Health Tips › Paediatrics

The Children’s Advocate

Paediatrics refer to a special branch of medicine that caters to patients whose ages range from newborn to teenagers up to 16 years old.  Mount Alvernia based Paediatrician Dr Terence Tan tells us more.

Q.  What’s the most challenging aspect of your job?

Paediatrics often involves taking care of sick babies and children who are unhappy and frightened. We paediatricians often add to this when we are forced to perform procedures like injections. Nonetheless, I feel privileged that parents trust us to treat their children.

 
Q.  What do you enjoy most about your job?

I most enjoy the contact with kids and their parents. It's really fulfilling to make a difference when children are sick and frightened.

Meeting new people and seeing kids grow up are also makes every day interesting and worthwhile. It’s also intellectually quite stimulating because every child is so different, and each child is also changing as he or she grows and matures. Also, children of different age groups often have very different problems and issues which makes the scope of our work very broad.

Q.  What are the most common health issues a paediatrician encounters on a daily basis?
 
Acute infections account for the great majority of consultations and admissions. Allergic disorders like asthma, rhinitis and eczema are also very common conditions.
 

Q.  Children may not always be able to tell you what the problem is. In fact babies can’t even talk. As a doctor, how do you get round this?
 
Children and babies can tell us a lot by their behaviour. Often, it's a lot easier reading a young child's state of well-being because they don't have any hidden agendas and show how they really feel.

Young kids communicate non-verbally a lot so it's often possible to tell if a part of their body hurts or they feel tired or irritable. It does mean that we paediatricians need to infer a lot from the kids' actions and behaviour but that's what makes the practice of paediatrics so interesting.
 
Q.  Similarly, babies/young children may not be able to tell their parents what is upsetting them or causing them discomfort. What are the signs that a parent should look out for to know it is time to consult a doctor?
 
I always advise parents that we need to accept complaints from children as true until proven otherwise. The younger the child, the more important it is to have an idea of the overall 'well-being' of the child in terms of basic functions like appetite, activity, sleep and mood. The more these are affected, the more we need to be careful to rule out something serious.

I believe parents should be taught how to manage simple conditions and even self-medicate if needed so as to avoid unnecessary trips to the doctor or emergency department. This of course comes with experience and the basic guideline is for parents not to handle something with which they are not familiar or comfortable. I would advise parents to err on the side of caution and consult a doctor if there is any doubt or uncertainty.
 
Q.  Due to their tender age, children probably do not fully understand what is going on. How important is it to explain things to them? How can one help them better relate to what is going on?
 
Children, like adults, are frightened by things they don't understand. Explaining can relieve some of this fear by taking away uncertainty and anticipation. For example, declaring very early on in the consultation that there will not be an injection or vaccination may allay anxieties and make the rest of the consultation easier and less frightening for the child.

Of course, explanation can only work if the child comprehends. In very young children, speaking more softly and slowly may be useful. Reassuring the parents often calms the frightened kids somewhat too as they can sense his parents are relaxed and calm.
 
Q.  Siblings – whenever one child is ill, the attention of the parents is often diverted to the sick child and the other children sometimes feel neglected. Do you have any tips for parents in that situation?
 
We encounter this situation a lot especially when one child is admitted to the hospital and parents have to spend time away from the other kids. In such situations, the parents are also very stressed and it's helpful to get 'all hands on deck'. I often advise parents to recruit assistance from their relatives or even close friends.

When the acute situation has stabilised, I advise parents to take turns spending time in the hospital with the sick child. This allows some respite for each parent and the other well kids at home also get to see both parents.

Mount Alvernia has a Clinical Pastoral Care team which visits the patients and family in the wards and they provide an excellent service. The hospital’s paediatric ward deals with such situations daily and the nurses themselves go above and beyond the call of duty to assist, comfort and lovingly tend to the sick kids and their families.
 
Q.  When should a baby be transferred to the special care nursery or neonatal intensive-care unit (NICU)?
 
This decision is based on whether the baby requires this higher level of care at birth. Of course, it is most natural for all babies to be with their parents after delivery but sometimes, this is not possible immediately after birth. For example, when a baby is very premature or has an acute problem such as breathlessness or looks unwell. In such situations, the baby is transferred to the special care nursery or NICU for professional care till the problem is sorted out.

Q.  Most parents are a bag of nerves when their child is ill. What advice do you have for a parent in that situation?
 
It's common and very normal for parents to feel desperate and isolated when forced to cope with a serious illness in their child. I would advise parents in this situation to communicate their concerns and fears to the doctors and nurses helping them. The reason is that often it's easier for doctors and nurses to directly address the parents' main worries when communicated clearly because we may not always know what weighs on their minds.

If the doctors and nurses seem too busy to fully address their concerns in the busy-ness of the morning visit to the wards, I recommend they schedule a time and place to meet their doctors so that communication can take place at a less rushed pace. This can be, for example, at the clinic or in the wards after clinic hours when the doctor is often less pressed for time.

Speaking to the nurses about their concerns can also help as they can bring this to the attention of the doctors. In certain situations, the Clinical Pastoral Care team can also be activated for advice and counselling.
 
Dr Terence Tan is based at Kinder Clinic, #06-03/04 Blk A, Mount Alvernia Medical Centre, Tel: (+65) 6478 5925.