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Case Study Examples for Under 5s
Case Study Examples for Under 5s
Under 5s Case Studies
Under 5s Case Studies
Case Study - 3-year-old with multiple episodes of respiratory infection and wheezing
Case Study - 3-year-old with multiple episodes of respiratory infection and wheezing
Assad is a 3-year-old living with both parents and his 18-month-old sister in a rented two-bedroom flat in Willesden, Brent. He has had many respiratory tract infections affecting his chest, and his coughing keeps his sister and parents awake. He has been seen at the practice ever since aged 18months after he was admitted to the local hospital overnight with severe breathing difficulties. Since then, he has had 4 separate similar episodes, all triggered by recent colds or, in one case, sleeping over at a relative's house nearby.
On each occasion, he is seen by a separate team at the hospital and is given a course of steroids, oxygen and inhaler treatment and observed by the nurses on the ward. The family have little understanding of English, and adherence to inhaler treatment is poor.
Scenario 1- Assad continues to come in and out of the hospital, his GP makes a referral to the respiratory paediatrician, and there is a 4-month waiting list, during which time he returns to the practice on two separate occasions with an exacerbation. The GP escalates the referral by letter. When he is seen at the hospital, he is referred to the Brompton specialist service for further testing, with a further 3-month delay.
Scenario 2 – Assad’s case is discussed in the monthly GP CHH MDT meeting, and it is agreed that he should be seen in a specialist 'Under Fives Respiratory Health Clinic' with the local paediatric specialist and asthma/allergy nurse in an adjoining GP surgery hub site. The family link worker for the practice approaches the family and makes a home visit to get a better idea of the environmental hazards, including assessing mould, indoor pollutants and cigarette smoking, which could be making things worse. Assad is seen in clinic locally in the hub within 4 weeks with an interpreter and a diagnosis of preschool asthma is confirmed using a point of care test and careful history taking, his inhaler therapy is rationalised and explained in detail by the nurse and his technique is checked and an appropriate asthma plan is given to the family and also attached to his medical records in the practice and in the hospital. Father is enrolled in a smoking cessation programme with the support of the local pharmacy ( nicotine replacement), and an environmental health officer is contacted by the link worker, showing photographs of the mould in Assad’s bedroom in order that steps can be taken to treat and prevent further build-up.
Case study – Jake, a four-year-old with difficult behaviour
Case study – Jake, a four-year-old with difficult behaviour
Jake lives with his mother and 2-year-old brother Lee. The family live in a two-bedroom flat in Harrow, which is the third home the family have been in since the father left after a domestic violence complaint was made by his mother. He has been asked by his nursery to be seen by the GP for further medical input as to why he has such destructive behaviour in the nursery as well as poorly developed speech and language. The GP has concerns that there may be an underlying neurodevelopmental impairment, such as autism or ADHD, which is contributing to Jake’s behaviours.
Scenario 1: The GP refers to the community paediatric team for assessment. The waiting list is 9 months. In the meantime, Jake’s mother is finding his behaviour increasingly difficult to deal with and is feeling unable to cope with day-to-day tasks. The GP subsequently refers on to Early Support services locally. An initial assessment is planned for 5 weeks.
Scenario 2: The GP brings the case to the GP CHH MDT for discussion. The community paediatrician suggests the GP checks Jake's ENT and makes an early referral to audiology, as well as explore Jake’s sleep hygiene and test him for anaemia and thyroid dysfunction, as well as a referral to speech and language therapy. The paediatrician also wants to make certain that Jake doesn’t have other underlying conditions, such as eczema or constipation, which could be making things worse. The Early Help team member also suggests a parenting group which mothers might be interested in, which is taking place at the local Children's Centre.
Jake is subsequently seen by the speech therapist and is placed on the autism pathway with further support from the local voluntary services whilst awaiting further specialist paediatric input.
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