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by Deirdre White, Paediatrician, Flinders Medical Centre
A key role of the paediatrician is to acknowledge and respond to developmental and behavioural concerns as early as possible. This involves a partnership with parents and starts with an assessment of a child’s general health and development. Paediatricians do this by taking a comprehensive medical and relevant family history from the parent (covering areas such as pregnancy, previous illnesses, family history of developmental problems, medications, developmental milestones, general behaviour, sleep, appetite, hearing, vision, academic achievement and socialisation etc). Information is also gathered from other carers and this may include child care, kindergarten or school. Paediatricians will often have access to reports from other professionals that are useful in assessing a child’s development (speech pathology, psychology etc).
A paediatrician will also perform a full general physical and neurological examination. The examination also looks for any birthmarks or unusual features that may suggest a syndrome as a cause for the child’s difficulties as well as any related illnesses that may impact upon development. Paediatricians may use developmental screening tools as well as observation of the child and parent interview to identify specific or global delays in individual children. In some cases a paediatrician may suggest blood or urine investigations to exclude known causes of developmental difficulties in children. They may also refer to appropriate therapists where specific difficulties are identified eg language delay, fine motor difficulties and arrange a review appointment. They may also refer a child for formal vision and hearing testing if not already done and refer to other medical specialists such as a geneticist or neurologist as required.
Paediatricians who work in developmental paediatrics often have a role in coordinating the ongoing care and follow-up of children with special needs as well as prescribing medication for children when required. Very often children with special needs have more than one condition and these also need to be identified and managed. This may include conditions such as anxiety or depression and, like their peers, they may also have unrelated medical conditions, such as asthma.
Developmental special needs, such as
Behavioural special needs, such as
Emotional special needs, such as
Your paediatrician may refer your child to one of the Child Development Units at the major teaching hospitals if this is appropriate. A paediatrician will give feedback to parents regarding their child’s difficulties as to a diagnosis; and discuss recommendations, interventions and referrals to other agencies if appropriate.
Following the assessment, the paediatrician will also communicate with your GP and, if required, with your consent they may also communicate with your child’s school, child care or other involved agencies. Some are able to attend interagency case conferences generally based at the major teaching hospitals.
Most children found to have developmental difficulties will be reviewed regularly by their paediatrician. This may be until all investigations are undertaken, a diagnosis is reached and a clear pathway of recommendations has been generated. For some children this will mean reviews every 6 months or so, for others yearly. A paediatrician can offer ongoing support and advocacy for children with emotional, social or behavioural difficulties.
Paediatricians tend to be the ones who treat the more complex behavioural problems when behavioural interventions are insufficient. This may include the monitoring and medical treatment of anxiety disorder, OCD, ADHD, depression, epilepsy and sleep disorders. The paediatrician may be part of an ongoing therapy team for these children that may involve a child psychiatrist and mental health services such as CAMHS or school counselors.
For some children with special needs the family will be eligible for a Centrelink payment which is not means tested and is called the Carer Allowance. There is a medical part to the application form that a paediatrician can complete particularly if your GP is not familiar with your child’s difficulties.
If seen at a public hospital in paediatric clinic (Lyell McEwen, Women’s and Children’s Hospital or Flinders Medical Centre) there is generally no charge to parents. If seen in private rooms by a paediatrician, it is best to ring and check any out of pocket fees you may need to pay, as these vary. To see a paediatrician privately you will need a current referral from your GP.
Assessment and support is available through hospital-based inter-disciplinary support teams for children with multiple or severe developmental problems at Flinders Medical Centre, Women’s & Children’s Hospital and Lyell McEwin Hospital.
Children’s assessment /support teams include some or all of the professionals listed below. Other departments and/or community agencies may also be involved.
Contact details for the children’s assessment/support teams at the three hospitals are listed below. For more information, go to the website for each hospital or ring the co-ordinator.
Flinders Medical Centre: Children’s Assessment Team (CAT) Flinders Drive Bedford Park, SA 5042 Once a month, an outreach service is provided at Noarlunga Health Village for families living in the outer southern areas.
Women’s & Children’s Hospital: Kingsley Fairbridge Child Development Unit 72 King William Rd Adelaide, SA 5000
How to access the service: The Child Development Unit has an open-referral policy. Anyone may refer a child to this service. Referrals may be made by letter or by telephoning the Unit on (08) 8161 7287, 9am – 5pm weekdays. For more information, go to www.wch.sa.gov.au
Lyell McEwin Hospital: Gordon McKay Child Development Unit Haydown Rd Elizabeth Vale, SA 5112
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