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Pediatrics – Dr. Kathrin Christine Foehe

1. How Can I Tell If My Child Has Allergies or a Common Cold?

Symptoms of allergies and colds can be similar, but here’s how to tell the difference:

Symptoms: Both allergies and colds cause symptoms of sneezing, congestion, runny nose, watery eyes, fatigue, and headaches. However, colds often cause symptoms one at a time: first sneezing, then a runny nose, and then congestion. Allergies cause symptoms that occur all at once.

Duration of symptoms: Cold symptoms generally last from seven to 10 days, whereas allergy symptoms continue as long as a person is exposed to the allergy-causing agent. Allergy symptoms may subside soon after elimination of allergen exposure. Colds may cause yellowish nasal discharge, suggesting an infectious cause. Allergies generally cause clear, thin, watery mucus discharge.

SneezingSneezing is a more common allergy symptom, especially when sneezing occurs two or three times in a row.

Time of year: Colds are more common during the winter months, whereas allergies are more common in the spring through the fall, when plants are pollinating.

Presence of a fever: Colds may be accompanied by a fever, but allergies are not usually associated with a fever.

2. Is having a seizure the same as having epilepsy?

Not necessarily. In general, seizures do not indicate epilepsy if they only occur as a result of a temporary medical condition such as a high fever, low blood sugar, or immediately following a brain concussion. Among people who experience a seizure under such circumstances, without a history of seizures at other times, there is usually no need for ongoing treatment for epilepsy, only a need to treat the underlying medical condition.

3. What is a food allergy?

A food allergy is an adverse immune system reaction that occurs soon after exposure to a certain food. The immune response can be severe and life threatening. Although the immune system normally protects people from germs, in people with food allergies, the immune system mistakenly responds to food as if it were harmful.

4. When should my child see a pediatric rheumatologist?

If your child has complaints of pain in the musculoskeletal system (joints, muscles, bones, or tendons), other symptoms of arthritis, or an autoimmune disorder. Children are not just small adults. Their bodies are growing and have unique medical needs. A pediatric rheumatologist is experienced in interpreting your child’s:

  • Unexplained musculoskeletal pain
  • Unexplained physical findings, such as rash, fever, anemia,weakness,weight loss, fatigue, or loss of appetite

5. Why are Ear Tubes needed?

Tubes are placed when a child has recurrent or chronic ear infections. Up to 90% of children will get an ear infection in their first few years of life. Tubes are recommended when a child experiences:

  • Four or more ear infections within 6 months
  • Seven or more infections within a year
  • Three or more infections a year for 3 years
  • Persistent ear fluid lasting 3 months or more
  • Recurrent otitis with speech delay
  • Cleft palate or other craniofacial anomalies and have persistent fluid

6. When should I have my child's eyes checked?

Children should have their vision checked by a pediatrician, as part of regular well-child care. A doctor will refer your child to a specialist in ophthalmology if they see any sign of amblyopia, difficulty in measuring vision, if they suspect an abnormality of the alignment or structure of the eyes or if there is a family history of vision problems. Ophthalmologists can perform a complete eye exam on children of any age.

Speech and Language Therapy– Speech Therapy Team

7. What is a Speech-Language therapist?

Speech-language therapists work to prevent, assess and treat communication, language and swallowing disorders in children, adolescents, and adults. Depending on the area of difficulties, speech therapy may focus on improving several different areas such as speech production, understanding language and expressing language, reading, spelling, social skills, swallowing etc.

8. Do Speech and Language disorders affect learning?

Speech, language and communication skills are crucial to learning and academic success. Reading, writing, gesturing, listening, and speaking are all forms of language. The ability to communicate with peers and adults in the educational setting is essential for a student to succeed in school.

9. What is a Speech or Language Delay & Disorder?

Speech refers to the actual process of making sounds, using such organs and structures as the lungs, vocal cords, mouth, tongue, teeth, etc. A speech delay refers to a delay in the development or use of the mechanisms that produce speech. Language has to do with meanings, rather than sounds. Language delay refers to a delay in the development or use of the knowledge of language. The delay can be expressive, receptive, or both.

Speech and language delays are the most common developmental problem among preschool children. It affects 5 – 10% of preschool kids.

10. Is my child's speech and language normal?

Language milestones vary widely. As a rule though, a typical 2-year-old should use around 100 words. Young children understand the meaning of many words before they are able to produce these same words. Children start putting two words together such as “mommy go” or “red car” between 14 and 28 months. At 24 months, a toddler will understand up to 900 words, and will produce about 9 or 10 different sounds, such as M, P, B, T, and D. As a general rule, children should be understandable 100% of the time by age 4. However, many children have some “later developing” sounds that they have not yet mastered, such as R, or TH.

11. How can I help improve my child's speech and language skills at home?

  • Speak clearly and at a slow rate.
  • Use lots of facial expressions
  • Be at his eye level (even when it is on the floor)
  • Talk about the things the child is playing with.
  • Follow your child’s lead in play.
  • When your child says something that is not accurate, repeat what he says correctly.
  • Play sounds games if your child is interested.
  • Tell your child when you don’t understand what she has said but let him know that you will listen and try to understand.

12. At what age should I seek out help for my child?

A Speech-Language Therapist works with children from infancy to adolescence. If you are concerned about your child’s communication skills, please call us to find out if your child should be seen for a language / communication assessment.

Physiotherapy

1. Scolioisis

What is Idiopathic Scoliosis?

Among other types of scoliosis, Idiopathic Scoliosis is the most commonly found spinal deformity. Scoliosis is a 3 dimensional bending of the spine. There is a side shift to the left or right and also a rotational element. Scoliosis may be mild i.e. less than 20 degrees or may be more severe. Physicians and Physiotherapists describe the curve based on location and direction.

There are three types of idiopathic scoliosis:

  • a) Infantile Scoliosis: birth to 3 years old
  • b) Juvenile Scoliosis: from 3 – 9 years old
  • c) Adolescent Idiopathic Scoliosis: from 10 – 18 years old.

Approximately 80% of cases are the last category. Especially in younger children, congenital spinal malformations need to be ruled out as a cause for progressing spinal deformity.

Scoliosis is diagnosed in the clinic and confirmed by an x-ray.

A comprehensive Scoliosis intervention programme includes regular follow ups with an Orthopaedic Surgeon, a Physiotherapist specialised and trained in scoliosis management and an Orthotist for TLSO bracing system. Braces are typically prescribed if the curve is greater than 20 degrees. Other factors that can affect scoliosis progression are age of diagnosis, skeletal maturity of bones, other underlying conditions and a family history of scoliosis. Children diagnosed with Adolescent Idiopathic Scoliosis should be monitored closely for progression as during this age, growth is the most rapid and there is a risk of scoliosis progression.

Physiotherapy Scoliosis Specific Exercises such as Schroth Therapy, SEAS and BSPTS have been shown to help prevent the progression of scoliosis, improve scoliosis, and prevent and/or delay surgery.

2. Toe walking

What is toe walking?

Toe walking is when a child/person walks on their toes with very little or no weight on any other part of the foot. Toe walking may be normal for toddlers but should not persist in a school age child and/or in adolescence.

Persistent toe walking may result in tight heel cord and calf muscles which may need further intervention such as:

  • a) Physiotherapy to stretch and strengthen the muscles involved;
  • b) Casting to provide a constant stretch to the muscle that is tight;
  • c) Orthotics/Braces to provide a heel to gait pattern;
  • d) Botox to relax the tight muscle and increase movement of the joint/muscle;
  • e) Sensory Integration Interventions.

The intervention chosen is typically related to the cause of toe walking, which may be one of many. Some of the typical causes are:

  • a) Idiopathic toe walking/ Habitual
  • b) Cerebral Palsy
  • c) Sensory Processing Disorders
  • d) Charcot Marie Tooth and other neurological conditions
  • e) Post-surgery

Toe walking can result in delays in achieving gross motor milestones, such as standing, walking, balance and jumping skills and therefore should not be ignored.

3. Plagiocephaly and torticollis

Plagiocephaly or, flat head syndrome” is characterized by the development of a flat spot on the back or side of the head. An infant’s skull is very soft and prolonged pressure can cause head deformity. Plagiocephaly does not have a significant effect on infant’s neurological development. However, if left untreated it may progress to noticeable facial asymmetry, jaw misalignment and a misshapen head into adulthood.

The cause of Plagiocephaly is certainly multifactorial including womb position, size of baby, possible breached orientation, limited space due to multiple births, prematurity, developmental delay, back sleeping without appropriate positioning or extensive use of carriers and bouncy seats. Most parents notice the appearance of plagiocephaly features between 6-8 weeks of child’s age.

One of the most common conditions associated with Plagiocephaly is Torticollis.

Congenital muscular torticollis is the most common form of pediatric torticollis. The sternocleidomastoid (SCM) muscle becomes shortened and contracted. SCM tightness on one side predominantly causes side preference which in many cases gradually leads to development of plagiocephaly. The most common reasons why the SCM muscle may have become contracted are damage to the muscle during birth and positioning of the baby in the womb. Occasionally a small pea-sized lump is found on the sternocleidomastoid (SCM) muscle, especially in the case of birth trauma. As a result, children may have limited range of motion in the neck and head tilt to one side while the child looks to the other side.

In addition, less common cases of congenital torticollis may be also seen as a symptom of other underlying conditions such as Dwarfism, Shortened neck, Achondroplasia, Klippel-Feil syndrome and others.

For the best outcomes of your child’ treatment it is important to start physiotherapy soon. In general, the majority of children with congenital muscular torticollis and plagiocephaly improve after a few months of physical therapy when started early. Physical therapists can use different techniques in treatment of plagiocephaly and torticollis including supervised tummy time, correct manual handling, repositioning techniques together with specific stretching and strengthening techniques. In more severe cases, a multidisciplinary team approach (Pediatric physiotherapist, Orthotist and Pediatric orthopaedic surgeon) will be necessary.

4. Special considerations for the premature infant

Special considerations for the premature infants – do they require physiotherapy?

If your baby had a difficult start, spent time in a neonatal intensive care unit (NICU) as a result of prematurity they will take longer to reach their developmental milestones.

You will need to look at the milestone guidelines a little differently when assessing your baby’s’ development. The age at which your baby is expected to reach various milestones is based on the due date. So use your baby’s adjusted age when looking at the milestones. For example a baby born 2 months early and is aged 4 months old will not be doing the same as a 4 month old baby but as a 2 month old baby – this is the adjusted age. Even after adjusting for age, it’s important to remember that no two babies are the same.

It is important to seek advice from your pediatrician if you feel your baby is not reaching the correct milestones at their adjusted age. Your pediatrician may suggest for you to see a physiotherapist if they feel that your baby needs some help to catch up.

Physiotherapist will assess your child’s muscle tone, strength, movement patterns, reflexes and motor skills including a general assessment of vision, play skills, social interaction, communication and fine motor development. The physiotherapists will track the development of you babies’ gross motor skills using various outcome measures.

They may also use the General Movement Assessment.

The General Movements Assessment (GMA) is a non-invasive, observation-based and cost-effective way to identify neurological issues which may lead to Cerebral Palsy and other developmental disabilities.

All infants have typical and distinct spontaneous “general movements” from before birth right through to 20 weeks post term known as ,,writhing” and ,,fidgety” movements. Infants whose general movements are absent or abnormal are at higher risk of neurological conditions. GMA is used to identify pathologies in movement patterns and, depending on the type of abnormality, can be highly predictive of Cerebral Palsy by about 3 months of post term age.

The assessment can be completed from birth to approximately 5 months of age including necessary correction for children born before due date. GMA may give information on how your baby’s neurological system is developing especially if there were medical concerns at birth such as oxygen deprivation or prematurity. As a result, if an infant is diagnosed as at risk of cerebral palsy using GMA, the treatment intervention can start very early with potentially better outcomes.

It is important to seek attention as early as possible if you feel your premature baby isn’t moving correctly, acquiring motor skills in line with milestones, feels stiff / floppy in their muscles and lacks strength. Early intervention by a highly specialized pediatric physiotherapists is essential.

Physiotherapists use different techniques but essentially they aim to improve strength so that your baby begins to reach motor milestones. They often use a neurodevelopmental treatment approach (Bobath) through play using facilitation techniques.

Another treatment approach used in early intervention is Vojta therapy.

Vojta Therapy is a neurologically based treatment approach with aim to activate basic, pre-determined movement patterns in child’s brain. This leads to gradual improvement of coordination and movement performance in many areas including postural control, gait, grasp, breathing, speech, eye movements, the swallowing process, bladder and bowel function. Understandably, this type of treatment is the most efficient in early infancy as Central Nervous System is enormously adaptable and abnormal movement (substitutive) patterns have not been established yet. Therapy is carried out by stimulation of defined zones on the body in supine, prone or side position. Body musculature is activated on a subconscious level, thus eliciting two basic movement complexes- Rolling and Creeping. Therefore, child doesn’t practice single tasks such as reaching or sitting, but tends to activate the whole body as well- cooperating unit in order to achieve automatic regulation of posture, support function of the extremities and required movement precision.

The Vojta therapy is characteristic for its close cooperation between the therapist and parent/s as commitment to structured home exercise program is vital for treatment success. The therapist supports parents and regularly adjusts the treatment program based on child’s overall progress.

5. When should my child walk independently?

All children are different. As an early intervention physiotherapist I usually tell parents that children may walk independently anytime between 10 and 16 months.

Walking is one of the most anticipated developmental milestones where desire, motivation and a child’s temperament have at least the same impact as brain and physical development.

However I would like to check children when they are 9-10 months old and not yet able to do one of these- Roll, Sit Up or Move around using Crawling on tummy or knees.

6. What does an Occupational Therapist Do?

Paediatric Occupational Therapy encompasses working with children aged from 0 – 18, covering a wide range of conditions and problems to promote their function. Some of the conditions we work with include Autism Spectrum , Attention Deficit Hyper Activity Disorder, Dyspraxia and Cerebral Palsy, working to improve function in activities such as writing, dressing, fine motor and gross motor activities and self-care based activities.

Our aims are to enable your child to live as happy and independently as possible. We meet goals that YOU set through meaningful activities that children enjoy doing.

As children grow and develop they may encounter some development problems, both as a result of a diagnosed condition and environmental factors or biological influences. Children may be not meeting their developmental milestones at the right time, compared to other classmates, or be struggling in school with handwriting or in P.E, which can worry a parent. One of our highly trained and experienced therapists will help alleviate some of these concerns through assessment and a personalised treatment plan.

  • Fine motor skills: Coordinating the small muscles such as the hand (usually in co-ordination with the eyes), to enable your child to hold, explore and manipulate toys and tools such as a pencil or spoon. Fine motor skills are used in activities such as handwriting, dressing, feeding and using scissors.
  • Gross motor skills: Involve the large muscles of the body that are important for major body movement such as sitting, walking, jumping, and throwing a ball.
  • Tool Use: Involves utilising objects within the hand such as cutlery or pencils for play, self-care and handwriting skills.
  • Handwriting: A child must have sufficient manual dexterity, fine motor coordination and visual motor skills for handwriting. Areas such as letter formation, reversals, speed, legibility, pencil grip, reducing pain and/or fatigue may be addressed.
  • Table top and School Readiness: These activities are generally the expected requirements when starting kindergarten. For example: drawing, cutting, on-task classroom behaviour, task completion, following instructions and craft skills.
  • Self-care skills: Involve skills such as using a knife and fork, tying shoelaces, fastening buttons and dressing and toileting.
  • Play skills: Are those that are used in everyday play, such as threading and using puzzles as well as the imaginative, social and communication requirements.
  • Visual perception: Involves understanding what is being seen. Visual perception is highly important in completing many activities, such as reading a story, completing a puzzle, identifying letters and numbers, copying and writing.
  • Sensory processing: Involves the way the body processes and reacts to the information it receives from the surrounding environment. Children may demonstrate over or under sensitivity to certain sensations such as loud noises or certain items of clothing; sensation seeking behaviour, such as chewing on things or enjoying being spun repetitively; and difficulty maintaining a calm state.

Hand therapy

It is a service provided by either an Occupational Therapist or a Physiotherapist with a higher degree of training in the rehabilitation of hand and upper limb. It is a specialized service that often requires advanced certification or accreditation. Hand Therapy involves the use of physical modalities, therapeutic exercises and splinting in order to facilitate the reintegration of clients into their various roles.

  • Hand, Wrist and Elbow fractures/dislocation
  • Post-operative hand rehabilitation
  • Trauma and Crush Injuries of the Hand
  • Upper Extremity Splint prescription for correction/prevention of injury
  • Work Hardening & Manual Dexterity Skills Training/re-education
  • Activities of Daily Living Skills re-training
  • Hand & Upper Limb Sensory rehabilitation after nerve injury

Neurosychology – Helene De Bergeyck

1. Which children would benefit from a neuropsychological assessment?

Any child who encounters difficulties in daily and/or school activities.

The difficulties may vary from one child to another: difficulties in paying attention, problems of hyperactivity or impulsivity, reading and/or writing difficulties, speech difficulties, behavioural problems, difficulties in coordinating movement.

An assessment is also beneficial when there is a suspicion of intellectual precocity (gifted children) or a suspicion of developmental delay.

Neurodevelopmental Pediatrics – Dr Shola Faniran

1. What is a Developmental Paediatrician?

A developmental pediatrician is a medical doctor trained in pediatrics with additional, specialist training in the physical, emotional, behavioral and social development of children. They work in a multidisciplinary setting and coordinate care for children at home and school with therapists and other health care workers. This team approach can provide a more in-depth perspective for a parent, which will ultimately help your child be the best that they can.

2. When should my child see a Developmental Paediatrician?

  • If you have concerns about your child’s development in any area; social, emotional, behavioural or developmental (e.g. speech, motor skills).
  • If your child has trouble in school (behaviour issues, learning, making friends)
  • If your child has bedwetting, faecal soiling, trouble sleeping or eating
  • If your child is anxious or seems depressed
  • If your child was born preterm, has a chromosomal abnormality or a chronic medical problem
  • If anyone has raised the probability of a neurodevelopmental disorder (see question 3)

3. What are neurodevelopmental disorders?

Neurodevelopmental disorders are a group of conditions with onset in the developmental period. The disorders are characterised by developmental deficits that produce impairments of personal, social, academic or occupational functioning.

Neurodevelopmental disorders include:

  • Autism Spectrum
  • Attention-Deficit/Hyperactivity Disorder
  • Intellectual Disabilities
  • Global Developmental Delay
  • Communication Disorders/Language Disorders
  • Social (Pragmatic) Communication Disorder
  • Specific Learning Disorder
  • Motor Disorders
  • Developmental Coordination Disorder
  • Stereotypic Movement Disorder
  • Tic Disorders

4. Why does my child need an assessment?

The purpose of an assessment is not only to arrive at a diagnosis, but most importantly to identify the child’s strengths and difficulties. Being able to arrive at a particular diagnosis guides therapy along more appropriate evidence-based treatment, informs on prognosis and genetic counselling as appropriate. However, having a clear understanding of the child’s current level of functioning, forms the basis for developing the therapy programme and serves a baseline to monitor progress. It allows more focus on areas of difficulty and also using the child’s strengths to support areas where they may be deficient. A comprehensive assessment also informs of co-morbidities and associated difficulties which can be targeted with therapy, thereby reducing the burden of the child’s difficulties.

Guidelines and clinical practice parameters that guide assessments and diagnosis in neurodevelopmental disorders, strongly advocate for all children with difficulties to have a comprehensive assessment by a trained specialist.

5. What happens during an assessment?

Assessments are usually conducted over 3 sessions, with the 4th session happening 2 weeks after the assessments are completed. Each session last for one hour. The first session is for the parents alone. The 2nd and 3rd sessions are with the neurodevelopmental pediatrician conducting the necessary assessments with the child. Parents/carers of young children are welcome in the assessment with their child. The 4th session is for the parents only. This is when the findings of the assessment and recommendations will be discussed with the parents, and a management plan to support the child is agreed upon. The child is then referred to the appropriate department(s) to carry out the management plan.

Some children may need to come for extra assessment sessions, depending on the areas of difficulty being assessed.