BEST PRACTICE Article

BMJ September 2020

Jessica R Turnbull, Michael Farquhar

Fifteen-minute consultation on problems in the healthy child: sleep

ABSTRACT

Sleep-related issues are common reasons children present to health professionals. Many factors can adversely affect sleep quality, and there are many associations of inadequate sleep, including behavioural problems, obesity and accidental injury. We review the current evidence, and suggest practical management strategies to promote better sleep, and hopefully, better functioning for child and family alike.

Click here to read the article

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RCPCH statement on Child Mental Health

1st September 2020

Mental health issues are increasingly common among children and young people—suicide is now the leading cause of death for both males and females aged five to 19 years old, and one in eight people among this age group is currently living with a mental health condition. 

Children and young people in vulnerable groups are even more at risk, including LGBTQ+ people, low income households, children in care, and those with parental mental health issues, special educational needs, on child protection plans, or in the criminal justice system. 

Underinvestment in mental health is a longstanding concern. This has been amplified by the pandemic due to the extra stress caused by prolonged school closures, social isolation, adverse social and environmental circumstances, and a lack of access to usual support services. 

RCPCH’s Assistant Officer for Mental Health and Wellbeing, Dr Karen Street, says: “Our key message is that our patients’ mental health is our business. There is a joint responsibility to provide necessary services across the children’s workforce. 

“In the wake of COVID-19, many children and young people will have greater mental health support needs. As services begin to recover, the time is ripe to connect across the entire child health workforce and local, regional, and national boundaries. Together, we can work to develop improved and integrated mental health services.” 

In its statement, the College includes a number of recommendations, including: 

  • All paediatric teams should have a nominated lead for mental health. 
  • Paediatric training must include promotion of wellbeing in children and young people and management of common mental health issues. 
  • Paediatricians with higher exposure to issues need more extensive training and support. 
  • Paediatricians should not be expected to work in isolation when managing severe cases of mental illness. 
  • Use of mental health screening tools in higher risk people should be considered. 

The College will also continue to support mental health through its activities, including: 

  • Having an Assistant Officer for Mental Health on its Health Improvement Committee. 
  • Working with NHSE and HEE to implement of the NHSE Long Term Plan. 
  • Developing training through its Child Mental Health Specialty Advisory Committee. 
  • Developing the Progress curriculum for all paediatric trainees to include mental health. 
  • Partnering with MindEd to produce a paediatric ‘learning path’. 

Read the College’s full position statement on the role of paediatricians in mental health here

RCPCH Online course

The RCPCH is organising this interesting one-day online course

How to Manage: Emotional and behavioural problems in community paediatrics

“This online course will help you to confidently support children and young people with a range of emotional and behavioural difficulties.”

October 16 from 09.45 – 16.00

For more information, click on the link below:

https://www.rcpch.ac.uk/education-careers/courses/rcpch-course/how-manage-emotional-behavioural-problems-community

Journal Article: Care for children and young people with eating disorders

This article was published in the journal ‘Clinical Child Psychology and Psychiatry’ (June 2020) and may be of interest:

Paediatric medical care for children and young people with eating disorders: Achievements and where to next

Lee D Hudson and Simon Chapman

No other diagnoses epitomise the need for dual consideration of mental and physical health more than eating disorders. Anorexia Nervosa (AN) for example has the highest mortality rate of any mental health disorder, and half of deaths are thought to be due to physical complications (Sullivan, 1995). For this reason it is crucial for acute paediatrics and eating disorder teams to work closely over the assessment and management of these disorders, particularly in the early stages when physical risks are often highest.

This is not as easy as it sounds: mental health and physical health teams are often geographical distant from each other, have different ways of working, and may even view and speak of risk in different ways. Despite this, as for many countries, in the United Kingdom (UK), the journey to provide better paediatric care for children and young people (CYP) with eating disorders has been a gradual one, albeit with a number of recent victories. As two paediatricians working with CYP with eating disorders and eating disorder teams in the UK, we summarise the important developments of the past 10 years in the UK, and look to future steps…

To read the full article, click on the link below:

https://journals.sagepub.com/doi/pdf/10.1177/1359104520931573

PAEDIATRIC MENTAL HEALTH: A NURSE’S PERSPECTIVE

CCCU BSc Child Nursing alumna Kim Cunningham discusses the unique mental health care needs of children, and her experience as a hospital lead for the ‘We Can Talk’ initiative.

I studied paediatric nursing at Canterbury Christ Church University (CCCU) and during my time as a student nurse I came across lots of children and young people with mental illness admitted onto the paediatric ward. Quite often they were just there for a short time, whilst assessed and discharged back to the community. However, sometimes those with more complex mental health needs, their admission stays were for a few days and sometimes weeks, whilst awaiting an inpatient bed.

https://www.canterbury.ac.uk/health-and-wellbeing/nursing-midwifery-social-work/child-nursing/paediatric-mental-health-nurse-perspective.aspx

The Importance of Human Contact Today

During the interval of a recent concert by the Orchestra of the Age of Enlightenment, Dr Dickon Bevington, Consultant Child and Adolescent Psychiatrist, gave a thought provoking, and topical talk:

The Importance of Human Contact today, about Mentalization, Attachment and Kindness.

About Dr Dickon Bevington:

Dr Bevington is the Medical Director at the Anna Freud National Centre for Children and Families and a Consultant Child and Adolescent Psychiatrist in Cambridgeshire and Peterborough NHS FT where he leads CASUS, an outreach service for complex substance using youth. He is also a Fellow of the Cambridge and Peterborough CLARHC, a collaboration based in Cambridge University dedicated to developing leadership and research in health and social care.

Dr Bevington’s consultant career started in adolescent in-patient psychiatry, but he now concentrates on developing and delivering innovative home-based or street-level out-reach interventions for complex, co-morbidly burdened young people who are socially excluded, using mentalization to underpin both the therapeutic and the organisational approach to this work. In this respect, together with Dr Peter Fuggle, he is the co-lead for the Adolescent Mentalization-Based Integrative Treatment (AMBIT) project.

Dr Bevington trains and lectures internationally on MBT and AMBIT, and has published a number of papers and chapters in the eld of mentalization and multimodal outreach approaches, most recently with Dr Fuggle. He is also co-author of “ What works for whom: a critical review of treatments for children and adolescents” which is a review of all treatment trials in the past 10-15 years across the world.

Take a look at the Anna Freud Centre website for more information about this field of Child Mental Health.

For a great resource for on-line learning, click on link below: https://www.annafreud.org/mental-health-professionals/anna-freud-learning-network/

Don’t miss! : PMHA online talks on paediatric mental health

Due to overwhelming demand, this event is currently fully booked, but the PMHA are currently trying to make more spaces available. If you are interested, please try again! If you continue to have problems, click here to send us an email.

15th July 2020 – A free online event

Please register below with your
NHS / university / affiliation email

Closing date for registration: 1st July 2020

The PMHA, supported by RCPCH, is holding an afternoon of talks on Paediatric Mental Health. They are aimed at all interested health professionals, including paediatric trainees, SAS doctors, Consultants, Clinical Psychologists Child Psychiatrists, and other CAMHS professionals.

Draft Programme:

11.45 Opening

12.00 – Attachment and Autism
Dr Gina Gomez, Clinical Psychologist in Community Paediatrics – Cambridge and Peterborough NHS Foundation Trust 

13.00 – Maximising therapeutic benefit during mental health crisis in a paediatric ward
Dr Rory Conn, Consultant Child and Adolescent Psychiatrist – Devon Partnership Trust 

14.00-14.15 Break

14.15 – Update on how to manage eating disorders
Dr Nasima Matine, Consultant Child and Adolescent Psychiatrist Cambridge and Peterborough NHS Foundation Trust – Clinical Lead for The Phoenix Centre

15.15 – The mental health crisis in school – Education and mental health interface
Prof Tamsin Ford, Professor of Child and Adolescent Psychiatry at the University of Cambridge

16.15 Close

Please use the button below to REGISTER

Staying Sane in the Times of Covid-19

An article by Dr Emma Blake, Consultant Paediatrician, now Chair / Convenor of PMHA

Well, in these crazy times – with universal maelstroms – all of us are trying to cope with our personal whirlpools. Being a front line medic, whilst coping as a “full time” parent and teacher; trying to keep yourself, your kids and everyone else around you sane – it’s not manageable, is it?

I wish I had all the answers. Medice, cura te ipsum. Heal thyself. But no-one knows the cure for Covid-19, no immunisation – even against the anxiety and psychological impact of it. As a paediatrician, mother of four, with “shielded” vulnerable relatives; suddenly homeschooling three children and trying to get a “gap-year” son trapped in Vietnam back to the family;  I, like the rest of us, am trying to juggle all the balls whilst wearing minimal / flimsy PPE.

At the PMHA (Paediatric Mental Health Association) we are trying to find resources to support parents who are doing the best they can to care for their children’s health, education and emotional needs at home. A popular PMHA Facebook post (which has currently reached over 9.6 million people!) suggests taking the pressure off ourselves with regard to home-schooling or children; to try to take the stress out of the situation as much as possible.

Enjoy the time together – “cuddle up and read, read, read” etc. The best way to de-stress kids is to de-stress ourselves (often easier said than done). Obviously older kids (GCSEs and A Levels) need more structured work (thank you teachers!), but the principle is the same – our kids will remember what this felt like at home. They will remember the emotions and relationships.

We are seeing an increase in mental health presentations to paediatric wards – when we are doing our best to keep people safe at home. However, not all young people are safe at home. Abuse is escalating, domestic violence and parental mental health / substance abuse difficulties are worsening. As paediatricians, we need to be more aware of mental health and safeguarding issues, more than ever. The most vulnerable children are more hidden from view – and we are waiting for a tsunami (not only from Covid-19 ventilated elderly – but also young people who have had to cope with the “perfect storm”at home).

In addition to our Facebook page; the PMHA, along with Serena Haywood (St Georges) and Simon Chapman (Kings) have also developed a website – Indoor Explorers – to try to bring together resources to support parents at this difficult time.

If you have any useful resources for parents or professionals at this time – please share them with us at ContactPMHA@gmail.com

Dr Emma Blake,
Child Mental Health & General Paediatric Consultant,
Designated Doctor for Safeguarding Children, Isle of Wight,
Vice Chair PMHA and Chair of Child Mental Health (CSAC) at the RCPCH

PMHA online talks on paediatric mental health

15th July 2020 – A free online event

Please register below with your
NHS / university / affiliation email

Closing date for registration: 1st July 2020

The PMHA, supported by RCPCH, is holding an afternoon of talks on Paediatric Mental Health. They are aimed at all interested health professionals, including paediatric trainees, SAS doctors, Consultants, Clinical Psychologists Child Psychiatrists, and other CAMHS professionals.

Draft Programme:

11.45 Opening

12.00 – Attachment and Autism
Dr Gina Gomez, Clinical Psychologist in Community Paediatrics – Cambridge and Peterborough NHS Foundation Trust 

13.00 – Maximising therapeutic benefit during mental health crisis in a paediatric ward
Dr Rory Conn, Consultant Child and Adolescent Psychiatrist – Devon Partnership Trust 

14.00-14.15 Break

14.15 – Update on how to manage eating disorders
Dr Nasima Matine, Consultant Child and Adolescent Psychiatrist Cambridge and Peterborough NHS Foundation Trust – Clinical Lead for The Phoenix Centre

15.15 – The mental health crisis in school – Education and mental health interface
Prof Tamsin Ford, Professor of Child and Adolescent Psychiatry at the University of Cambridge

16.15 Close

Please use the button below to REGISTER