So you’re new to General Paediatrics…
My first job as an F1 was paediatrics, so I wasn’t even sure how to be a doctor, let alone a paediatrician the first time I stepped into the world of general paediatrics. To say it was daunting is a laughable understatement, and I was, and am still, extraordinarily grateful to the consultants and registrars who dragged me through those first two weeks. Seeing as September is just around the corner, and a fresh faced bunch on new paediatricians are about to embark on training, I thought reach out to the good people of #TeamGenPaeds and come up with a helpful list of resources and pearls for those coming to join the team in August.
So, you’re new to general paediatrics…
Resources that it’s good to know exist
NICE Bronchiolitis Guidelines
“Winter is coming” might be the Stark family words, but they have been firmly adopted by the general paediatricians. Once October rolls round, the wards will start being flooded with children with bronchiolitis. Although very common, its extreme hands-off approach may be a little unerring for the new paediatric trainee. The NICE Bronchiolitis guidelines take the stress out of the history taking and management, and give you clear advice on when to send home, and what to tell them when you do
NICE Fever under Five Guidelines
If you haven’t realised by the time you rotate on, you certainly will have by the end of the first week – Children spike temperatures a lot! Unfortunately, spotting the ones we need to treat fast from the vast numbers of hot-but-well children can be difficult. This guideline is very well written, with a clear traffic light system and management plan based on that traffic light for children under the age of five with a temperature.
NICE UTI Guidelines
We dip a lot of urines in general paediatrics. UTIs are both a common cause of fever in pre-verbal children, present with a wide range of non-specific signs, and are important to pick up. This guideline is very well written, gives clear advice about interpretation of results, and gives a clear outline for ongoing management should you diagnose a child with a UTI.
BTS Asthma Guidelines
Wheezers, wheezers everywhere! The BTS Asthma guidelines are the bible of all things wheezy, and is a great go-to for acute and chronic management for the older, non-bronchiolitic wheezers
ESPGHAN Gastroenteritis Guidelines
A chunky text, with a lot of fluff about medications, but the management section is solid, and very easy to read. Rough main take home – oral rehydration is king, markers of dehydration are tricky to assess (but some are better than others), beware the very small vomiting child, and not all that spews is gastroenteritis (watch for your own anchoring bias on this one)
Archives of Disease in Childhood E&P: Fifteen Minute Consultations
Not a guideline per se, but I guarantee, if you have a patient with a condition and you are not sure how to proceed in a structured way, there is definitely a Fifteen Minute Consultation section on it. Anything from chest pain, fever and cancer, fainting children, stridor, tongue tie, if you want to know it, they’ve got it. A brilliant resource that I come back to time and again, and great for reading after a day on CAU when you think “how could/should I have managed this?”. Though there are hundreds to choose from, if I had to pick, I’d go with “Preschool Wheeze”, “When is a seizure not a seizure”, “Oral analgesia” and “Troublesome Crying”. If your hospital gives OpenAthens access, get it through that, read and inwardly digest.
Spotting the Sick Child
Thankfully, in this age of vaccinations and public health awareness, serious illnesses in children are at a record low. Unfortunately, pressures on the services have also never been higher. Essentially, we have made the needle smaller, and the haystack bigger. Sick children often present non-specifically, and with limited or no history to accompany it. This website does a great job in systematically breaking down what to look for in terms of picking the sick child out of a full take of miserable-but-well children
Don’t Forget the Bubbles – Getting Started
As ever, we finish where it all began. Over the past few years, the crew at DFTB has put together an enormous amount of work to become the premiere site for #FOAMped. If you are just dipping your toe into the paediatric world of Free Open Access Medical Education, then please click here and get started, you never know what you might learn…
Top paediatric apps to download
BNFc – The Children’s BNF
Dosing drugs for children is hard, as children come in all sort of shapes and sizes. Having the information to hand is super useful, even though you will spend most of your time on it looking up the dose for paracetamol and ibuprofen. Again. And again. And again (this is a good thing, promise)
Growth Charts
Growth is everything in paediatrics, and as the old adage goes “Thriving is surviving”. Simply plug a date of birth, weight and height into this app, and it will instantly give you their centile for both, as per the WHO Standard Growth charts.
BiliApp – Neonatal Bilirubin Charts
Jaundiced babies are a common reason for readmission shortly after birth. Some need phototherapy, some don’t. Very, very few might need an exchange blood transfusion. This app uses the UK standard neonatal jaundice charts, simply plug in the date of birth, time of birth, and gestational age, and it will tell you where that baby is sitting. Saves waiting for the computer to load up!
Neomate – Neonatal Intensive Care Tool
Covering a neonatal unit for the first time, and apprehensive? Not sure quite what to do with the tiny little things behind the glass. Neomate has you covered. Anything from ETT length, to UVC/UAC placement and measurements, this is a one stop shop for neonatal intensive care doctors and nurses, and cuts down on the cognitive load in a crisis, to help you focus on the necessary.
LactMed – Breastfeeding and medications
Breastfeeding is fantastic, there is no doubt to the evidence. It’s also hard, and very stressful, especially for first time Mums. Often times they will ask about breastfeeding and medications that they are taking, asking if it is still safe to breastfeed their child. Whilst the answer is usually “Yes!”, this app is chockablock full of the hard evidence on the safety of a vast range of drugs and drug groups, to make sure you can confidently tell that Mum that she’s fine to keep breastfeeding.
Top tips from top people
I reached out to the Twittersphere to get people’s top tips for the new starters in general paediatrics. Here’s what they had to say!
Top tips for new general paediatricians from Twitter
At one point, I’ll be honest, it turned into a small bun-fight about the best children’s TV programme, which everyone got wrong, because no-one said Thunderbirds. If you wish to delve into the madness, you are more than welcome to click the link here, there are loads and loads of great #TipsForNewDocs shuffled away in there, between strong opinions about the quality of Duggee, so read away!
Bottom line: paediatrics rocks. Ask for help always, be kind, trust your team, and enjoy yourself. Welcome to General Paediatrics, we are thrilled to have you!