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Headline

This contractual postnatal checks idea is giving me sleepless nights

Comment

I take your point about failure to address the shortage of midwifery and HV care and, of course, GPs should not be used in a tokenistic way, substitute for inadequacies elsewhere, and as a bottomless pit of resources. But I still think that, medically speaking there is value in a dedicated appointment with the GP for maternal and child health at 6-8 weeks. I could be persuaded that the post natal appointment may not be needed if there were sufficient midwives and health visitors to do the job, who would only refer those women who had a medical problem to the GP. But I do think there is important medical input for the child 6-8 week check. Not only do we sometimes pick up conditions that have been missed or that don’t present til that point, but it's also an opportunity to advise about less serious problems but which are worrying for parents, and for which they value medical input. I am thinking of conditions like infantile eczema, feeding difficulties, reflux and bowel function problems, persistent crying/colic, concerns about weight gain, minor skin abnormalities and blemishes, all the odd little movements and snuffles that parents worry about but are usually normal. All these things come up regularly in the 6 week check (and at other times in infancy) and they are the kinds of things that health visitors refer the child to the GP for anyway. Occasionally one of those things turns out to be something serious but usually they are normal and the parents can be reassured. Does no-one remember Illingworth’s “The Normal Child”? And does the GP not have a role in helping parents distinguish between disease and normality and major and minor illnesses and give them confidence to manage their child’s everyday problems? This is from the introduction in the BMJ review of Illingsworth’s “The Normal Child”: "Variation in humanity is so great that it is sometimes challenging to tell the normal from the pathological. This distinction is critical in paediatrics, where variation in children’s growth, physical appearance, behaviour, and emotional development can be enormous without amounting to disease. Recognition of the normal child is an acquired skill; one that is fraught with the dangers of overinvestigation and of the failure to reassure parents. Ronald Illingworth’s The Normal Child, a landmark in the paediatric literature, saved countless doctors—specialist and non-specialist—from the perils of misdiagnosing normality in children."

Posted date

04 Nov 2018

Posted time

7:31am

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