Families consult general practitioners (GPs) and community nurses more commonly than any other health professional for problems arising in infancy.1 The most common presentations in the first three months of life include immunisation, six-week check, upper respiratory tract infections, oesophageal reflux, bronchiolitis, dermatitis, infectious conjunctivitis, irritability and fever.2
To provide quality care to children and young people, it is imperative that GPs understand the stages of childhood and can recognise, diagnose and manage both the common presentations of childhood, as well as recognise an acutely unwell child. Identification of a seriously ill child is an essential skill for GPs to develop, as children have a greater capacity for physiological compensation when unwell. GPs must be able to provide age-appropriate care and be aware of the special clinical, ethical and medico-legal considerations that apply to children and young people.
Effective communication skills to engage with children, young people and their families is an essential skill for GPs. Establishing rapport and building a trusted relationship with a GP during childhood years is important so that it may continue across the lifespan.3 This continuity of care places GPs in the ideal position to address the main drivers of healthcare for young people, advising on preventive health strategies, including vaccination, development of protective factors and addressing the social determinants of health to remove barriers to young people accessing medical care in any setting.4 GPs need to be proactive about discussing topics, such as contraception, sexual health, gender identity and body image concerns with young people.5 Explaining confidentiality to young people is imperative, as is understanding determination of capacity for informed consent in mature minors.6
GPs play an essential role in screening and supporting families to promote long-term physical and mental health and wellbeing in children and young people. With recent evidence indicating a rising prevalence of metabolic risk factors, such as obesity and inadequate exercise,5 and the rise of childhood neuropsychiatric conditions,7 early recognition and management of developmental or psychological issues – and appropriate referral to support and therapeutic services –generally leads to improved outcomes for children and their families.7 Neurodivergent individuals can benefit from extra support and recognition; however, it is important to recognise that neurodiversity does not require a cure.8 For children with chronic, ongoing or rare conditions that require long-term care, GPs play a critical role in care coordination over a patient's lifespan, including transition from child to adult services.
Being alert to both subtle and more obvious signs of neglect or abuse, and following mandatory reporting procedures if abuse is suspected, is essential for all GPs. In 2017–18, approximately 26,400 children aged 0–12 years had one or more child protection notifications substantiated, with emotional abuse being the most common form of abuse reported at 59%.9 Aboriginal and Torres Strait Islander children were seven times more likely to be receiving child protection services than non-Indigenous children. The cause for this disparity is complex and likely due to issues such as healthcare access, intergenerational trauma, disempowerment and loss of culture.10 Without early identification and intervention, health inequities lead to poor outcomes in long-term health and wellbeing. Low socioeconomic status and lack of access to services can result in cumulative health vulnerabilities in young people, such as higher teenage pregnancy and smoking rates.11,12
The use of a trauma-informed approach is essential when working with vulnerable children and young people who may be impacted by adverse childhood experiences.13 This may include children in out-of-home care; children from families impacted by addiction, abuse or violence; Aboriginal and Torres Strait Islander children; and refugee and asylum seeker children.