Briefly describe your management of the following:
a) A newborn infant with convulsions.
b) A newly born pre-term infant with respiratory distress.
c) An infant born to a mother who is a poorly controlled diabetic.
a) Convulsions (10 marks)
· Stabilise (e.g. airway, temp) and resuscitate if necessary (1)
· Dextrostix- response and monitoring (2)
· Investigations – LP, blood, sonar (1)
· Drug therapy – phenobarb, epanutin, clonazepam, diazepam (2)
· Possible aetiologies and response, e.g. meningitis (2)
· Further support, management and outcome (2)
· Resuscitation and stabilisation (1)
· Assessment of severity (1)
· Oxygen therapy – need, modes of delivery, adequacy (1)
· Monitoring (dextrostix, oximetry, etc) (1/2)
· Routine care (warmth, positioning, etc) (1/2)
· Feeding, intravenous fluid, NG tube (1)
· Investigations (bloods, CXR, ABG) – need, timing, value (1)
· Antibiotics – indicated? (1)
· Assisted ventilation – indications, timing, modes (1)
· Surfactant – need, timing, value (1)
· Ongoing care and evidence of improvement (1)
· Risks- RDS, hypoglycaemia, congenital abnormalities, birth injury, etc (3)
· Precautions/ Monitoring- dextrostix, haemoglobin, bilirubin (as necessary) (1)
· Prevention of complications- e.g. early feeding, phototherapy, fluids (1)
· Management of hypoglycaemia
o At first diagnosis (1)
o Failure to improve (1)
o Drug measures (glucagon, hydrocortisone, etc) (1)
· Management of any of the other complications (2)
Discuss the following, with particular reference to South Africa:
a) Consent to medical treatment in children
b) Placement options for children in need of care
c) Child social support grants
Consent to medical treatment in children
(10 marks)
· Relevant legislation is the Child Care Act no.74 of 1983
· Person over 18 years can consent to “operation” on self.
· Under this age consent of a parent or guardian required
· Child of 14 years or older can consent to “medical treatment”
· Adolescents can obtain contraceptives without parental consent.
· Similarly, termination of pregnancy, but should be encouraged to inform parent
· Unmarried mother aged over 14 years can consent to medical treatment of child but not to an operation on the child. This has to be provided by mother’s guardian.
· If urgent operation or surgery needed and parents/guardian deceased, missing, mentally incompetent or refuses, the following persons may be approached (as appropriate)
o Minister of Welfare
o Medical superintendent
o Foster parent or official custodian
o High Court
· Sterilisation under 18 years requires consent of parents, etc. and only if severe mental disability. Decision to be approved by a panel
· HIV testing- if undertaken in best interest of child still requires parental consent
· Difficult in some South African setting getting appropriate person to consent
Placement options for children in need
of care (10 marks)
· Definition of “child in need of care” and categories of such children, e.g. orphan, abandoned, uncontrollable, adverse circumstances, neglected, abused, etc.
· If reason to believe that any child in need of care- brought before Children’s court, who will conduct inquiry
· If court finds child “in need of care”, it has several option:
o
The commissioner may place the
child back in the care of the parent/guardian/custodian, under the
supervision of a social worker, subject to certain conditions
o The commissioner may order that the child be placed in foster care, a children’s home, or a school of industries. State grants are available to these contribute to costs of providing care.
· Adoption- option for children whose parents have died or are unable to care for themselves. This is placement of choice for abandoned babies. Child cannot be adopted without consent of both parents
· The Child Care Act empowers Minister of Welfare to establish and maintain “places of safety and detention”- state facilities, shelters, children’s homes, residential facilities
· Minister may operate children’s home - however, these are normally run by NGOs
· Any non-governmental facility caring for more than six children away from their families must be registered with the Department of Welfare
· Hospitals can be “place of safety”
Child Social support grants (10 marks)
Various documents and special forms are required to be completed.
As requirements change with time, the local Social Worker should be consulted, who will assist the process.
· A grant of R130 payable to a primary caregiver for any child under the age of 7 years.
· A primary caregiver is any person who takes primary responsibility for the daily care needs of the child and need not be a relative of the child.
Qualifying requirements:
· Parent/s and child/ren must be resident in South Africa AND South Africa citizens
· The primary care-giver and the child/ren must comply with the financial criteria in the means test (income of primary care-giver and spouse) below:
· Payable to foster parent/s for a foster child who has been placed in their custody in terms of the Child Care Act, i.e. through social welfare services.
· Additional income the child may receive from other source must be considered.
·
Amount of R450 per month is
paid
Qualifying requirements:
· Children must be legally placed in the care of foster parent/s
· The applicant and the children must be resident in South Africa at the time of application BUT need not be South African citizens
· Payable to parent/s or foster parent/s for the support of a severely mentally or physically disabled child who requires full-time care and whose parents meet the means test. A seriously ill HIV positive child who meets these two criteria qualifies for this grant.
· A state-employed medical practitioner has to assess the child to determine if the child qualifies.
· At present, a monthly amount of R 620 per month is provided.
Qualifying requirements:
· Parent/s and child/ren must be resident in South Africa AND South Africa citizens
· A medical report and functional assessment must be submitted (on the appropriate forms)
· The family income must not exceed R48 000 per annum
· The child must not be cared for in a State institution