Paediatrics: Clerking & Discharge tips

As an FY1 it is likely that you will manage paediatric patients during their admission, often in other specialties like general surgery. Having a few paediatric skills under your belt will help you feel more confident admitting them & ensuring you appropriately raise any safeguarding issues and safety net them at discharge with appropriate support.

Paediatric Clerking
There are a few additional aspects to an adult clerking to consider when taking a Paediatric History.

  • Presenting Complaint: Very similar to adults, but remember to take as much history as possible from the child and let the parents fill in the gaps. Always ask if they are eating and drinking normally, passing urine and opening bowels regularly.
  • Past Medical History: Go right back to the antenatal scans. Were there any abnormalities on these? How was the birth (was it a normal delivery or Caesarean section etc)? Were they well afterwards or did they require a stay on the neonatal unit? Remember to ask about immunisations (make sure these are up to date).
  • Growth and Development: Record height and weight, and plot these on a growth chart if you are able to. Ask if the child is meeting their developmental milestones and how they are doing at school.
  • Drug history: Remember to ask the formulation of any medications, kids often take syrups instead of tablets. Also, some medications come in paediatric sizes for example Movicol comes in paediatric sachets.
  • Social: Ask who the child lives with, where they go to school and if there are any smokers in the household. Another key thing to mention is if the family/child has a social worker.
  • Diet: Particularly useful in younger children.
  • Family History: Is there anything that runs in the family? Particularly with siblings.
    • It’s also expected that you draw a family tree of the close family in this section.
Safeguarding Children
Whenever you see a child, always keep safeguarding and non-accidental injuries at the back of your mind. Remember, abuse can take many forms, including emotional, physical etc.

Remember to look-out for abnormal bruises, inconsistent stories and abnormal behaviour in children.

Who to go to? Most hospitals have a designated Paediatrician for safeguarding children. There is also the Paediatric safeguarding Nurses who can provide valuable information and advice. They are often a good first step. If it is out of hours, the Paediatric Registrar on-call should be involved.

Do look at the following sites for official advice

Discharge Letters
Again, these tend to be very similar to adults with a few exceptions:

  • Going back to school: Some schools can be very strict about time off. It is important to document how long the child might need off school and any activities the child cannot do when they return e.g. PE.
  • Follow-Up: Remember to document if any follow-up is required. Sometimes a GP follow-up 48 hrs to 1 week after discharge is required.
  • Support on discharge: Parents like to know there is support available on discharge, in case something happens/something goes wrong. Some wards have open access, where patients can call the ward for advice at any time and return for review if needed. If this is the case, it is important to document any relevant information for the family to see.

A final note…
Most importantly, enjoy working with paediatric patients as no matter what specialty you go into, you will usually see or work with children. It can be very rewarding & very fun so do make the most of it!

Dr A Przystupa (FY3 Paediatrics: DGH in the East of England)

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