Paediatrics

Core Generalist#

Knowledge#

CG.K.1#

Define the rights of children and adolescents including individual rights, use of chaperones, age of consent, confidentiality, and power of guardians over the rights of minors

CG.K.2#

Describe the range of normal growth and development in infants, children and adolescents

CG.K.3#

Discuss links between early childhood development and the early origins of chronic disease, including:

providing appropriate advice and management for conditions that affect normal childhood development and education, such as otitis media, urinary tract infections, intestinal conditions, skin conditions and upper respiratory infections
providing nutritional advice appropriate to the child’s age, food supply, family income and social situation
providing regular antenatal care, including intervention and follow up for common conditions of pregnancy such as urinary tract infections, hypertension, anaemia and poor weight gain
showing an understanding of the importance that remote Aboriginal and Torres Strait Islander mothers may place on delivering their babies on their homelands
identifying and following up children at risk, and
participating in childhood immunisation programs

CG.K.4#

Explain specific developmental issues and psychological issues of children and infants including:

normal and abnormal growth and development
failure to thrive
growth velocities in early life
the parent held record
the inter-relationship of physical and mental well-being
role of achievement
early detection and management of vision and hearing problems
behaviour
disability
family development and dynamics

CG.K.5#

Describe the aetiology and pathogenesis, investigations and pharmacological and non-pharmacological treatment options for conditions in childhood and adolescence

CG.K.6#

Discuss the need to adjust the consultation style and management plan to respond to influencing factors such as:

beliefs and expectations of the wider family which shape the presentation of the problem
the effect on treatment compliance of parental attitudes to illness, medication, fever and alternative remedies
pressures of work, and the necessity to maintain employment by both parents (as they affect the capacity to care for sick children)
the quality of family and community support, ie the immediate environment in which care occurs (the same clinical situation may require home or hospital management)
linguistic, ethnic and cultural barriers (which may exclude a parent from part of the consultation)
anxiety, sleep deprivation and level of understanding affecting potential expectations of the consultation both in the family and the practitioner

CG.K.7#

Describe specific nutritional and physical fitness issues in children of infant, toddler and school-aged years including:

nutritional goals by age group
flexible feeding patterns
risk factors for deficits
iron and calcium deficiency
vegetarian and vegan diets
food allergy, sensitivity
age specific exercise
recreation and fitness
obesity

CG.K.8#

Define problems common in adolescence including:

acne, seborrhoea, tinea, scabies
sporting injuries, spinal pains
interaction of lifestyle issues
anxiety and mood disorders
drugs
eating disordered behaviour
organic weight loss
chronic illness and disability
learning disorders
developmental disorders
use of anabolic steroids

CG.K.9#

Discuss common developmental issues for adolescents including individuation, sexual maturation, cognitive development and self-esteem

CG.K.10#

Discuss the barriers perceived by adolescents which may limit access to effective medical care

CG.K.11#

Describe a range of adolescent communication/assistance strategies including:

emergency strategies
engagement strategies
family counselling
organising support
resources
drop in centres

CG.K.12#

Describe how to plan emergencies at home and in the community including preparing an asthma action plan, use of medical alert tags and Epi-Pens®

CG.K.13#

Discuss mandatory reporting requirements for children, including child abuse and neglect

Skills#

CG.S.1#

For common and important conditions and presentations, with consideration of clinical services capability:

recognise the presentation of illness
establish a provisional diagnosis
plan and arrange appropriate investigations
initiate appropriate medical manage for uncomplicated disease
monitor for complications
recognise if there are complications, or if procedural intervention is required, provide initial emergency management and refer appropriately

CG.S.2#

Independently perform the following assessments:

height, weight, head circumference evaluation
use standard growth charts
physical and functional clinical assessment
growth and developmental assessment
home, education, activities/employment, drugs, suicidality, sex, eating and safety (HEADSSS) assessment for adolescents
suicide risk assessment
paediatric neurological assessment
hearing assessment

CG.S.3#

Independently perform the following procedures on children and adolescents:

use medication delivery devices
use spacer devices
nebulisation therapy
nasogastric tube insertion
local anaesthesia administration
superficial skin lacerations repair
subcutaneous foreign body removal
urethral catheterisation
suprapubic aspiration
venous blood sampling

CG.S.4#

Assist with performing the following procedures on children and adolescents:

child sedation
fracture reduction
dislocated joint reduction
thoracentesis
intercostal catheter insertion

CG.S.5#

Perform emergency procedures specific to children and adolescents including

endotracheal intubation (child and neonate)
resuscitation (child and neonate)
external cardiac massage
bag/mask ventilation
oropharyngeal airway
defibrillation
synchronised direct current (DC) cardioversion
intravenous access
umbilical catheter (neonate)
intraosseous access

Attributes#

At.1#

Accountability

At.11#

Integrity

At.7#

Empathy

Advanced Specialised#

Knowledge#

AS.K.1#

Describe the physiological differences between a neonate, child and adolescent

AS.K.2#

Discuss the principles and issues relating to patterns of inheritance, newborn screening and counselling

AS.K.3#

Describe early attachment theory

AS.K.4#

Demonstrate knowledge and understanding of the causes of inter-uterine conditions likely to cause developmental delay, including:

anomalies of the central nervous system
low birth weight – especially less than 1000 grams
chromosomal abnormalities – including fragile X syndrome
congenital infections
cerebral palsy
disorders of the sense organs
inborn errors of metabolism
neuromuscular disorders
foetal alcohol spectrum disorder (FASD) and maternal drug ingestion
orthopaedic abnormalities
poverty and maternal malnutrition

AS.K.5#

Demonstrate advanced understanding of the five domains of developmental disability:

speech and language delay
gross motor delay
fine motor delay
personal and social delay
global delay

AS.K.6#

Discuss pervasive developmental disorders, including:

Autistic Spectrum Disorder (ASD)
Rett’s Syndrome
childhood disintegrative disorder
pervasive developmental delay not otherwise specified

AS.K.7#

Describe learning disabilities and the protocols for administering and interpreting the results of the Wechsler Intelligence Scale for Children (WISC)

AS.K.8#

Explain aspects relating to nutrition, including

causes and implications of low birth weight, prematurity and intrauterine growth retardation
the principles and issues associated with nutritional goals by age group including flexible feeding patterns, risk factors for deficiencies, as well as food allergy and sensitivity.
the application of knowledge to age-specific exercise, recreation and fitness programs and reducing the risk of obesity and other related diseases

AS.K.9#

Describe when a child can consent to medical treatment on their own behalf, and without their parents’ knowledge.

AS.K.10#

Discuss issues relating to adolescents, including:

rights of children and adolescents including individual rights, use of chaperones, age of consent, confidentiality, and power of guardians over the rights of minors, in everyday patient care
normal striving for independence and the issues of concern to young people as they progress through adolescence
barriers perceived by adolescents which may limit access to effective medical care and how best to address these
effect of peer pressure, school, mass media and employment prospects on the attitude and behaviour of adolescents
common developmental issues for adolescents including individuation, sexual maturation, cognitive development and self-esteem
strategies to manage problems that can arise during adolescence including peer issues, and problems with body image, support/alienation from family/school/peers, oppositional behaviour, school dysfunction and self-harm
strategies to manage psycho-social issues in adolescents including effects of homelessness, unemployment and their health impact, risk-taking behaviour including substance misuse (normal, experimentation, at risk, out of control), suicidal intention or self-harm, dysfunctional families, eating disorders
financial and compliance issues when prescribing for adolescents
family development and dynamics affecting children including parental substance use, the effects of smoking, childhood caffeine use and high-risk families

AS.K.11#

Discuss issues relating to Aboriginal and Torres Strait Islander children, including:

knowledge of the diseases over-represented in Aboriginal children,
understanding the impact of poor living conditions and over-crowding
management of acute episodes of disease
long-term management of chronic conditions
population health initiatives for disease prevention and management
understanding Cultural Safety
understanding Guardianship within communities
understanding barriers to effective prevention, treatment, and compliance with advised care

AS.K.12#

Discuss sexual health issues, including:

knowledge of child protection including knowing the relevant laws in their state or territory
knowing the role of chlamydia testing and screening in teenagers
knowing when to take a more detailed sexual history
having information and resources available regarding common sexually transmitted diseases
know the local resources
know local treatment protocols

AS.K.13#

Describe toxicology, poisoning and envenomation, including:

know the venomous animals etc in their area of work and the principles of treatment – local spiders, snakes, marine animals
know the treatment of common childhood poisons and overdoses and be competent in their treatment
be familiar with the Poisons Information Centre including the phone numbers

AS.K.14#

Discuss palliative care in childhood, including:

principles of palliative care in the paediatric setting
knowledge of local resources and referral protocols
knowledge of local support services and other patient resources
understanding the importance of supporting the child and family in a culturally appropriate manner
pain management

AS.K.15#

Discuss vaccine preventable infectious diseases:

advanced knowledge of the immunisation schedule
ability to describe the complications of immunisations
ability to discuss the myths of immunisations
knowledge of the immunisation preventable diseases

AS.K.16#

Discuss growth and nutrition including:

growth faltering/failure to thrive,
overweight/obesity,
specific nutritional deficiencies including iron deficiency,
vitamin D deficiency outside of the neonatal period

AS.K.17#

Discuss diagnostic testing in children, including:

understanding of the indications, contra-indications and techniques for an extended range of paediatric diagnostic investigations
how to arrange a wide range of paediatric tests and interpret their results, taking into consideration age variation and findings relevant to different age groups
explaining to parents and caregivers the relevance of the results

AS.K.18#

Discuss principles and practices for pharmaceutical prescribing in children, including differences between paediatric and adult prescribing, including but not limited to:

thrombolytic therapy
treatment of bleeding disorders
inotropic therapy
disease modifying anti-rheumatic drugs
insulin therapy
chemotherapy
advanced palliative care
anticoagulation
mental health conditions

AS.K.19#

Discuss the indications, contra-indications and techniques for an extended range of paediatric diagnostic investigations

AS.K.20#

Describe formulas for paediatric resuscitation, including:

weight
endotracheal tube size
fluid resuscitation
dose of adrenaline
joules for electrical shock

AS.K.21#

Describe appropriate pain relief: oral sucrose for infants, topical amethocaine

AS.K.22#

Discuss characteristics of rural and remote settings and their implications for child and adolescent health practice, including:

types of conditions likely to be encountered
impact of rural and remote attitudes
impact of distance – including delays in transport/referrals
impact of limited resource availability

AS.K.23#

Utilisation of technology where useful, including video/tele conferencing, video-otoscopy, picture archiving and communication system (PACS) utilisation including USS 'quality control', and microscopy of CSF

Skills#

AS.S.1#

For the less common or more serious conditions and presentations of childhood and adolescence with consideration of clinical services capability:

recognise the presentation
establish a provisional diagnosis
plan and arrange appropriate initial investigation
initiate empiric therapy
discuss broad therapeutic options
refer appropriately
provide ongoing management

AS.S.2#

Obtain a clinical history including:

maternal
family – including cultural and social factors
genetic
birth
neonatal
developmental
nutritional
immunisation
environmental
past medical

AS.S.3#

Engage with and perform a relevant physical examination and developmental assessment including:

elucidation of a wide range of clinical signs including subtle clinical signs indicative of dysmorphology
investigation for negative signs (i.e. signs that are absent)
assessment of developmental age and/or learning ability
neonatal examination
growth and serial measurement
examination and assessment of a child with a convulsion and/or altered level of consciousness
assessment for physical signs of nutritional and metabolic disorders including growth failure, obesity and insulin resistance
identify physical signs and behaviour patterns associated with neglect and abuse
examination of all joints for differential diagnosis

AS.S.4#

Order and/or perform diagnostic tests, including:

full blood count – understand and advise on normal blood results
Point of care testing and interpretation of urine, Hb, WCC, chem8, chem4, international normalized ratio (INR), brain natriuretic peptide (BNP)
gram stain on cerebrospinal fluid (CSF)
specialised blood tests – including arterial blood gases, renal biochemistry, liver function tests (LFTs), bacterial serology and viral serology
chest X-ray – interpretation of chest X-rays in children and adolescents, understanding and advising on age-appropriate variations and abnormalities
growth charts – understand the normal growth patterns in childhood, and appropriate use and interpretation of growth charts
abdominal ultrasound
bronchoscopy
CT scan interpretation
MRI interpretation
electroencephalogram (EEG)
electrocardiogram (ECG)
bone marrow examination
behavioural assessments and specialised developmental testing

AS.S.5#

Manage abnormal results, including:

screening of high-risk pregnancies – including cervical cytology
vitamin D deficiency
screening for Haemoglobinopathies
varicella, cytomegalovirus and toxoplasmosis serology
chlamydia screening
thyroid function test
‘triple’ or’ quadruple’ testing
ultrasound for nuchal translucency
neonatal fever and suspected neonatal sepsis
neonatal jaundice
neonatal hypoglycaemia
ability to perform a heel prick test and discuss with parents the conditions it is used to test for
reasons for administration of Vitamin K, BCG and Hepatitis B vaccine at birth
respiratory distress in the newborn
feeding of the newborn
management of the infant of a diabetic mother

AS.S.6#

Assess and manage children with psychosocial issues including:

behaviour management – including children with challenging behaviours
sleep difficulties
nocturnal enuresis
parenting issues
eating disorders
swearing problems
issues relating to the context of childhood within the family
children at risk of child abuse
grief responses
school performance issues

AS.S.7#

Assess and manage mental health conditions, including:

ability to perform a mental health screen for children and adolescents
high prevalence anxiety and mood disorders
the child whose mother has depression especially post-natal depression
intervening in a case where a child or adolescent is at risk for suicide
early psychosis with appropriate support or referral

AS.S.8#

Identify early indicators of ‘at risk’ behaviours of adolescents and initiate harm minimisation strategies

AS.S.9#

Use range of adolescent communication/assistance strategies including:

emergency strategies
confidential history taking
minimising anxiety
encouraging compliance
direct family counselling and
assist in coping with imprisonment

AS.S.10#

Prevent occurrence and recurrence of primary conditions and prevent secondary complications from primary conditions

AS.S.11#

Recognise conditions in childhood that may only show their consequences in adulthood e.g. obesity, bone health, rapid weight gain in growth retarded infants

AS.S.12#

Manage acute conditions requiring inpatient admission specific to children and adolescents including:

head injury
hypovolaemia
hyper and hypoglycaemia
acidosis
hypoxia and
blood transfusion

AS.S.13#

Estimate and administer fluid requirements for ongoing maintenance

AS.S.14#

Manage neonates admitted with common neonatal medical conditions

AS.S.15#

Meet mandatory reporting requirements, as relevant to state or territory

AS.S.16#

Manage conditions overrepresented in Aboriginal and Torres Strait Islander children

AS.S.17#

Competent, confident and independent performance of the child and adolescent procedural logbook skills