Child Health

Eight week check

Elaine Burfitt

July 2010

Child Health

Eight week check

Check list

Referral information

DVD

Pitfalls

Schedule

Screen Newborn - SHO or midwife 6-8 weeks - GP or HV

Non screen status 2 year check - nursery nurse

Eight week check

Newborn & Infant Physical Examination Standards and Competencies March 2008 UK National Screening committee

Local referral information

Awaiting Public Health oversight

Eight week checklist

Examine in appropriate surroundings, preferably with calm, fed baby

Take opportunities to discuss health promotion messages along the way e.g. smoking, back to sleep, careful handling, etc.

Brief review of birth history, general health and feeding.

Review red book information to

date including hearing screening data

Ask carer if they think baby can

see and hear

Ask carer if any concerns about baby

Sets context of examination and growth assessment. May have missed hearing screen or not had a clear response.

Eight week checklist

Head to toe examination All areas of skin must be seen at some point during the examination. May carry out some parts of examination when babe is dressed or partially dressed in order not to disturb ie when auscultating the heart but still need to carry out examination appropriately.

Including general handling, demeanour, skin, head shape and size, fontanelles, dysmorphism, eyes including red reflex and visual fixation and behaviour, palate, neck, heart, abdomen, genitalia, spine, anus, hips, limbs including hands and feet.

Eight week check

Eight week check

Eight week checklist

Plot and assess growth

Complete red book Discuss outcomes with

parent/carer

Send in return slip Make any referrals needed

Immunisation as appropriate With appropriate consent

Eight week check

Eight week check

Eight week check

Sacral dimple is simple if:

< 5mm diameter Lying in midline <25 mm from anus

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

Heart defects

6-8 week check

Refer by phone if symptomatic at that time

No other timescales recommended at present

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

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

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

Hearing

Pre screening average age of aiding 22 months

i.e. huge loss of developmental window for learning language

Recent good examples of successes

Vision

Neonatal check no concerns

8 weeks parental concerned about visual behaviour

Reported to HV/ GP at time of 8 w check

Vision

Referred to paediatrician by letter

Seen by paediatrician at 12 weeks

Concern regarding red reflex

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

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

Vision

Neonatal Inspect external eye structures and red reflex Referral to ophthalmologist see below National recommendation to be seen within 2 weeks of birth Retinopathy of prematurity, < 31 weeks and/ or < 1500g then should be in ophthalmology screening pathway at neonatal unit.

6-8 week check

Establish if any concerns of parents and check relevant family history

Observe visual behaviour Observe visual fixing and following Inspect external eye structures Check red reflexes

Abnormal red reflexes are to be referred urgently to ophthalmology at Manchester Eye Hospital. Urgent means including phone contact ASAP with paediatric ophthalmology, via switch 0161 2761234 Retinoblastoma can be life threatening Congenital cataracts need to be operated upon by 12 weeks of age to prevent loss of vision development.

Other vision concerns include possible severe vision impairment or parental concern of such. Refer to Mr Simon Wallis, Bolton Royal, does weekly Thursday Pendleton Gateway clinic and will see with low threshold urgently. Urgent fax referrals 01204 390051, Confirm by Tel 01204 390390 ext 3935 Squint, family history of squint or any vision concerns/reduced vision will be seen by orthoptists via chose and book and liase with Mr Wallis accordingly

Vision

4-5 years Universal screen by orthoptist. Orthoptists available for discussion of concerns. Work closely with ophthalmology, based in Sandringham 0161 2124128 or Orthoptics.Salford@nhs.net

8 week vision

Fixing and following

Hips

Neonatal examination

Universal Ortolani and Barlow screen in hospital Dislocated or dislocatable hips for urgent referral to orthopaedics and hip ultrasound Ultrasound arranged for high risk babies, screen positive as above or clinical concern, particularly marked limited abduction.

Referrals are made directly to orthopaedics from neonatology and Dr Jill Carling, paediatric radiologist at SRFT

Hips

8 week check Universal Ortolani and Barlow screen (Not if already seeing orthopaedics for such/ in harness!) Confirm US appointment has been attended if high risk National Screening Committee March 2008 definition of high risk:

Clinical diagnosis of breech presentation at any time, even if cephalic birth

Family history of DDH (Developmental Dysplasia of the Hip)

Locally Talipes or other lower limb abnormality is also considered to indicate a high risk baby Screen positive, clinical concern or high risk baby not already in the system at SRFT or elsewhere then referral for urgent hip ultrasound at SRFT. Urgent fax number at SRFT is 0161 2065494 Note that asymmetrical thigh creases with no other positive findings or history are not an indication for referral.

Hips

Older ages Refer if needed because of clinical concern at any later date direct to Mr Henry orthopaedic surgeon at RMCH Refer via fax to 0161 7015421 Tel confirmation of receipt is requested on 0161 7015352 Referral will be triaged clinically Weekly hips clinic is at RMCH

Hips

Video / DVD

Testes Neonatal check

Bilateral undescended – 100% to see paediatrician within 24 hours

Unilateral – make parent aware and review at 6-8 weeks

Testes 8 weeks

Bilateral undescended

Refer to surgeons

C&B

Appointment by 1 year old Operation by 2 years old

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

Eight week check

Be thorough

Check slips and send in returns

Thank you very much

DVD