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6 week check

Clinical Discipline(s)/Organ System(s)
General Practice, Paediatrics
Progress Test Topic(s)
Child health
Description
A mother brings her Māori baby for their 6 week postnatal checks and to discuss his immunisations.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Normal physiology of breastfeeding
   - Anatomy relevant to congenital anomalies
   - Nutrition (iron and vitamin D metabolism)
   - Metabolic disease and newborn screening
Clinical and Communication Skills 
   - Talking to mothers/carers of newborn baby, accurately recording mother/ whanau/carer baby and carer names
   - Assessment of growth and normal development of newborn, plotting growth charts and correcting for prematurity
   - Normal newborn behaviour; recognition of overdiagnosis of gastrooesophageal reflux and allergic disease that is 'medicalising normal infant crying'
   - Taking a feeding history for a neonate and understanding advantages of breast feeding
   - Examination of the newborn, assessment of dysmorphism and congenital anomalies; outline the management of common congenital abnormalities
   - Evaluating social history, screening for domestic violence/safety and postnatal depression
   - Discuss contraception in the postpartum period and while breastfeeding
   - Explain to caregivers about seeking help for common symptoms in infancy (including fever, rash, apneoa) as well as symptoms and signs of vaccine preventable disease and severe illness
Personal and Professional Skills 
   - Awareness of potential stress associated with a new baby in the household; personally, on relationships, and financially
   - Communicate empathetically with the parent/caregiver and show willingness to listen to their common concerns from caregivers around immunising their child and any contraindications
Hauora Māori 
   - Barriers to access to healthcare
   - Lower immunisation access and rates for Māori children
   - Strengths of whānau; learning care of newborn with support of extended family and older whānau
   - Appropriate recall/outreach systems in primary care to achieve equitable access to preventive care including Tamariki Ora and kaupapa Māori sudden unexpected death in infants (SUDI) prevention programmes
   - Ability to cater for differential health literacy needs of Māori patients and whānau
   - Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in NZ; ask about breastfeeding, smoking in home, heating at home
Population Health 
   - Preventative health in particular sudden unexpected death in infancy (SUDI) prevention (and awareness of New Zealand literature on this); accident prevention in the home; informing parents of the recognition of the sick infant
   - Design of observational clinical studies; case-control, cohort
   - Know the common reasons for caregivers not immunising their child and any contraindications for immunising
   - Promotion of breast feeding
   - Newborn screening for metabolic disorders (Guthrie card)
   - New Zealand Immunisation Schedule
Conditions to be considered relating to this scenario
Common
normal/abnormal newborn behaviour, normal infant crying ('reflux'), congenital melanocytic naevi and other skin conditions, haemangiomas and vascular malformations, Mongolian blue spots, difficulty establishing feeding, maternal depression/stress, concerns about vaccination
Less common but 'important not to miss'
developmental dysplasia of the hip, cataracts, cleft palate, cardiac murmurs, coarctation of the aorta, retinoblastoma (red reflex eye examination), hypospadias
Uncommon
inherited metabolic disorders
Related Scenarios
[Before school check]
Resources

New Zealand Immunisation Handbook
http://www.health.govt.nz/publication/immunisation-handbook-2014

Note the following sections:
  • National Immunisation Schedule  - Table 1 Introduction
  • General Immunisation Principles and Processes for Safe Immunistion - Chapters 1 and 2
  • Vaccination questions and  concerns - Chapter 3