Topic of the month: Paediatric Mental Health
Across London, paediatric trainees and trainers are focusing on Paediatric Mental Health. Here are some ideas to think about.
Many children in paediatric care, especially those with life-limiting illnesses or chronic disorders – for example asthma or diabetes – experience psychological and developmental difficulties. Children with epilepsy are four times more likely also to have a mental disorder. Parents of under 5s with severe feeding and sleeping disorders often require mental health management beyond medical investigation and treatment of the child. Persistent medically unexplained symptoms at any age are common in paediatric practice and require careful liaison between paediatrics and mental health in order to avoid prolonged or recurrent hospital admissions. So as you can see the emotional well-being and mental health of the child and family is important to all paediatricians
The RCPCP oversees the developing sub-specialty of Child Mental health within paediatrics, which the focus is the emotional well-being and mental health of paediatric patients. A Child Mental Health Paediatrician is a doctor who has expertise in promoting mental wellbeing, “parity of esteem” and working with children and families with mental health difficulties.
Conditions to think about are children with somatisation and complex presentations, behavioural challenges, neurodevelopmental disorders, eating disorders, mood disorders, anxiety and other mental health presentations. Close relationship with Paediatric neurologists, consultants in Paediatric Neurodisability looking after children with potential and ongoing learning and/or physical disabilities. These including epilepsy, autistic spectrum disorders, head injury rehabilitation, sleep disorders, neurometabolic conditions, dysmorphic syndromic and non-syndromic disorders.
Suggested curriculum competencies / learning ideas
- To be able to take responsibility for an effective consultation that routinely includes biological, psychological, educational and social factors in the child and family.
- The ability to conduct a consultation in such a way that a child or YP and their family feel able to talk about difficult or emotional issues.
- Have developed some strategies and skills to support and engage parents of children with emotional or mental health difficulties.
- Know about the MDT nature of CAMHS and be able to apply this knowledge in discussion of cases.
- Are able to undertake the initial assessment and mx of common causes of admission to hospital due to psychological distress such as self harm, somatic symptoms of distress and to refer when appropriate.
- Be able to recognise signs and symptoms that could indicate serious conditions such as ADHD, ASD, depression or psychosis.
- Be able to participate in the MDT approach to management.
- Show compassion and respect for children, YP and their families.
- Be aware to local services and how to access them.
- Be able to undertake an assessment of the mental state of a child or young person and know when to seek help.
- Understand the emotional dimensions of eating disorders and recognise and initiate treatment.
- Be able to recognise indicators of stress or mental health problems in family members and communicate appropriately with relevant professionals
- Be able to liaise with parent support and self help groups when necessary.
- Consider mental health needs of refugee and asylum seeking children and families.
(Adapted from Thinking Together resource pack)
Consider using paediatric training to gain further exposure to paediatric mental health:
Paediatric settings to consider:
General paediatric clinics
Community developmental clinics
Child protection medicals
Looked After Medical clinics
Special Needs School medicals
ASD assessment, Referrals meetings
CAMHS settings to consider:
General CAMHS clinics
MDT (generic, neurodevelopmental, other)
Inpatient child and adolescent unit
Emergency rota (A&E, paediatric liaison)
Out of hours rota
(Taken from Thinking together Resource pack)
Courses and resources:
- RSM day, 18th April 2017
- RCPCH: How to Manage: Child Mental Health in General Paediatrics, check RCPCH for dates of course
- London School of Paediatrics: Thinking together programme- a collaboration between psychiatrists and paediatricians (http://www.londonpaediatrics.co.uk/education/thinking-together/ )
- RCPCH Child Mental Health Curriculum http://www.rcpch.ac.uk/sites/default/files/page/August%202016%20Paediatric%20Child%20Mental%20Health%20Curriculum_0.pdf
- E-learning health care online modules:
- – Mental Health Awareness Programme ( http://www.e-lfh.org.uk/programmes/mental-health-awareness-programme/ )
- – MindEd (http://www.e-lfh.org.uk/programmes/minded/ )
- Simulation Workshop at the Mental-Physical Interface: Children and Young People (SWAMPI-CYP). www.maudsleysimulation.com :Video: https://youtu.be/57L8vJc5HeE