A small toy. This just needs to be something colourful which will entertain a small child for a couple of minutes whilst you try to examine them. It doesn’t have to be anything big or flashy. Lots of people will attach a small keyring to their stethoscope in the shape of an animal. Often this can double up as something else useful (for example, getting a toy which lights up with a bright white light for looking in throats, or is a clock with a second hand). If you actually hand the toy to the child for them to hold (rather than just look at) then make sure to clean it thoroughly afterwards for infection control reasons.

  Calculator. Most people will have a calculator function on their phone but it is not always convenient to take your phone around with you on the ward. You may wish to invest in a miniature calculator to carry around with you.

  Stethoscope. Obviously you need one of these. It’s not necessary to get a paediatric stethoscope initially, adult ones will work just fine.

  Pen torch. For looking more closely at rashes, checking pupillary reactions, looking in the back of throats or entertaining small children (lighting up the torch and then pretending to blow it out and letting go of the button so it turns off is a great way of engaging young children who will really want to have a go themselves).

  Watch with a second hand. The problem with the bare below the elbow policy is that if you’re not wearing a watch, you can’t count respiratory and pulse rates. These are crucial parts of your assessment of any child so invest in either a fob watch with a second hand or a keyring with a watch on it that you can attach to your stethoscope.

Jargon Buster

Key: Each term that LOOKS LIKE THIS is a jargon buster!

32 PLUS 3 This is just an example of the actual numbers used but when people talk about a baby who was born at ‘32 plus 3’, what they mean is that the baby was 32 (completed) weeks and 3 days gestation when he or she was born. This is often written as ‘32⁺³’ when it is recorded in the notes.

5 IN 1 Single vaccine against five different diseases: diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b.

ACHIEVING BEST EVIDENCE This is the guidance set out for police officers about the best way of interviewing children about crimes that they have been victim of or witness to. It is about asking open, non-leading questions in order to gain the most reliable story from the child. This is important in cases of abuse when taking a history too as you want to avoid asking any leading questions in your history taking. If you have asked the child leading questions, it may mean that their statements will be judged as less reliable by the courts and could alter the outcome of a court case.

ADLS This stands for activities of daily living. It refers to all the things that we all do every day like washing, eating, dressing and going to the toilet.

ALTE This stands for apparently life-threatening event and is the term used to refer to reported episodes (usually in young babies) of the child becoming floppy, blue and unresponsive.

BLOOD GAS Do not assume when people talk about blood gases in paediatrics that they are referring to an arterial blood gas. These are rarely done in children and a venous or capillary blood gas is much more likely to be used instead. See Chapter 6 – Practical Procedures, for information on how to take a capillary blood gas sample.

BODY MAP A standard blank diagram of a child’s body on which you can draw any injuries or marks you have seen in the appropriate places. This makes it much easier to be accurate than trying to draw the child yourself or just using words to describe the size and location of marks. There are different body maps available for infants, older children and genitalia.

BURST THERAPY Giving three lots of salbutamol nebulisers and one lot of ipratropium nebulisers back to back to a child presenting with asthma.

CAIT If you hear people referring to ‘CAIT’ they may not be talking about a person called Kate, but about the Child Abuse Investigation Team! This is a specialised team of police officers who investigate possible criminal offences related to the abuse of children.

CAF You may hear people talking about ‘caf’ forms. This stands for ‘Common Assessment Framework’. These are often used for communicating child protection concerns to social services in writing (usually following a phone conversation with them about the case).

CAFCASS This stands for Child and Family Court Advisory and Support Service. This is an organisation which provides support and advice to families going through court proceedings. Their social workers act as advocates for children and help to advise the courts as to what is in that child’s best interests. Their website (www.cafcass.gov.uk) has lots of information written specifically for children, teenagers and families about the support that CAFCASS provides and the processes involved in court proceedings.

CAMHS You may hear people referring to ‘cams’. This stands for ‘Child and Adolescent Mental Health Services’.

CAPILLARY REFILL TIME This is often abbreviated to CRT. It is a way of assessing any problems with the child’s circulation by looking at skin perfusion. It is best measured centrally (usually over the sternum) as the peripheral measurement can vary depending on the room temperature. Press down for 5 sec and then remove your finger and count how long it takes for the skin to return to a normal colour. Anything less than 2 sec is normal.

CENTILES The lines on growth charts which document the range of normal growth for children. If a child’s height is on the 98th centile, this means that only 2% of children this age will be taller.

CHAIN OF EVIDENCE If you take a sample, the result of which may end up being used as evidence in court, you must use the chain of evidence process for that sample. For example, if you suspect a sexually transmitted infection in a young child, the result of any swabs you take may subsequently be used to convict someone of sexual abuse. This means that it must be clear that this is the right result for the right patient. For more about the chain of evidence process, see Chapter 4 under the Sexual abuse subheading.

CHILD IN NEED A child in need is any child who will need input from services in order to reach or maintain a good standard of health and development. This means that all children with disabilities and LOOKED-AFTER CHILDREN are automatically defined as children in need. A child who is at significant risk of abuse or neglect is also a child in need. For more about the child protection process, see Chapter 4 under Working with social services, education and the police.

CHILD PROTECTION CONFERENCE This is a formal meeting that forms part of the assessment process if there are concerns that a child is subject to abuse or neglect. The meeting involves family members (including the child if appropriate), with any relevant supporters, advocates or professionals who have been involved with the child or the family. The purpose of the meeting is to decide if the child is at risk of significant harm in the future and therefore should be subject to a CHILD PROTECTION PLAN. For more about the child protection process, see Chapter 4 under Working with social services, education and the police.

CHILD PROTECTION PLAN This is a plan put in place for children who have been abused or neglected and who are at ongoing risk of harm. The plan outlines what needs to be done and by whom in order to keep the child safe. The type of abuse to which the child was being subjected is recorded as part of the plan (i.e. physical, sexual, etc.) and a lead social worker will be allocated to be in charge of the case and ensure that all the plans are implemented. For more about the child protection process, see Chapter 4 under Working with social services, education and the police.

CHILD PROTECTION REGISTER The child protection register used to be a list kept by the local authority of all children who were felt to be at risk of significant abuse but these lists no longer exist. You may well still hear people referring to a child being ‘on the register’ but this is outdated terminology. What they probably mean is that the child is ‘subject to a CHILD PROTECTION PLAN’.

COMPENSATED SHOCK This expression tends to be used much more frequently in paediatrics than in adult medicine. Children have a greater physiological reserve than adults and so can compensate for shock very well for some time before rapidly deteriorating. Compensated shock means that the child is still managing to maintain perfusion of their vital organs but you need to intervene soon in order to prevent progression to DECOMPENSATED SHOCK. For more about shock and resuscitation of acutely unwell children, see Chapter 5 – Common Paediatric Emergencies.

CORE ASSESSMENT

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