Paediatrics Without a medical background, it can be challenging to know what is normal in children’s health and what needs attention from a paediatrician. But as a parent, you are the first to know if something is not right with your child. Trusting and acting on your instincts can be one of the most valuable things you can do for your family.

A comprehensive physical examination of your newborn baby is an important part of their healthcare. This check is usually performed within a few days of birth to identify any problems early, allowing for timely treatment.  

Your baby’s paediatrician may assess for:

• Normal vital signs, such as temperature, breathing, and heart rate
• Eye and vision problems, such as congenital cataracts
• A cleft palate or tongue tie
• Fractures that may have occurred during the birthing process, particularly around the neck and collarbones
• Hip dysplasia, a developmental condition involving instability of the hip socket
• Jaundice indicating a serious health problem
• Normal genital development
• Normal newborn reflexes, including the startle reflex and grasping

Depending on the findings of the assessment, your child’s paediatrician may refer you to another medical specialist or healthcare professional for further investigation, initiate treatment, or recommend close monitoring.

Infant concerns

Parents often have concerns about their infants’ health, growth or development in the first few months of life.

Paediatricians can help with concerns such as feeding difficulties or slow weight gain, crying or distress, gastrointestinal concerns and worries about their development. Seeing your local early childhood nurse is a great start for helpful advice.

An allergy is an inappropriate immune response from the body to a harmless substance, such as grass pollen or a certain food. In some cases, this immune reaction can be severe and life-threatening, a situation known as anaphylaxis. A paediatrician can help you to identify the triggers for your child’s allergic reactions and provide you with strategies to manage these allergies. 

Allergic conditions in children that can be managed by a paediatrician include:

Eczema – also known as atopic dermatitis, eczema is a common allergic skin condition in children, often found in infants and toddlers under 2 years old. Severe eczema can cause significant distress to both your child and yourself. Your child’s paediatrician can help you understand how to avoid exacerbating situations, and prescribe topical medications to manage flare-ups.

Asthma – this chronic respiratory condition is very common among children, and a source of great worry among parents. Exposure to an asthma trigger, such as cigarette smoke, pollen, or changes to the weather can cause your child’s airways to swell and narrow, making it difficult to breathe. Your child’s paediatrician may prescribe medications to relieve or prevent an asthma attack, and help you to put together an asthma action plan.

Hayfever – also known as allergic rhinitis, hayfever is another exceedingly common allergic condition among children. Characterised by itching and watery eyes, itching nose, congestion, and sneezing, hayfever is often associated with seasons when certain grass or tree pollen concentrations are at their highest, but can also be present all year round. If hayfever is interfering with your child’s sleep, pre-existing asthma, or concentration in school, a paediatrician can help identify the triggering allergens and discuss how to manage them.

Where necessary, your child’s general paediatrician may refer them to a paediatric allergist or immunologist for specialist treatment, such as immunotherapy.

Bedwetting is very normal for young children. As children get older, the likelihood of wetting the bed during sleep decreases – where almost one third of 4-year-olds wet the bed, by the time your child reaches 10 years old, only 5% of their peers are expected to be bedwetting. Though children are expected to develop at their own pace, it’s best to see a paediatrician if:

• Your child is at least 7 years old and still wetting the bed during sleep
• The bedwetting is causing you and/or your child distress or frustration
• Your child has trouble controlling their bladder or bowels during the day as well 
• Your child has started to wet the bed after being dry at night for the previous six months 

As treatment for bedwetting isn’t typically effective for children under the age of 7, your child’s paediatrician may recommend simply monitoring if your child is still young and there are no other reasons for intervening yet. It’s important for the family to avoid criticising or punishing your child as wetting the bed as they sleep is entirely out of their control.

If you and your child are motivated to reduce how often bedwetting occurs, your child’s paediatrician may recommend:

• Bedwetting alarms
• Avoiding caffeinated drinks before bed, including certain soft drinks or tea
• Medications to reduce urine production at night and avoid your child’s bladder becoming overly full as they sleep

Febrile convulsions can occur in up to 2-5% of healthy children between 6 months and 6 years of age, but can be scary for parents. A paediatrician may be helpful if your child has multiple or prolonged febrile convulsions. Assessment by a paediatrician is important for further assessment and investigation if there are seizures in children without fever or illness.

Paediatricians can assess and investigate when there are concerns about growth such as slow weight gain or a child being above a healthy weight. They are also helpful if there are worries about short/tall stature or early/late onset of puberty.

Having regular mild viral illnesses is a normal part of childhood. It is worth assessment by a paediatrician if your child is having very frequent infections, serious infections that require hospitalisation, or if the infections are associated with growth or developmental concerns. A specialist assessment is also important for certain types of infection, for example, recurrent urinary tract infections.

Neurodevelopmental disorders is a category encompassing several specific developmental conditions that affect your child’s cognitive functioning, social interactions, emotions, and general behaviours. These disorders can be highly complex and require a multidisciplinary team of specialists collaborating with your child’s paediatrician, including child and adolescent psychiatry, psychology, occupational therapy, and speech therapy.

Among other neurodevelopmental conditions, a paediatrician may be involved with the assessment, diagnosis, and treatment of:

• Attention deficit hyperactivity disorder (ADHD) – characterised by difficulties with maintaining attention and concentration, restlessness, and impulsivity, ADHD is one of the most common neurodevelopmental disorders among children. As ADHD can present differently in girls from boys, and in children from adults, it’s important to see an experienced paediatrician if you have concerns that your child may have ADHD. In addition to behavioural therapies, your child’s paediatrician may prescribe medications where appropriate.
• Autism spectrum disorder (ASD) – children with autism have difficulty with adhering to the social norms surrounding interaction and communication. You may suspect your child has autism if they demonstrate underdeveloped social skills for their age, are hypersensitive to sensory stimulation, or display repetitive behaviours such as rocking or flapping their hands. Despite the challenges that come with caring for a child with autism, some of these children may demonstrate brilliance in specific areas, such as maths, music, or memory. Although there is no specific treatment for autism, a paediatrician can assist in making a diagnosis, and assess and treat your child for co-existing physical or mental health problems. Your child may need formal standardised assessments via a psychologist to confirm an autism diagnosis.
• Intellectual disabilities – an intellectual disability is a developmental condition that affects both cognitive function such as learning, and daily function such as communication skills. Intellectual disabilities may be caused by many conditions such as a genetic difference or an acquired illness. Early support for your child with an intellectual disability can improve their day-to-day function and allow them to achieve the best possible quality of life. A paediatrician can assist in making a diagnosis as well as identify and manage other co-existing health concerns, such as autism, ADHD, depression, or physical health issues. Your child will need formalised assessments to confirm an intellectual disability, which may be performed by a school counsellor or psychologist.

Most parents have worried about their child’s eating at some point, whether they’re eating enough, eating too much, or eating the right things. Caring for a child with an eating disorder is often highly stressful, but treatment with a paediatrician experienced in managing eating disorders in children can help. Abnormal eating behaviours can be present even in young children, affecting their growth, development, schooling, and overall wellbeing.

In children and adolescents, eating disorders include:

• Anorexia – anorexia is the most well-known eating disorder, caused by an unhealthy preoccupation with body weight. Children and adolescents with anorexia restrict their food intake severely and may also engage in excessive physical exercise and other behaviours in order to avoid gaining weight.
• Bulimia – bulimia most commonly starts in the late teenage years, and is characterised by a cycle of binge eating (uncontrolled food intake) and purging (forced vomiting, using laxatives, restricting food intake, or excessive physical exercise). Similar to anorexia, individuals with bulimia have distorted body image and fear gaining weight. 
• Avoidant/restrictive food intake disorder (ARFID) – unlike anorexia or bulimia, ARFID is not associated with concerns about weight or body image. Instead, children and teenagers with ARFID are highly and abnormally selective about their foods based on textures, taste, or an eating-related fear, such as vomiting or choking.

In severe cases, your child or teenager with an eating disorder may need hospitalisation as an inpatient or at least to have their mealtimes supported and supervised by a healthcare professional. A paediatrician can help to:

• Coordinate your child’s care with other practitioners 
• Assess and manage physical conditions and illnesses that arise due to the eating disorder
• Diagnose and treat co-existing mental health problems, such as depression, obsessive-compulsive disorder, or anxiety

Up to 4% of Australian children are affected by a learning disorder, with difficulties in areas such as reading, writing, or maths. You may suspect your child has a learning difficulty once they start primary school, which may appear as:

• An aversion or dislike of reading, writing, or maths
• Making excuses to avoid doing schoolwork or homework
• Problems with basic numeracy skills, such as counting
• Being very slow when reading
• Messy handwriting
• Difficulty identifying rhyming words

It’s important to also remember that children develop at their own pace, and being behind the class in one or two areas doesn’t mean they have a learning disorder. 

The first step if you are concerned about your child’s academic progress is to speak to their teacher. If your child’s teacher also has concerns and if school-based interventions aren’t effective, being referred to a paediatrician can help to:

• Identify whether another health problem is impacting your child’s learning, such as hearing or vision issues
• Perform a formal assessment to identify a specific learning disorder, such as dyslexia (problems with reading), dysgraphia (problems with writing), or dyscalculia (problems with numeracy)
• Determine whether other neurodevelopmental issues are present, such as autism or ADHD, and manage these accordingly