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5 Paediatrics
5.4 Child and Adolescent psychiatry in A & E
Professor David Cottrell Nov 2003
1. How the local system works
Three catchment – area based, outpatient multidisciplinary teams:
East (covers E and NE PCT) 0113 206 4068
West (covers W and NW PCT) 0113 295 4111
South (covers South PCT) 0113 295 1760
There is always a child psychiatrist available out of hours- contact via St Mary’s switchboard on 0113 305 5000.
1. When to refer
If in doubt about the mental state of any child you can always call for telephone advice- see above.
a) If you think a child might be psychotic.
• Hallucinations
• Delusions
• Thought disorder
b) If you think a child is seriously suicidal and not consenting to admission.
c) If a child is very acutely anxious/distressed and cannot be settled.
d) Deliberate Self Harm.
All children under the age of 16 who deliberately self harm/ overdose should be admitted, preferably to a paediatric ward, and assessed the following day. If the ward then calls 0113 295 1760, before 10am the following day the child will be assessed.
Guidelines for the management of repeated attendance by looked after adolescent children in the A & E department are available in the Paediatric A & E.
Why the need for admission?
• Time for effects of drugs to wear off
• Time to access information from school and social services
• Time to conduct a proper assessment that involves the family and assesses the home environment.
It is not appropriate to discharge young people back to an environment which has not been properly assessed.
2. When not to refer
• Crises of accommodation
• Disclosure of abuse ( see section 2.1 and refer to paediatric SPR)
• Aggressive parent-child relationships
In the first example call social services. In the third CAMHS may be of help but not in the emergency situation.
4. Guidelines for urgent referral see