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Our Department of Developmental Paediatrics consists of a team of doctors, nurses and specialist practitioners who see children with possible developmental difficulties to aid in their assessment and management. We also have a team of admin staff who aid in co-ordinating our assessments and communication with other professionals.
We work with many other professionals in assessing and managing developmental difficulties. The people we work with include therapists (speech, occupational and physiotherapy), educational psychology, educational professionals, child mental health service (CAMHs) and charities. This multi-team approach aims to support not only the children we see but also the families.
Changes to Melatonin Prescribing February 2018
We assess and manage conditions like:
We assess and manage children with complex neurodisability, working alongside other specialist doctors and teams, for conditions like:
Often the children we see can have a complex mix of physical and developmental problems (including learning difficulties) and we are a part of a wider team involved in their care.
We don’t manage physical or mental health conditions such as:
If you are concerned about your child’s mental health you should talk to your GP, school nurse or health visitor who may suggest a referral to CAMHS. We do not medically manage behaviour problems or isolated sleep problems, and we do not assess for dyslexia, dyscalculia or sensory processing difficulties. However, the children we see can sometimes have these problems and may need assessment for these difficulties by relevant professionals.
At an initial appointment we aim take a developmental history from the child’s parent or carer. This includes any problems during pregnancy, birth and the period soon after birth. We ask about current concerns, when these started and how they affect daily life. We also need to know about other health problems, medications, medical problems in the family and any other concerns. This often includes a social history.
We also examine the child for assessment of underlying medical problems that could be associated with their difficulties.
We may need further information from other people involved with your child, such as from school or nursery. We might request reports or send questionnaires for this extra information. We may ask to see the child in the nursery/school setting.
Sometimes we may need to organise medical tests such as blood tests or scans. These are usually to look for a cause for the difficulties your child has presented with. We assess each case as to whether further tests are needed.
More information about the Local Offer for Children, young people and families can be found at http://fsd.liverpool.gov.uk/kb5/liverpool/fsd/localoffer.page?familychannel=10
To make a request for a repeat prescription, please fill out the repeat prescription form by clicking the below button.
The Developmental Paediatrics team is based on the Alder Hey campus but not in the main hospital building.
We are located in The Catkin Building, which is one of the older hospital buildings that you can access from our Eaton Road entrance (same entrance as A&E).
This is a different entrance to the new hospital entrance.
Department of Developmental Paediatrics
(ADHD/ASD/Community Paediatrics Team)
The Catkin Building, 1st Floor
Please be aware many of the medications that we use are “controlled medications” legislated for under the misuse of drugs act 1971.
The medications we use should not be increased/stopped unless discussed with your prescribing clinician or one of the clinical team. They should not be used for other people. We do retain the right to refuse to prescribe medication if there is a reasonable concern that the medications are being used inappropriately.
We require two weeks notice to provide a repeat prescription due to the checks needed. We do not provide emergency prescriptions.
Liverpool: 0151 293 3648
Sefton/Knowsley: 0151 252 5337
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) while others are slow to develop skills in more than one area such as gross motor and speech and language. This may indicate ‘global developmental delay’.
Our doctor will take a history from the parent/carer and examine their child. This will help to assess if any investigations are needed. Some children catch up in their development while 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.
Professionals from either health or education can refer to the service for assessment; these can include your GP, health visitor, school SENCO or school nurse. Part of the assessment is collecting information from professionals involved with your child. This means part of the referral proforma requests your consent to contact them prior to seeing you in clinic.
Please use our Referral Proforma for all Developmental Paediatrics and your referral will be allocated to the correct pathway.
FAX: 0151 252 5301
ADHD is a developmental disorder where children have difficulty with attention and/or hyperactivity and impulsivity. Their 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 six.
There doesn’t have to be behavioural 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 their good behaviour. We may offer a referral to a parenting course to help parents gain more knowledge about ADHD and to manage their child's behaviours. Please see the links below.
ADHD can be managed medically. The medications are only licensed above the age of six. 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.
Autism spectrum disorders are developmental disorders 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 or have difficulties understanding other people and how to react socially to other children/adults. They often have difficulties with coping with change in their 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 child, 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.
Demand avoidance is a common response to anxiety in children with and without Autism Spectrum conditions. In contrast, Pathological demand avoidance (PDA) is not common and is characterised by a continued and pervasive extreme resistance to everyday demands through strategies of social manipulation that originate from an anxiety-driven need to be in control.
PDA is increasingly understood in the UK to be part of the autism spectrum. However, it is not widely recognised outside the UK and is not a recognised category in standard diagnostic manuals. There is limited research evidence on its diagnosis and interventions. The Developmental Paediatric team at Alder Hey Children’s Hospital do not assess for PDA in isolation.
Where there is good quality research evidence and national guidelines about assessment and treatment we strive to follow these as closely as we can. However we do recognise that some children with Autism present with characteristics of PDA in terms of their emotional and behavioural difficulties. These children require careful and thorough assessment within the neurodevelopmental services, CAMHS and child disabilities teams.
Private Diagnosis of ASD
Advisory appointments are available to parents/carers of children diagnosed with ASD or on the Alder Hey Liverpool Autism Spectrum Pathway.
Parents and carers can meet professionals from the Liverpool Pathway for information, support and advice in an informal setting.
Topics the team can advise on may include;
· Behaviour Management
· Sensory Issues
· Social communication difficulties
When: Every Tuesday between 9:30am -12:30pm
Where: Department of Developmental Paediatrics’, Catkin Building, Eaton Road. Liverpool. L12 2AP.
Appointments are available in 30 minute slots.
To book an appointment, please contact the team on: 0151 252 5252
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 a 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 child has 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.
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.
The team works closely with the Ophthalmology team and specialist teachers of visual impairment to support children with vision impairment.
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" and 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.
Local offers for:
Alder Hey Children's Charity