Tag Archives: psychology

October 2018 newsletter

This month brings a handout entitled “Towards a healthy lifestyle…” which is a collaboration between dietitians, physiotherapists, psychiatrists and paediatricians at Homerton Hospital.  We have found many families are keen to do something about their child’s weight but don’t know where to start.  Hopefully this friendly article aiming for families to be “healthy enough” is a good place to start.

Also a bit on faltering growth, on-line safety, BRUE and the investigations that do not need to be done.  Tachycardia is (of course) mentioned again.  Do leave comments below.

HEADSSS tool

Using HEADSSS assessment by Dr Emma Parish

In the UK we often discuss our ageing population but sometimes fail to see the significant proportion of those in adolescence, between 12 – 19% of the total UK population in 20171.

Engaging this age group can be daunting for health professionals. HEADSSS is an interview prompt or psychosocial tool to use with young people. Still growing in the consciousness of health professionals (and in the letters making up its acronym) HEADS(SS) was first presented in publication in 19882. It has a reported yield of 1 in 3 for identifying concerns that warrant further investigation.

It follows a simple structure remembered by the acronym:

Home

Education & Employment

Activities

Drugs/Drinking

Sex

Self-harm, depression & suicide

Safety (including social media/online)

The great news is that many studies have shown that self-assessment with HEADSSS tools before discussion (completed at home or in waiting rooms) yields equal, and in some cases more, information than conducting the assessment in person. Helpful for time-strapped clinicians and better utilisation of time for young people attending appointments.

Key tips for using HEADSSS

  • Greet young person first, let them introduce others
  • Practice discussing issues that embarrass you
  • Be clear in what you mean by confidentiality relating to discussion
  • See young people on their own routinely (whenever clinically appropriate)
  • Use linking phrases and questions that don’t presume:
    • Do you have a boyfriend/girlfriend?

Vs

  • Do you have someone important in your life?
  • Have you been in a relationship before? Tell me more…

For more details see the RCPCH Young People’s Health Special Interest Group (YPSIG) app – free to download here: https://app.appinstitute.com/heeadsss

Or this short HEADS-ED assessment tool: http://www.heads-ed.com/en/headsed/HEADSED_Tool_p3751.html

  1. Association of Young People’s Health – Key Statistics Document 2017 download here: http://www.ayph.org.uk/keydata2017/FullVersion2017.pdf
  2. Cohen, E, MacKenzie, R.G., Yates, G.L. (1991). HEADSS, a psychosocial risk assessment instrument: Implications for designing effective intervention programs for runaway youth. Journal of Adolescent Health 12 (7): 539-544.

July 2017 PDF

Proteinuria this month, babies’ poo, bedwetting and a bit more on paediatric hypertension.  Please do leave comments below.

August 2016 uploaded

Sepsis and the “in-betweeners” this month.  How to categorise the unwell children you are just not quite sure about.  Also testing in malaria, the new NHSGo app and cardiac assessment prior to starting medications for ADHD.  Do leave comments below:

Parent Infant Mental Health

With thanks to Geoff Ferguson, Director of the Parent Infant Centre (www.infantmentalhealth.com) for the following explanation of the Acquarone scales:

The Acquarone Detection Scales for Early Relationships are observational scales that provide a powerful tool for assessing an infant’s capacity to form relationships and a mother’s ability to respond to her infant. The scales have been developed during several decades of clinical practice by Dr Stella Acquarone, who is also the author of several books on infant development and parent infant psychotherapy and Principal of the Parent Infant Clinic.   The Parent Infant Clinic is a private service but does have some subsidised places for families with limited financial resources.

There are two scales, a 25 item scale for observations of the infant and a 13 item scale for observations of the mother. In each case observations are divided into four domains: interpersonal, sensorial, motor and affect. Within each domain observers are asked to note the frequency of certain behaviours. For example, when observing ‘calling’ the observer is looking for ‘facial expressions, noises or gestures that seek to produce an affectionate response from the partner’.

A concern about the infant or the mother might be raised if a particular behaviour was never observed, perhaps showing a difficulty in relating, or was constantly observed, perhaps showing a defensive repetitiveness. The scales can be used to establish a thorough observational benchmark against which later changes can be compared.

Click here to see an example.

 

November 2015 newsletter

November 2015: diagnosing asthma this month, a synopsis of vitamin D deficiency as we go into the winter, a helpful cartoon around mental well-being and hypermobility demystified.  All comments gratefully received!

January 2015, late but useful!

January 2015 newsletter is being published late with apologies.  The newsletter is circulated prior to publication to be checked by my 8 paediatric consultant colleagues and any guest authors.  I neglected to attach the newsletter to my initial email, a fact pointed out to me on the 31st January…..  Now checked and ready to go.

Andrew Lock has put together a really helpful guide to viral exanthems with trustworthy links to proper images, Vicky Agunloye is back this month with an invaluable guide to the healthcare professional’s assessment of a crying baby (and his/her mother).  Tom Waterfield has looked at the usefulness of saline nebs in bronchiolitis, there are some more “do not do” recommendations from NICE and a link to Suffolk’s guideline on managing anaphylaxis and its follow up from primary care.  Do leave comments below:

September 2014 newsletter published

Warts this month, steroids in Bell’s palsy, a recap of the year for the new trainees and some more edicts from NICE on what not to do. A couple of links to good CPD opportunities too. Do leave comments below.

April 2014

More musings from Dr Waterfield this month – this time on paracetamol for immunisation discomfort.  Also the 7 important features of a headache y0u must ask about, a link to a very good paediatric emergency medicine site, NICE quality standards in depression, molluscum contagiosum and more musings from me, this time on paediatric phlebotomy.  Do leave comments below.

Obesity – assessment in secondary care and associated dysmorphisms

Article by Dr Hajera Sheikh, paediatric registrar

Assessment in Secondary Care

History:
• Lifestyle Assessment
• Menstrual History
• Obstructive Sleep Apnoea:  Snoring, difficulty breathing during sleep, morning headaches or fatigue
• Symptoms of co-morbidity including psychological
• Drug use (particularly glucocorticoids and atypical antipsychotics)
• Family history, particularly diabetes <40 yrs, early heart disease <60 yrs
Examination:
• Height, weight, BMI
• Obesity pattern: generalised, central (greater risk of adverse cardiovascular outcomes), buffalo hump and neck (may be suggestive of Cushing syndrome)
• Blood pressure
• Pubertal assessment
• Acanthosis nigricans (indicative of insulin resistance, first seen round neck and axillae)
• Signs of endocrinopathy
• Dysmorphisms: (Look out for early onset obesity, learning difficulties, deafness, epilepsy, retinitis, dysmorphic features, hypogonadism)

Investigations (directed)
• Urinalysis
• Thyroid function
• Fasting lipids (total and HDL cholesterol), triglycerides
• Liver function, including ALT
• Fasting glucose and insulin not usually done first line

Refer to Paediatric Obesity/Endocrinology or other specialist service if further investigation is required

Aetiology
• Genetic studies
• Thyroid studies: T3, thyroid antibodies, calcium, phosphate
• Cushing syndrome investigations

For co-morbidities
• Oral glucose test
• PCOS studies (LH, FSH, adrenal androgens, Sex Hormone Binding Globulin, prolactin, pelvic ultrasound)
• Sleep Study

Dysmorphic and monogenic syndromes associated with obesity:

Main clinical obesity associated syndromes:
• Chromosomal
Prader-Willi syndrome
Trisomy 21
• Autosomal dominant
Biemond syndrome (some cases)
• Autosomal recessive
Aistrom syndrome
Bardet-Biedl syndrome
Biemond Syndrome(some cases)
Carpenter syndrome
Cohen syndrome
• X-linked inheritance
Borjeson-Forssman-Lehmann syndrome
• Single gene lesions affecting leptin metaboilsm
Congenital leptin deficiency
Leptin receptor mutation
Prohormone convertase 1 mutation
Melanocortin 4 mutation

Clinical features suggesting obesity may be secondary to another condition or syndrome
• Severe unremitting obesity
• Disorders of the eyes
Colobomata
Retinal problems, especially retinitis pigmentosa
Narrow palpebral fissures
Abnormally positioned palpebral fissures
Severe squint (eg Prader-Willi)
• Skeletal abnormalities
Polydactyly
Syndactyly
Kyphoscoliosis
• Sensorineural deafness (eg Alstrom syndrome: sensorineural deafness, diabetes mellitus, retinal dystrophy, obesity)
• Microcephaly and/or abnormally shaped skull
• Mental retardation
• Hypotonia
• Hypogonadism
Crptorchidism
Micropenis
Delayed puberty
• Renal abnormalities
• Cardiac abnormalities