Survival Guide to General Paediatrics
General paediatrics is a fast-moving and varied specialty but it can also be a long old slog especially in the winter when you’re reviewing your umpteenth child with bronchiolitis. Here are my top tips to help them survive, you survive and ultimately embrace and learn from your general paediatric rotation.
1) Do the basics well- I know it’s busy but it’s a little embarrassing when that 2 year old attending for the 5th time with his viral induced wheeze, is referred by the GP as he’s not walking yet. Once you’ve got your history taking system down, you can be thorough and speedy, providing a holistic service for that child. It just takes practice…
2) Wheeze, wheeze, wheeze- Bronchiolitis, Viral induced wheeze, Asthma. They may all sound the same but don’t treat them the same. Basic rules as below (Have a browse of the Cochrane Library for the evidence base)
3) Think before investigating– Always think is what I’m doing going to change my management? If we performed an Xray and did bloods on every child that walked through the door, that’s a lot of radiation and a lot of upset little ones. This is good practice in any area of medicine and although investigations are sometimes necessary, it’s important to consider their value. Chest X-Rays in lower respiratory tract infections in well children are a classic example.
4) Learn the Bristol Stool Chart– Constipation is an ever increasing problem in paediatrics, especially when children seem to survive solely on potato products and gallons of cows milk. You should be prepared to have in-depth discussions about the finer aspects of a child’s poo and the process of bowel retraining.
5) Refine your handover skills– Over the winter period, the general paediatric handover list can stretch for miles with seemingly identical chesty children. Observe a senior colleague handing over after a busy night shift to get some tips about what’s important. It’s important to know that a child has gone into oxygen overnight but not that they vomited after eating too much chocolate the week before. Try the SBAR approach to refine your handover skills (Situation, Background, Assessment, Recommendation).
6) Breathe, A, B, C, D, E– The general paediatric team are often the first point of call in all resus situations. If you’re prone to panic like myself, I find the above approach works very well. Be systematic when assessing unwell children and vocalise your thoughts to the rest of the team.
7) Learn whats normal– It’s hard to reassure first time parents about a newborn babies interval breathing or possetting if you’re unsure of normal yourself. Observe senior colleagues and try and get a grasp of the ‘normal’ behaviours that may present
8) Nursing staff can be the best teachers– Recognise the value of good paediatric nurses in helping to spot the sick child and guide you through their management. Paediatric nurses have a wide range of skills and can help you become competent in many things from safe prescribing to cannulation