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Developmental Paediatrics

The Developmental Paediatrics team can help with a number of conditions, and often we are part of a wider team involved in the care of children with complex physical and developmental problems.

Here you can find out more about the conditions we help with.

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a developmental disorder where children have difficulty with attention and/or hyperactivity and impulsivity. The difficulties should be evident in more than one setting (for example, school and home) and be significant enough to interfere academically/ and/or socially. In most circumstances we see school-aged children for assessment  and would normally only be able to diagnose after the age of 6.

There doesn’t have to be behaviour difficulties or learning difficulties, in fact a number of famous people have disclosed they have ADHD like Michael Phelps, the most decorated Olympian, Jamie Oliver and Rory Bremner.

ADHD is diagnosed through the history, examination and assessment of the problem both at home and school. We would request a report of the problems from school, normally using specific questionnaires. Sometimes we may need a further assessment using a QB test. None of the tests can diagnose ADHD by themselves and it is not diagnosed with blood tests or scans.

ADHD is managed in a variety of ways. At school, the children can benefit from being in smaller groups with reduced distractions and with clear, simple instructions. Children usually have a less stressful time in school, if school are aware of the diagnosis.

At home, children with ADHD need patience, structure and a lot of positive praise. They need instructions to be clear and simple with a quick reward system in place. The reward does not always need to be monetary or food/sweets. Whatever the reward, it needs to be immediate so it can be associated with the good behaviour. You would be offered a referral to a parenting course to help gain more knowledge about ADHD and to manage the behaviours. Please see the links below.

ADHD can be managed medically. The medications are only licensed above the age of 6. The most common medication used is methylphenidate. This comes in different forms that last for different amounts of time during the day. Should your child need medication to help with their symptoms a discussion will need to take place with your doctor about which medication might be the most appropriate. They are all controlled medications (class 2) therefore it is important to be assessed before starting and have regular monitoring . All medications can have side effects and if you have concerns you should contact your doctor.  Please see the links for the medications we use.

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Autistic Spectrum Disorder (ASD) – includes autism and Asperger Syndrome

Autism spectrum disorder  is a developmental disorder which causes difficulties in social communication and interaction along with  difficulties with rigidity of thoughts, behaviour and limited imagination. Children can often have a speech and language delay, difficulties understanding other people and how to react socially to other children/adults. They often have  difficulties with coping with change in the routines and/or environment.

Some children may have difficulties with sensory processing, for instance they may find being stroked painful or get very upset with certain noises. Others may seek sensations for instance licking, sniffing or touching  people or objects, or wanting to be squeezed.

We assess for ASD, by referring children into the Autism assessment pathway, for a more in depth assessment. We also assess for other conditions which may look like ASD such as some genetic conditions. ASD is not diagnosed using brain scans or blood tests, but by assessments from  professionals such as paediatricians, speech and language therapists and educational psychologists. The assessment involves gathering information from the children, parents/carers and school about areas of strength and difficulties.

There are thought to be many causes of ASD but not one in particular. No link has been discovered between immunisations and autism despite intensive research into this area( please see the links for further information).

There is no cure for ASD but the condition can be managed with extra knowledge, informing school of the diagnosis and support through parenting groups, speech and language and the ASD training team.

We aim to assess and manage sleep problems which can be a common problem in children with ASD. Long term management involves consistent sleep hygiene (habits and practices that are conducive to sleeping well). Cerebra is an online service for sleep support, Sleep Solutions via Face to Face provide support and courses as do most of the children’s centres in the area.

Some children can benefit from melatonin, which can support sleep hygiene, however 80% do not need medication if parents have attended a sleep course.

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Developmental Delay

Children develop in the same way but at different rates. Sometimes children need to be assessed for possible underlying medical conditions if they have had delay gaining certain skills by a certain age for e.g. delay in walking by 18 months of age.

Some children are slow to develop skills in one area only such as gross motor (sitting, walking, and jumping) but others are slow to develop skills in more than one are such as gross motor and speech and language. This may indicate ‘global developmental delay’.

The doctor will take a history from the parent/carer and examine the child. This will help to assess if any investigations are needed. Some children catch up in their development whilst others will need support. Some children may need investigation for medical conditions and the doctor may suggest blood tests (such as genetic testing) and sometimes brain scans. Occasionally, other tests such as hip X-rays may be needed.

Neurodisability

Some children have conditions which affect the brain that they were either born with, occurred around the time of birth or develop over time. This might include children who develop cerebral palsy and other neurological difficulties. This can sometimes be related to being born early or having had difficulties prior to or during birth or can even be related to problems that have happened in the first two years of life. Children with meningitis or encephalitis, hydrocephalus or other acquired brain injuries need help from our team.  The team is currently developing pathways of care with the maternity hospital to provide early multidisciplinary intervention for children identified as being high risk in the perinatal period.

The initial assessment often needs a team approach to decide what the concerns are and which assessments and therapy or treatments are needed. The children have a holistic assessment and management plan to meet their medical, social and developmental needs.

As children grow, their needs change; therefore children are followed up in clinic regularly.

We assess and manage these conditions alongside other professionals such as physiotherapy, occupational therapy, speech and language and other medical/surgical colleagues. We link in with education and we also link in with other services particularly neurology and orthopaedics, gastroenterology and respiratory medicine. This will help support children who have long term difficulties with spasticity and tone as well as those who have difficulties with feeding, constipation or with their chest. We also work closely with special schools and often see children within this setting with their network team.

Neurofibromatosis: The Regional Neurofibromatosis service provides comprehensive diagnostic evaluations, follow-up care and coordination of care for children with NF1. This service is closely linked to the complex National NF1 service based in Manchester.

Tuberous sclerosis (TS): The Regional Multi-Disciplinary Tuberous Sclerosis Service brings together multiple specialties to provide neurological and neurodevelopment  care for children with Tuberous Sclerosis.

Sensory Impairment: the team works closely with the Ophthalmology team and Specialist teachers of Visual Impairment to support children with vision impairment.

Links

Special Educational Needs

A number of the children we manage have medical conditions which can affect their ability to access mainstream education.

Each state school has a designated amount of money for children with special educational needs called “SEN support”. This has replaced “school action” and “school action plus.” Some children have access to extra funding through the “pupil premium” for instance if they are fostered.

Some children need extra support beyond this and school and/or family can apply for an Education Healthcare Plan (EHCP). This is a statutory document based on the local authority’s “Local Offer” therefore may change if you move area. Please see the links for your area’s local offer.

We provide the medical information to the education panel. The decision regarding granting an EHCP is not dependant on having a diagnosis but rather on the needs of the child. An example of this is the diagnosis of Autism Spectrum Disorder; children at the severe end of the spectrum may be unable to speak and need a lot of support  whereas other children may function independently in mainstream school with much less support however they have the same diagnosis.

Schools will use funding in different ways depending on the needs of the child and also if the school already has an expertise in particular conditions. One-to-one support is not always required or offered.

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