating variety in Ebola treatment across centres and the fears they had that they were not treating other serious diseases such as malaria adequately. Despite difficult conditions, she conducted research that showed that actually they had done rather well in her centre, maintaining usual mortality rates in Ebola negative cases of illness and missing very few positive cases of Ebola.

The fabulously named Lord Crisp then gave a thought provoking lecture entitled ‘Turning the world upside down’. He’s written a book by the same name and several others that might be worth a read. He focused on low resource countries within Africa, a continent which carries 25% of the worlds’ disease burden and only 3% of it’s health care workforce, giving fantastic examples of health care workers who have delivered real change. In particular he talked about community participation in health care delivery and changing skill sets across professionals. In 1976, Mozambique had lost many of its doctors following a period of civil war. The minister for health subsequently trained theatre assistants to perform caesarean sections to improve the maternal mortality rate. They achieved this with no higher complication rates than when performed by surgeons. He also gave recognition to the current sub-Saharan scheme successfully reducing the condition river blindness and showed all that can be achieved with simply a stick and a smart phone. Prize for who can guess what the stick is for (see below).

The quote at the end really summed things up: ‘Health is made at home, hospitals are for repairs”

As doctors we can lead in raising awareness of global health issues but often we are limited in what we can do to achieve them as the most important determinants of health are what happens in homes and in communities and therefore it is in these places where real change can be achieved.

The global health theme continued through the sustainable development goals workshop. These have replaced the previous global development goals created in 1990. Over a 15 year period significant achievements were made in reducing poverty and improving female access to education. However despite playing a significant role in reducing child mortality under 5 years, the proposed target of 66% reduction by 2015 was not met overall and several deficiencies in the 1990 goals have been identified. The previous goals did not target neonatal survival specifically, and lacked focus in important areas such as equity, mental health, adolescence and sexual health, non-communicable diseases and disability.

The sustainable development goals were therefore launched in September 2015. Although child health was not specifically identified as goal, health was directly influenced by 16 of the 17 new goals. Have a read and you’ll see what I mean here. 

The new goals involved the creation of much more specific targets in areas such as neonatal mortality. Playing devil’s advocate, one of the speakers identified the problems that arise when you target set across all nations. A target already achieved in the UK for example may not be an achievable target for sub-Saharan Africa and would not promote an environment of ongoing improvement in the UK.  He identified the need to support national individualised target making and suggested that rates of progress may be a better indicator of how a country is performing. He also identified the difficulties in assessing achievement of the goals without developing solid information collecting systems across the world. For example, in countries where birth registration is poor, many mortality figures are only estimated.

Dr Elizabeth Mason from the World Health Organisation outlined their role in both supporting governments in building strong, sustainable health services and collecting and using evidence to develop standards and guidelines. More recently they’re presence has been prominent through disease control and monitoring with both the Ebola and Zika virus outbreaks respectively.

The recent development of the Global Strategy for Womens, Childrens and Adolescent Health 2016-2030 has identified 3 key themes- Survive, Thrive, and Transform which describe how the WHO are working to improve Child Health. ‘Survive’ describes such areas as improving access to vaccines and antibiotics and preventing early neonatal mortality;  ‘Thrive’ tackling both growth stunting and obesity and encouraging breast feeding amongst other things; ‘Transform’ looks at wider societal issues such as inequity, secondary education, prevention of gender violence and child maltreatment.

Rosie, a ST8 trainee from Bristol received a prize for advocacy following her work developing the ISSOP (International Society of Social Paediatrics) trainee group and her recent work in lobbying for new college regulations surrounding the advertising of formula milk. A vote on this important issue was due to occur later that afternoon at the college AGM. Unfortunately I was on the train home by then so haven’t been able to cast my vote and don’t know the result yet! Her inspiring well prepared talk identified that all children have needs but these needs become rights when they are unable to fulfil them themselves and it is then our duty to uphold them.

The cupcakes at lunch were fabulous. I had too many but only to keep my energy up for another stimulating afternoon. Paul Davies, our very own South Wales factitious and induced illness expert spoke about his specialist subject quoting Robert Burns.

“For humans are sick fools, for all their colleges and schools, that when no real ills perplex them, they make them themselves to vex them”

This an area which makes many paediatricians uncomfortable and he explored the reasons why in detail. It is rare although the true prevalence is unknown as it exists in the form of a spectrum varying from mild exaggeration of symptoms and severe parental anxiety to carefully planned fabrication (True FII). We also need to overcome a ‘believability hurdle’ as it not natural to think the worst of parents and through it’s very nature, the medical team may feel an element of responsibility for the unpleasant procedures the child may have endured. The media has played a roll in misinforming the nation and the very public striking off of Professor Ray Meadow with his later reinstatement brought the issue to the forefront for a period.He also stressed the importance of raising safeguarding concerns to others before disclosing concerns to parents from simply going off to find a different opinion and putting the child at further risk. Specific guidance has been produced to manage such cases and there is a useful section in the child protection companion on perplexing presentations including FII. 

Dr Christopher Bass, an adult psychiatrist then spoke, identifying maternal features seen commonly in cases of FII. To name a few; evidence of early childhood abuse, abnormal illness behaviour including evidence of somatoform disorder and frequent interactions with and changes of health care providers, history of self harm and pathological lying from adolescence. There are many theories about why mothers fabricate and reunifying mother’s with children after a period apart is often tricky. It requires acknowledgement that they have abused their child and compliance and engagement with health care professionals. Sadly this in only possible in 1 and 10 of the more extreme cases.

A team from Milton Keynes then talked about identified patterns of A+E attendance in young people at high risk of sexual exploitation including presenting following assault, drug or alcohol misuse, self harm and medical overdoses and other mental health crises. Then Emily Payne (Wales trainee!) presented on the recent success of the child protection simulation course in Bridgend. I attended this myself and it really was very good. Unfortunately this meant I was in one of her slide photographs…

Following this we has a rather grim talk on child maltreatment fatalities and the combination of factors that may increase its risk. These included the well known toxic triad- domestic violence, mental ill health and substance misuse. However it was stressed that in isolation mental health and substance misuse don’t necessarily increase risk.

Unfortunately at this point I had to run out of the door and catch a train and so was sad to miss the young persons’ refugee forum that followed. So I’m now back in South Wales after a fab RCPCH 2016 experience, temporarily enlightened and full of the need to share my new found knowledge. Just wish I could have stayed 1 day longer…

  • Twitter Social Icon
@drkatysiobhan