CSA troubleshooting: 3 - Paediatric consultations

Part three of this series explains how to consult with children in the CSA exam. By Dr MeiLing Denney

Paediatrics is an important part of a GP's work and the CSA may cover any aspect of the curriculum statement 'care of children and young people'.

When sitting the CSA exam you should expect to encounter a paediatric case , which could be with a child of any age.

How it is covered in the CSA exam

In the CSA you may come across child role players and there may also be older actors who look young enough to play teenagers.

Consultations involving infants or very young children will be proxy consultations, where you can expect a parent, relative or carer to come with questions about a child. These could be face-to-face or telephone consultations.

The cases may include acute childhood illnesses, chronic diseases presenting in childhood, childhood screening programmes and parental anxieties about growth and development. Third-party consultations bring extra challenges because the patient cannot be questioned or examined directly.

Consultations with teenagers raise the issue of communicating with young people who may be reticent, embarrassed or who are accompanied to the surgery for a variety of reasons.

What to do in the exam

If it is a proxy consultation, obviously the history will have to be taken from the person presenting.

There will be no point insisting on seeing the child before progressing with the consultation as this simply risks wasting valuable time.

Although no actual examination is possible during the CSA in a proxy case, it would be quite reasonable to state that you would like to examine the child, what you would examine and why this would be important.

If the child is present, you can go ahead and say what you wish to examine.

Remember to think about chaperones, competence, and consent - this includes prescribing medication, ordering investigations and referring to other services. The need to advise on teenage contraception and sexual health should not come as a surprise to you.

How to prepare

Be aware of common neonatal problems, childhood exanthemata, childhood immunisations, common problems relating to physical and mental development and failure to thrive.

Konw the basics about mental health problems, such as ADHD, autistic spectrum disorder, eating disorders, self harm and teenage depression. Be aware of the issues relating to looked after and accommodated children.

It is important to be able to recognise potential child abuse, but do not fall into the trap of assuming this is a hidden agenda in all paediatric cases.

Adopt a family-centred approach in dealing with children, listening to them and their carers, and involving other members of the primary healthcare team where appropriate.

  • You will need to be able to deal with both face-to-face and proxy paediatric consultations, where a parent or relative will attend with questions about a child in their care.
  • Think about the different communication skills you may need with children of all ages.
  • Consider chaperones, competence and consent.
  • Become confident in what is normal and what needs managing, including investigations or referring.
  • Understand the principles of paediatric prescribing.
  • Dr Denney is an MRCGP examiner and a GP in Edinburgh

Read more articles in this series and find other information for GP registrars here

Picture: iStock

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