decreased. HIE has an increasing trend over the whole period. Concerning the period 1991-2010, 141 "at-risk" babies stay with handicap (4,02% in risk population, 0,68% in total population). Conclusion Within the period 1991-2010, a new trend of increasing "at-risk" babies and HIE (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) requires attention, while in the same period asphyxia and ICH had a declining trend. In our Developmental consultancy all of "at-risk" children are constantly observed and treated in their best interest.

New Diagnosesneurodevelopmental and behavioural conditions:. 10 children: Significant learning disabilities, often patchy, involving language, non-verbal skills, and memory.. 1 child with ASD. 2 children with ADHD. 2 with anxiety. 2 with sleep difficulties New Diagnosesadditional conditions and physical health:. tics,. chromosomal abnormalities. sensorineural hearing loss. obesity Education and Health Care Plans (EHCPs)-changes after assessment:. 3 children had EHCPs at time of referral; 2 were significantly modified. 2 completed, 1 in process. 10 requests supported Impact The clinic was well received by carers. Families needed time and sensitivity to tell complicated stories and to find and interpret their family and health information. Explanation and advocacy were also needed and appreciated. An understanding of the impact of abuse and neglect on child development and liaison with colleagues in many agencies and disciplines were core.

groups will feed back on their progress at the monthly meetings to encourage action and momentum. Measurement of improvement We have now completed departmental audits that are up to date and shared with the team. Our monthly meeting has a full agenda promoting and sharing best practice. Effects of changes These changes have allowed the department to move to a more cohesive and coherent view of their work around quality. We have helped to standardise care, share good practice and maintain a quality service for the future. The staff wellbeing group has started a free fruit and lunchtime walking initiative. While the patient voice group have raised the profile of recoding this in clinic letters and meetings. Lessons learnt One of the greatest challenges was getting colleagues to prioritise "quality" work above their clinical case load. In a busy department it can be hard find time to implement change. The quality day provided a different environment away from clinical duties to allow people to think about what we could do better. Message for others Identifying "quality" and the evidence required to show this is the first step. Forming a central easily accessed folder containing all the information along with an index or database to assess progress is the next. Using the CQC standards as a template for our files helped us to organise our thinking in line with national standards. Engaging colleagues and encouraging personal responsibility to support ongoing improvement is also essential. Looked After Children (LAC) is a term used to describe any children under the care of local authority. Currently, 83,000 children are Looked After in the UK and the number is steadily increasing. As part of a statutory health assessment, the British Association for Adoption &Fostering (BAAF) has published in 2008 a guidance to help with the identification, assessment, testing and referral of those children at risk of blood-borne infections (BBI). G576(P)LOOKEDIn Community Paediatrics in our University teaching Hospital, specialist LAC clinics run 3 times per week. Our department trying to ensure that best care is delivered to this vulnerable population launched a quality improvement project, aiming to assess, how well and how effectively our service identifies and tests children at risk of BBI, interrogating simultaneously its cost-effectiveness. Taking into account the difficulties in organising and getting consent for investigations in the LAC population, the cost of those investigations to NHS, but, on the other hand, the implications of potentially missing a serious infectious disease, we wanted to ensure that only those children who met the criteria had a BBI screen.We assessed our service provision through an audit, basing our standards on the 2008 BAAF guidance. This was a retrospective audit from June 2013 to June 2014. In total 212 children attended the specialist LAC clinic. A risk assessment was carried out, based on information about parental health and lifestyle and the results of antenatal screening for Hepatitis B, Syp...

assess impairment of function before prescribing melatonin. The main preparation of melatonin prescribed is tablets (94%), followed by liquid (59%) then capsules (41%). Mostly (65%) slow release medication is given. The minimum dose of melatonin prescribed is 2 mg (range 0.5 mg-3 mg), maximum dose range (4-12 mg).Practice varies in how often children are reviewed. Some (35%) review in the first 3-4 months, others 6 monthly (29%). Most (94%) clinicians offer at least yearly reviews. Routine trials off melatonin are offered by 65%. On average children stay 26 months on melatonin before withdrawal (range 6-120 months). In comments Paediatrician gave views regarding the management of disrupted sleep, the need for good sleep hygiene support, which patient groups melatonin is best suited for and management of melatonin treatment. Conclusions This survey has highlighted variability amongst Community Paediatricians in the East of England in certain areas of melatonin prescribing, possibly due to lack of uniform standards. With these results we are therefore creating a generic regional algorithm for initiating melatonin in children with disrupted sleep pattern which may form a platform for developing a melatonin prescription and sleep guideline for individual Organisations. G430(P) IS IT POSSIBLE TO HAVE HIGH STANDARDS PRACTICAL PATHWAY FOR AUTISM SPECTRUM DISORDER?A Tarhini. Community Paediatrics, Shropshire Community Health NHS Trust, Shrewsbury, UK 10.1136/archdischild-2015-308599.384Aims Public awareness of Autism Spectrum Disorder (ASD) is increasing, as well as the demand for assessment. The implementation of high standards and practical pathway for assessment and diagnosis can be a challenge for many trusts including our trust. The aim was to reconstruct the current pathway by the trust to produce a practical pathway for assessment and diagnosis of ASD that meet the high standards of NICE guidelines and following the DSM-V criteria. Methods Firstly the strengths and weaknesses of the current pathway have been identified. Secondly set up the essential elements of the future pathway defined by DSM-V criteria and NICE guidelines for ASD assessment and diagnosis. An estimated time scale was calculated based on clinic and administration time required. Results Three essential elements for the assessment have been identified: A) comprehensive meeting with paediatrician, B) multisource observational reports and C) direct assessment. It was possible to incorporate in each step some elements of the NICE guidelines and DSM-V criteria to cover all the essential elements and criteria. Finally, a set of recommendations and suggested pathway for the assessment and diagnosis of ASD was produced. The estimated time to make a definitive outcome about ASD is possible within 240 min of clinician's direct clinical and administration work.See Figures 1 and 2 Conclusion It is essential for trusts to have a high standards and practical pathway for ASD diagnosis and assessment in line with NICE guidelines and DSM-V criteria. The current p...

We evaluated the quality of looked after children’s assessments by mapping the patient journey. Looked after children work is split across two different providers in our locality with our trust completing initial health assessments (IHA) and review health assessments (RHA) completed by another trust. We wanted to identify areas for improvement in joined up working to develop a truly patient centred service, crucial in this vulnerable population.We undertook two separate audits. The first assessed quality of information gathered at initial health assessment against payment by result standards. We used data from CHIMAT (National Child and Maternal Health Intelligence Network) to understand the specific health needs of the local population and compare to our audit population. The second audit focused on whether health recommendations made at IHA were completed by RHA.For the first audit, a sample of 70 IHA was assessed. The assessments were of a high standard. Every child had had GP and dentist registration checked, immunisation status recorded and pre-existing health needs identified. Pre-existing physical and mental health needs were found in 50% and 25% respectively. One fifth of children older than 18 months were not registered with a dentist. One fifth were not up to date with immunisation. BMI was not recorded in the assessments despite high prevalence of obesity in the local population. For the audit we calculated BMI. Only 10% were classified obese compared with 20%–25% of the local population. From the limited parental health and lifestyle information available parental smoking was six times higher than the national average.In the second audit, of 41 health recommendations made at IHA, 30 were completed. Those not completed included outstanding immunisation, emotional health needs and blood tests. The IHA recommendations included general advice which diluted those needs specific to the individual child.Our recommendations included improved assessment of nutritional status and drive to improve health recommendations by making them more ‘SMART’. We identified inconsistencies in parental health and lifestyle information sharing.We shared all the findings with the other providers. Agreement was reached for more cohesive streamlined working across agencies.