Early Years Toolkit​

Case Study Example: Zara, 12 year old girl

Referred with 2 week history of chest pain, difficulty breathing, which had resulted in her missing the last week of school. In two visits to GP, there was no obvious physical cause and it was clearly documented there was no evidence of stress/anxiety.

Seen with her mum in Child Health Hub by Consultant Paediatrician and two GP trainees. Additional symptoms of difficulty swallowing  and pins & needles sensation. No relevant past medical history/family history.

When seen alone, she reported persistent low mood since a difficult situation at school a few weeks ago. Doing well academically and wants to be a writer. Good insight into her symptoms and possible causes. 

Management:

Zara suggested to invite her mum back in and we agreed a plan for mum to speak to the school. 

We discussed psychoeducation and the mechanisms linking anxiety and low mood to her physical symptoms. 

Agreed no further investigations at this stage, and follow up with GP rather than CAMHS referral. 

Outcome: 

Zara returned to school the following week. She was later referred to paediatrics outpatients for some ongoing symptoms. ECG and blood tests were normal, and a CAMHS referral was made at that point. But she maintained good school attendance and participation in other activities throughout.