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  4. Age and stage development - 0 to 18 years
  5. 6 - 8 years
Announcements and latest updates

Welcome to the Right Decision Service (RDS) newsletter for August 2024.

  1. Contingency planning for RDS outages

Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.

We would like to invite you to a webinar on 26th September 3-4 pm on national and local contingency planning for future RDS outages.  Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.

I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.

 

2.National  IV fluid prescribing  calculator

This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids  . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery.  It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.

Please do spread the word about this new calculator and get in touch with any questions.

 

  1. New toolkits

The following toolkits are now live;

  1. Updated guidance on current and future Medical Device Regulations

We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.

 

  1. Guide to six stages of RDS toolkit development

We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit.  We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process.  The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.

 

  1. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:
  • Thursday 5 September 1-2 pm
  • Wednesday 24 September 4-5 pm
  • Friday 27 September 12-1 pm

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

7 Evaluation projects

Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.

We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.

If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

 

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

0 - 5   9 - 11   12 - 14   15 - 18   A - Z

Typical development 6 - 8 years old

Each child will be different and may not present as their chronological age because of past experiences or additional needs. (8) Therefore, you may need to use language and resources from other age/stage sections of this toolkit.

  • Children have more contact with large groups of people at school. They increasingly learn how they “should” behave (social rules).They learn that adults disapprove if they expose themselves in public and touch themselves or someone else. This makes them less likely to walk around in the nude in public and touch their genitals. 
  • Exploring their own and other people’s bodies is expressed more in the context of playing at first openly but later often in secret, because they learn that being naked in public is not allowed.  
  • Children are discovering their boundaries. They notice that saying certain words provokes a reaction in people around them. This is exciting and fun, so they repeat those same words.
  • At this age children are very interested in reproduction and ask many questions, such as “where do children come from?” Most children start experiencing shyness in regard to their bodies and start do draw boundaries. 
  • Children start to recognise their own gender; for most this means that they know that they are boys or girls. 
  • They pick up messages from the world around them about “what a boy does” and “what a girl does” (gender stereotypes). 
  • Children make friends with other children: of both sexes or sometimes just with other boys or girls (members of their own sex). Children of this age often associate friendship and liking someone with “being in love”. For instance, they often say that they are in love with their mother, teacher or rabbit. This usually has nothing to do with feelings of sexuality and desire. It is simply their way of saying that they are fond of someone. 
  • From 8 years old some girls will be starting to experience emotional changes due to hormonal changes associated with puberty. For most children, emotional ups and downs caused by hormone changes are experienced up to 2 years before physical changes start. 

Gender stereotyping

Gender stereotyping can limit children’s expectations for themselves and they need the adults in their lives to challenge this. It is important that caregivers help them learn that girls and boys are not limited by their gender. This can be done as part of day to day care by encouraging children to play with a range of toys, dressing up outfits etc and sharing stories about people that challenge gender stereotypes.

This video shows the impact of gender stereotypes on children’s ideas - Redraw the Balance (duration 2 minutes 07):

 

This story book - William's Doll by Charlotte Zolotow - is about a boy who wants a doll (duration 5 minutes 59):

 

What children should be learning at school and how to back it up at home

All children in Scotland should be getting Relationships Sexual Health and Parenthood (RSHP) lessons at school as part of the Health and Wellbeing curriculum. Individual schools can choose what resources to use but most will now use Go to website: rshp.scot, as it is the most up to date resource. All the content on this website is available for anyone to view and use. 

Children aged 6-8 years old are usually in P2, P3 or P4, which is called First level.

This link takes you to an overview of what children are learning at school and what you can do in the home setting to back this up. Go to website: First Level – RSHP.

Support and learning required from carers and staff

All children need help from adults to distinguish between appropriate and inappropriate behaviour. Past trauma may mean that a child or young person displays inappropriate and sometimes sexualised behaviour. Be clear with everyone in the house or care setting about what is acceptable and about the need for personal privacy. (8)

  • Children need to be taught the accurate names for the private parts of their body – penis or vulva and bottom. They may use a range of other words e.g. flower, wee man etc. It’s ok if they use these, as long as they are also taught the correct words. 
  • Children will need to be reminded that they don’t touch the private parts of their body in public. (e.g. in school, when they are tired!) They should not look at or touch someone else’s private parts and no-one should touch theirs. 
  • Even though children are using the bathroom by themselves at home and at school, they will still need some guidance/reinforcement about privacy and hygiene – shutting the door of the bathroom or cubicle, flushing the toilet, making sure pants, tights, trousers are pulled up before leaving the cubicle etc. If boys haven’t used urinals before starting school, they will need help to learn or be encouraged to use a cubicle. 
  • Staff and carers should demonstrate that they respect children's right to ownership/ autonomy of their body. As with teaching social rules, this can done as part of everyday situations, for example, saying goodbye, asking ‘would you like a hug?’ instead of automatically hugging them.  
  • Children need adults to help them learn how to assert and articulate their right ​to bodily autonomy. For example, if another child picks them up or hugs them without asking, the adult can intervene: ‘I’m not sure that x wanted to be picked up/a hug. You need to ask them first’. This short video explains it well - Consent for kids (duration 2 minutes 43):

 

Puberty

Girls who are taller or heavier than their peers are more likely to start puberty earlier than their peers. This can be as early as 8 years old with emotional ups and downs caused by hormone changes. For most children the emotional changes start to happen 1-2 years before any physical changes.

If you look after a girl who is experiencing this, she will need help to understand what is happening alongside reassurance that it is normal. Here is a short video to help discussion (duration 1 minute 46):

 

Behaviours that are not developmentally typical and how to respond

This tool has been developed by Stop it Now for parents, but is suitable for carers and staff to use. It describes behaviours that are developmentally expected and behaviours that are not healthy or safe.

Carers who are concerned about a child’s behaviour should share their concerns with the team around the child as a first action.

Staff should refer to their locality guidance and protocols.

Parents Protect: Helping you understand the sexual development of children aged 5-11