Childhood Development and Immunisations

By Dr Sarah Ramruttun-MulcockGPVTSChildhood Immunisations and Development1Brief OverviewIntroductionPractice AKT questions Revision of the diseases we vaccinate againstSmall group workMore AKT questionsChild development- Red FlagsEven more AKT questions!!Summary and answers2IntroductionWhy learn about immunisations/child development?Pass the AKT!! Area that is regularly tested and regularly deemed weak in examsCondensed curriculum: National immunisation programmes and the GPs role in promoting and organising immunisation.Normal growth and development, management of delayed development and failure to thrive Be able to talk confidently with parents about the immunisations (how many injections, after effects, what does it protect against)Health promotion...herd immunity, reduce illnesses normally caused by the diseases3Now for the Practice!!Have a go!!Questions have been lifted from passmedicineGives an idea of what to expect.......GUESS!!

4Overview of DiseasesDiphtheria (D): Corynebacterium diphtheriae. Throat and chest infection. Rare in UK.Tetanus (T): Clostridium tetani (found in soil) Severe muscle contractions- fatal.Haemophilus Influenzae type b (Hib): causes pneumonia and meningitis. Most risk below age of 4.Pertussis (aP): Whooping cough, Bordetella pertussis. Prolonged, distressing cough. Can lead to pneumonia and encephalitisD/ aP/Hib/: fragmented vaccines, extracts of the organism/ virus used Tetanus: detoxified exotoxins5Overview of DiseasesPoliomyelitis (IPV): infection through the gut, then on to cause meningitic type illness. Affects nerves resulting in muscle wasting which can cause paralysis of 1+ limbs. Affects breathing in some cases. Was given orally, now injected.Pneumococcus (PCV): causes pneumonia, meningitis. Extremes of age are most vulnerable to this disease. Introduced in 2006.Group C meningococcus (Men C): meningitis and septicaemia.PCV/ Men C: fragmented vaccines

6Overview of DiseasesMeasles: miserable feverish illness with rash. Koplik spots white spots on buccal mucosa. Increasing incidence due to children not being immunisedMumps: Inflammation and swelling of salivary glands. May cause permanent deafness in one ear.Rubella: mild illness with rash, starts on the face and then spreads.MMR and BCG are live attenuated vaccines ( also oral polio, yellow fever and oral typhoid)7Overview of DiseasesHuman Papillomavirus (HPV): affects skin and mucosa HPV 16 & 18 involved in most cases of cervical cancerCervarix (endorsed by government) 3 injections; 2nd given 1-2 months, 3rd at 6mGardasil: protects against viral warts, covers HPV 6, 11, 16 and 18 8Group Work2 small groups to devise imms scheduleMatch the corresponding ages to the relevant vaccinesEach vaccine at the correct time scores a pointWinning group gets a treat!!

9Correct ScheduleAt Birth:BCG/Hep B (if high risk)2 months:DTaP/ IPV/ Hib + PCV3 months:DTaP/ IPV/ Hib + Men C4 months:DTaP/ IPV/ Hib + PCV + Men C12-13m:MMR+ Hib/Men C + PCV3-5yrs:MMR +DTaP/ IPV12-13yrs:HPV13-18yrs:DT/IPVDT always given with IPV, given with aP apart from 1yr/18yrHib not given after age of 4 yrs2 lots of MMR back to backPCV/Men C given up to the age of 1 yr10Correct ScheduleAt BirthBCG/ Hep B (if risk factors)2 monthsDTaP/ IPV/ Hib + PCV3 monthsDTaP/ IPV/ Hib + Men C4 monthsDTaP/IPV/ Hib + PCV + Men C12-13 monthsHib/ Men C + PCV + MMR3-5 years (pre- school)MMR + DTaP/ IPV12-13 years (girls)HPV13-18 yearsDT/ IPV11More AKT questionsRe- answer previous AKT questionsAdded some curve- ball questions Answers revealed at the end

12Child DevelopmentNot something that is easily taught or learntEven as a parent.....each child is differentDevelopment is most rapid during the first four years of lifeKey is to notice the abnormal from the normalMay be useful to split the periods of development:-The newborn baby-The supine infant (6-8 wks)-The sitting infant (6- 9 m)-The mobile toddler (18- 24m)-The communicating child (3-4 yrs)13Red flags in DevelopmentDoes not roll over in either direction by the end of 4 months of ageyellow flagDoes not respond to sounds or turns head to locate sound by age 7 monthsred flagCannot stand when unsupported age 12 months yellow flagDoes not speak at least 15 words and begin to use 2 word sentences by age 2 years red flagDoes not walk by 18 months or walks exclusively on tiptoes red flagCannot build a tower of more than 6-8 blocks by the age of 3 yearsyellow flag

14Red flags in DevelopmentNot jumping by the age of 30 months red flagNot feeding themselves with finger food by the age of 14 monthsred flagNot smiling by 1 monthyellow flagNot interested in pretend play by 2-3 years of agered flagDoesnt pass objects from one hand to another by age 9 monthsred flag15Even more AKT questions!

16AnswersImmunisations:(b) Mumps is a live attenuated vaccine(e) Hib/ Men C, MMR, PCV(c) 5(a) Clean wound and IM tetanus Ig(d) MMR with repeat dose at 3 months(a) Child can have the vaccine

17AnswersChild development:(e) 4 years(b) 9 months(c) 6 weeks

(see handout on developmental milestones)18SummaryGone through and (hopefully) learnt the immunisation scheduleLearnt about some of the red flags in child development Answered AKT questions along the wayWow the examiners with our impressive knowledge at the AKT exam!

19Thank you for listening!!Any Questions.....

Ask the Boss!!

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