Preventive paediatrics and the well-child visit — formative SAQs

SAQ 1 — Architecture of the well-child visit (10 marks)

A registrar says a nine-month appointment is “just vaccines and a weight.” The mother also worries about sitting and money for food. [1] [3] [23]

Questions

1. Define primary, secondary and tertiary prevention with one well-child example each. (3 marks) [1]
2. Distinguish developmental surveillance, screening and evaluation, and state what you would do with caregiver concern. (4 marks) [3]
3. List three concrete actions that make this visit complete beyond giving vaccines. (3 marks) [7] [9] [23]

Model answer

Prevention levels (3). Primary: stop harm before it starts (due immunisation, safety guidance). Secondary: early detection (developmental screen, vision pathway). Tertiary: limit complications of established problems (coordination for known chronic disease during health supervision). [1]

Development pathway (4). Surveillance is every-visit concern elicitation, observation and milestone review. Screening is a standardised tool at key ages or on concern. Evaluation is diagnostic assessment after fail or strong clinical worry. Caregiver concern remains actionable even if a tool is reported as pass—plan early review or referral. [3]

Complete the visit (3). Shared agenda including food insecurity response; growth trajectory and exam; developmental action; social determinant pathway; anticipatory guidance matched to parent needs; document deferred items and close loops—not vaccines alone. [7] [9] [23]

SAQ 2 — Convert, confidentiality and redesign (10 marks)

A. An infant booked for a well visit is mottled and feeding poorly. B. A 14-year-old will only discuss mood if the parent leaves. C. A low-income clinic finishes forms but drops development content when running late. [1] [8] [18]

Questions

1. What is the correct management stance for the unwell infant slot? (2 marks) [1]
2. Explain why confidential adolescent time is part of preventive care and name its safety limits in principle. (4 marks) [18]
3. Outline practice redesign strategies that protect preventive content for low-income families. (4 marks) [8] [9]

Model answer

Unwell infant (2). Convert immediately to acute assessment (ABCDE). Do not complete a preventive checklist while missing serious illness. Preventive catch-up later. [1]

Confidentiality (4). Adolescents often disclose mental health, substance use or sexual health only in private time; without it, prevention fails. Explain confidentiality and the limits when there is risk of serious harm to self or others, then interview alone. [18]

Redesign (4). Use team-based delivery, pre-visit questionnaires, standing orders where appropriate, prioritisation tools, and non-physician contributions so dense Bright Futures content is not solely dependent on physician heroics under time pressure. Measure delivery of key services, not only attendance. [8] [9]