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Spotting the sick child (DVD)
  1. A Reece

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Edited by Ffion Davies. University Hospital of Leicester and Royal College of Paediatrics & Child Health, 2004, £8.99 single copy, or £6.46 for orders of six or more, ISBN 1 904039 11 1

This innovative joint project between the Department of Health and the Royal Colleges of Accident and Emergency Medicine and Paediatrics and Child Health is an extremely useful educational resource. The DVD was commissioned due to the concern of the Department of Health in England about door-to-needle times for meningococcal disease in children. The aim was to set up a video teaching package for A&E doctors and paediatricians about recognition of serious illness in childhood. The original remit was extended to include GPs, paramedics, emergency care practitioners, and others assessing children. I noticed that all the consultants received a copy as part of the Children’s National Service Framework package and it looked interesting. The cartoon representations on the cover artwork show a worried-looking doctor bemused by caricatures of spotty, crying, febrile, and flushed children. This simple and inviting imagery nicely reflects the subject matter.

The DVD uses an interface which will be familiar to most. Seven menus, covering the top presenting emergency symptoms in childhood, function as gateways to symptoms based tutorials. This simple menu system is useful to get to a particular section quickly. But there is no opportunity to interact with clinical material or cases, or for making management decisions.

The opening sequence contains many of the images we will see during the DVD set to a symphony of crying, coughing, and calming background banter from parents, nurses, and doctors. It might put off healthcare professionals who are not used to this sort of decorum in a paediatric A&E, but it is a cute way to introduce the content. Following this there is a head-to-head edited interview with a “TV doc” and an A&E consultant (you can skip the entire intro at the push of a button). The conversation makes interesting watching as the TV doc tries to justify why spotting a sick child is so important. The A&E consultant gives a far more grounded perspective to assessing children in the clinical setting. The TV doc suggests there is a culture of practicing defensive medicine, but the A&E consultant (much more the voice of reason) declares it is more to do with human nature that we try our best to spot the sick child and not miss something important. Surely safe medicine is defensible and that should be the focus.

There are many great video clips shown, often with explanatory narrative and some with a visual caption. Being involved in a similar project locally to capture video of acute presentations and clinical signs for teaching I can appreciate the time and effort put into obtaining useable footage as well as the goodwill of patients and their parents. Some of the clips within each section are repeated—the same breathless baby, croupy cough, or miserable infant. But that is reinforcement and a useful educational tool. The “red flags” are particularly helpful, although some are no more than a “talking head” explaining a worrying symptom or making a learning point without any video or visual aid to back up or reinforce the point. It is worth mentioning that along with excellent footage of symptoms, signs, and clinical evaluation is a lot of talk. The team of presenters use a formal and didactic delivery style, assiduously reading their script from an autocue. The tone is serious which is appropriate for the topic material, but paediatrics can be a fun and up-beat speciality. Most sick children do get better!

I liked the 3 minute toolkit showing how an examination can be completed with the child on the mother’s knee. I always think is nice to ask younger children if I can examine them but am in trouble if they defiantly say “no!”. I did not find any tips to deal with children who are difficult to examine. One highlight among the many excellent clips showing physical signs was the examination of the child with peritonitis. He winces and holds his abdomen rigid, even pushing the examining hand away. Watching such an examination is then next best thing to examining the child yourself, certainly better than a didactic session on clinical examination.

This DVD is a powerful, versatile, and informative resource which will be able to offer many healthcare professionals in all specialties and at all levels of training insight into how an ill child might look in practice. This is most useful in current times with the usual arguments over reduced time in training and the reduction in working hours. Anyone would feel more skilled after spending time with this DVD. I hope it will help to demystify the paediatric assessment and give those clinical signs which we strive to explain a real and “live” feel. This DVD, with its instructive and common-sense approach, should take pride of place in induction programmes and would be a valuable teaching resource in any A&E department, paediatric unit, or GP surgery. Overall it definitely does what it says on the box.