SLO 5 – Care for children of all ages in the ED, at all stages of development and children with complex needs

This Speciality Learning Outcome covers paediatric emergency medicine. It includes the fundamentals of evaluation, investigation, decision making, safeguarding, resuscitation and caring for families and loved ones of children attending the ED.

Domain 1: Professional values and behaviours

Domain 2: Professional skills

– practical skills
– communication and interpersonal skills
– dealing with complexity and uncertainty
– clinical skills (history taking, diagnosis and medical management; consent; humane interventions; prescribing medicines safely; using medical devices safely; infection control and communicable disease)

Domain 3: Professional knowledge

– professional requirements
– national legislation
– the health service and healthcare systems in the four countries

Domain 4: Capabilities in health promotion and illness prevention

Domain 5: Capabilities in leadership and team-working

Domain 7: Capabilities in safeguarding vulnerable groups

At completion of training an EM specialist will:

  • Be able to identify the sick child and initiate appropriate management steps
  • Acquire the special skills needed to resuscitate children of all ages, and know that this may differ dependent on developmental age and know how this differs from adult resuscitation
  • Be able to lead a multidisciplinary paediatric resuscitation including trauma
  • Assess paediatric patients with concerning presentations and know that some of the presenting symptoms could be manifestations of non- accidental injury (NAI)

An EM specialist is / can:

  • Able to interact with children of different stages of development and their families to elicit the history
  • Able to undertake a careful, sensitive and flexible examination of children of all ages, at different stages of development and with complex needs
  • Aware of the different developmental stages of children and their assessment and how injury and illness can affect this
  • Aware that paediatric life-threatening emergencies are infrequent and therefore prior preparation is essential i.e. successful completion of APLS or equivalent is needed
  • Able to lead a team debrief following a paediatric resuscitation/trauma
  • Acquire the special skills needed to manage the paediatric patient– e.g. airway management, vascular access
  • Know that the interpretation of vital signs and tests is age dependant e.g. ECG, radiology, bloods
  • able to safely and appropriately arrange tests such as radiology and blood tests, considering factors such as the ALARA principle and the trauma of unnecessary blood tests Be able to prescribe safely for children
  • Know when to utilize distraction techniques and play therapists to manage children in the ED
  • Know that paediatric trauma is different to adult trauma and be able to apply those differences clinically
  • able to talk with parents and inform them that a social services referral is being made
  • able to identify those patients needing urgent specialist attention and know when and how to refer
  • Have an understanding of which patients can be safely discharged home and what follow-up they may need
  • Know the immunisation schedules
  • Know and respect the legal framework and ethical issues relating to children in the ED including capacity, consent and confidentiality
  • Understand the impact of learning disability and chronic complex health needs on acute presentations
  • Able to liaise with Paediatric Critical Care Retrieval Services and plan for a time critical transfer
  • Know the local procedure for sudden unexpected death in infants and children (SUDIC)
  • Know self-harm in children and adolescents as an expression of distress.
  • Know how to refer to the Child and Adolescent Mental Health Service team.
  • Know how to manage the adolescent refusing treatment for a life – threatening overdose.
  • aware of the presentations of mental illness in childhood including depression, anxiety, OCD, bipolar and schizophrenia
  • aware of behavioural and developmental issues in childhood such as autism and ADHD with particular emphasis on how they may impact on a clinical assessment in the ED
  • Knows and understands the ways in which children may present with physical, sexual, emotional abuse and neglect.
  • Understand the ways in which children might reveal sexual abuse.
  • Understand and recognise the signs and symptoms of sexual abuse.
  • Understand the importance of seeking help from experienced colleagues in the assessment of children with possible NAI.
  • Know the relevant national documents which underpin the safeguarding children policy in the emergency setting
  • Understand the roles of other systems in protecting children, e.g. Social Services, the Child Protection Plan, Police Child Protection and Domestic Violence Units, SureStart, Childline, Health Visitors, School Nurses, Area safeguarding children Committee, Community Paediatricians
  • Know which infants are most at risk
  • Have a basic understanding of common problems e.g. toddler tantrums, food refusal
  • Have an awareness of the effect of bullying, truancy, and work pressure upon children
  • Aware of causes of learning disability and how these might affect presentations to the ED, including infection and NAI.
  • Aware of the stresses to the family and the increased risk of NAI, neglect and DV
  • Understands consent, capacity to take decisions, and confidentiality in relation to children, and is aware of the issues of parental responsibility
  • Calculate risk stratification score for those with suicidal ideation and refer appropriately.
  • Able to recognize patterns of injury or illness which might suggest NAI.
  • Able to initiate safeguarding children procedures including sexual abuse as per local policy.
  • Can engage children appropriately in their own decisions and protects the best interests of the child at all times.
  • Reliably pick up clues which should give rise to concern
  • Reliably document concerns, conversations with other professionals, and detailed descriptions of history or examination findings as appropriate.
  • 6 months in PEM in intermediate training
  • Completing APLS/EPALS (Optional Neonatal Life Support)
  • Completing Spotting The Sick Child Online Module (In Core when this includes care of children)
  • Completion of Safeguarding Level  1 – 3
  • Relevant RCEM Learning/FOAM modules content
  • In situ sim of PEM resuscitation scenarios
  • Simulation suite feedback of paediatric resuscitation team leadership/ human factors

There is no requirement to record feedback on the care of children in ACCS. Trainees may wish to do so if they provide care for children as part of their time in EM.

Suitable WPBAs include RCEM assessment App; Mini-cex; CBD; ACAT

During 6 month placement trainees will be expected to seek feedback on patients across the full range of ages and include those with illness, injury and psychosocial presentations. Trainees will be expected to be observed in the resuscitation room and to reflect on receive feedback received about their assessment and management of children there. Trainees are required to record a formative WPBA on a concerning presentation and reflect on the feedback received. There are no absolute numbers required, but is expected trainees need to be observed in some aspect of PEM care on most shifts in their time in PEM.

Suitable WPBAs include RCEM assessment App; Mini-cex; CBD; ACAT; ESLE.

In HST formative assessment will be appropriate in challenging or complex cases. This will include resucitation cases, and HST trainees are expected to receive feedback on their leadership of paediatric resuscitation cases. Feedback on the assessment and management of concerning presentations is also required.

Suitable WPBAs include the RCEM assessment app, CBD and ESLE.

Entrustment Decisions

End of core training

There is no requirement for an entrustment decision in ACCS. EM trainees may choose to work towards this point by seeking formative feedback in this SLO.

End of intermediate training Level 3

  • A trainee will be entrusted to take a history from a child and their parents, examine children of various ages and elicit key examination findings. They will construct an age appropriate differential diagnosis. Trainees at this point will be entrusted to identify spot the sick child and initiate age appropriate management steps.
  • They will be entrusted to assess a paediatric patient with concerning presentations and refer to social services and inform parents of this referral when appropriate

End of HST Level 4:

At the end of training an EM specialist will be able to deliver the above. In addition they will be entrusted to lead paediatric resuscitation effectively in the ED, including trauma, through to disposal. They will also be able to support the resuscitation team and lead a debrief to enable others to learn.

RCEM examinations

MRCEM 
SBA
OSCE
FRCEM
SBA
MSO

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