Practising paediatrics

The field of paediatrics and child health is exciting and varied. It is one of the few remaining fields of medicine where ‘generalist’ skills remain absolutely necessary, even for the ‘sub-specialist’. A typical ward round in a district hospital paediatric ward will cover a range of medical conditions, from heart murmurs to headaches, and from abdominal pain to skin rashes. This diversity makes every day a little different and every working shift an exciting challenge. It is hoped this handbook will give its readers the grounding and reference to keep them as young and as enthusiastic in outlook as the patients they are looking after. The editors unashamedly think paediatrics is the best career path any doctor could choose—we hope this book will help you agree!

Paediatrics, ethics, and the law

Treating sick children creates a range of ethical and legal considerations that are different from adult medicine. Paediatrics adapts as children develop cognitively, physically, and in autonomy. The introduction of new vaccines, therapies, and technology has improved the outcome for many conditions, including preterm birth, CHD, and oncology. At the same time as improvements in medicine and technology has come increased societal expectation, the impact of social media, and the rise of obesity in childhood. There are complex and blurred lines to be negotiated in parental, individual clinician, and institutional responsibility, especially when things go wrong. Paediatrics involves complex cases of neglect and abuse of children that have occurred in all societies and cultures. In this chapter, some of these aspects are discussed, including an outline of ethical principles that allow us to frame decision-making, how the law in the United Kingdom has evolved, and some of the principles of the Children Act 1989 and the Human rights Act 1998.

Audiology

Common ear problems encountered in day-to-day paediatrics are described here, alongside how to conduct an assessment and when to refer.

Nephrology

Renal disorders are common in paediatric practice. They may present as an association with other disorders. This chapter covers the presentation, investigations, and management of common renal disorders.

Child and family psychiatry

Mental health is intrinsically linked to many paediatric disorders, and a good working knowledge of psychiatry is important for all clinicians working with children and young people. Prompt recognition and diagnosis of mental health disorders improve the chance of successful treatment, and the close working relationship between the fields of psychiatry and paediatrics is pivotal to this.

Endocrinology

The human body goes through a number of complex changes during infancy, childhood, and adolescence. This chapter provides an overview of normal growth and puberty and discusses the investigation and management of deviation from the expected ‘normal’ trajectory. Key areas of paediatric endocrine medicine, such as pituitary, hypothalamic, and thyroid pathology, are discussed. This chapter is by no means an exhaustive guide to paediatric endocrine medicine but provides an introduction that will aid clinical practice.

Ophthalmology

The common eye problems of infancy and childhood are summarized here, along with outlines of basic bedside examination and work-up. Detecting visual problems early is crucial to optimizing long-term visual development. If any doubt about your assessment exists or you have concern about the child’s eyes, discuss with your senior early and seek a friendly ophthalmology opinion.

Inherited metabolic disease

Although individually rare, inherited metabolic diseases (IMDs) are a diverse and increasing number of recognized disorders. This chapter gives a practical overview of IMDs, concentrating on the approach to recognition, laboratory diagnosis, and initial management. Common presenting modalities of IMDs are described, including the acutely unwell child, elevated lactate, hypoglycaemia, hyperammonaemia, and metabolic acidosis. A systems-based approach is used to enable the reader to consider IMD in the differential diagnosis of organ-specific disease, as well as a description of the commoner diagnostic tests to consider. These include neurological (seizures, developmental delay), hepatic (hepatomegaly and liver dysfunction), and cardiac systems (cardiomyopathy). The IMDs causing dysmorphic syndromes are also considered.

Rheumatology

Presentation to paediatric rheumatology and orthopaedic services often overlap since both services assess conditions that present with musculoskeletal pain. By far, the majority of these conditions are diagnosed by a good history and examination and most are benign. A knowledge of benign conditions is essential for effective reassurance and to help distinguish them from conditions that should not be missed or that lead to progressive damage and disability. Presentations to orthopaedics include variation in limb position and limb deformity, and those to rheumatology include persistent fever and rash, unexplained high inflammatory markers, such as erythrocyte sedimentation rate, and fatigue. There is also overlap with conditions presenting to neurology, including gait disturbance and weakness, as well as multisystem involvement as the very nature of some inflammatory conditions.

Haematology

This chapter summarizes the key aspects of paediatric haematology. It is a big subject. Despite having detailed texts to hand, sometimes interpreting and evaluating the significance of certain blood results can be challenging for even the most experienced clinician. In this regard, one should have a low threshold for discussing the results (and further investigations, if needed) with a friendly haematologist and consult local guidelines.