Is it time for an alternative “facetime” intervention?
Dr Victoria Matheson (MBBS MPH FRACP FACEM) is one of the Gold Coast’s high achievers, a double medical specialist (Dual Emergency and Paediatric Emergency medicine and General Peadiatrican), Dr Matheson holds academic titles with both Bond University and The University of Queensland and is a member of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network. In 2015 she completed a Master of Public Health with a focus on childhood obesity. She is a keen runner and a mother of three children aged 1, 3 and 5.
Q. For most people becoming a medical specialist is an achievement of a lifetime, combining years of dedicated study and clinical expertise. You accomplished the rare achievement of two specialties before you were 36. How and why did you achieve it?
A. I started out doing Emergency Medicine training and I found I really loved the paediatric aspect. Then one of my rotations was a term of General Paediatrics and I just loved it. I was quite a way through my Emergency Medicine training when I decided to pursue Paediatrics as well. I sat the Paediatric exams as soon as I could and I was able to get through to the two specialties in nine years.
Q. How would you describe yourself as a child?
A. I grew up in the UK. I had a very different lifestyle compared to the outdoor lifestyle my children enjoy on the Gold Coast. I loved reading as a child and it is still a favorite pastime now.
Q. What made you decide to do medicine?
A. I had decided to do medicine from the youngest age. I’m not sure why, it was just always what I wanted to do. It actually caused some trouble when I went for interviews and they asked me why I wanted to do medicine. I didn’t have an answer lined up – I just thought it was meant to be!
Q. Have you ever regretted that decision?
A. When I got to Uni I really thrived. I met a lot of like-minded people and I was fascinated with medicine. But when I started work as a young doctor in the UK I came close to quitting. No one can prepare you for what it is like. Suddenly you have a huge responsibility dealing with people’s lives and emotions. There is no room for error and the system and the hours were exhausting.
Q. What changed your mind and made you persist?
A. A friend was traveling to Australia and I came along to do some electives. She was a surfer so we came to the Gold Coast, which I had never heard of before. At first I just couldn’t believe such a place could exist. From a medical perspective it was just what I wanted, high quality medicine and even the possibility of work life balance.
I had never experienced an outdoor lifestyle before and I couldn’t believe life could be so good. When we had time off we’d be out exploring and enjoying everything the Gold Coast had to offer. It felt very healthy and happy compared with the UK.
Q. Your husband Shane is currently studying for his second specialty (Dual Emergency and Paediatric Emergency Medicine and Intensive Care Medicine). How do you both manage such a busy household with three children aged five and under?
A. We are very supportive of each other and we both like challenges. We are both hands on parents and most of the time we are interchangeable. We can both cook (Shane is better!), manage the household and care for the children.
Some people ask how we can have a life, but we are not the type to sit still.
Shane and I are different in some ways but similar where it counts, like they way we raise our children.
We’ve become pretty flexible depending on the situation. We’ve both had time off to look after the children at different times.
Shane and I both find medicine absorbing and stimulating, and being at home with small children can be harder in many ways. Having said that the children bring us a huge amount of joy and they won’t be little forever so we try to make the most of each day. I think we work so well because we truly do understand how difficult both aspects of our life can be. Being a parent has been far and away the biggest challenge of my life.
Q. How does being a Paediatrician affect your parenting?
A. Having both parents as paediatricians makes some things much easier. We spent a lot less time sitting at GP surgeries with common paediatric issues, but the big ticket stuff around the emotional well being of your child and getting those things right is always a worry. I think my colleagues would all agree with that.
Q. How do you keep fit?
A. Scott (Dr. Blundell) and Annelise (Dr. Wan) are very fit and amazing runners. They dragged me along to compete in races through the Gold Coast Hinterland forests. I was not sporty as a child, but I did start running at Uni. It has been a huge challenge and I have come to love it. I’m not very fast but I am out there doing it, and it feels great.
Q. What book is currently beside your bed?
A. I still read constantly. I like fantasy; perhaps because work is so serious it is good to have an escape.
Every night we sit on the sofa with the children and read for half an hour before bed. It is such a joy to revisit our old favorites and explore new ones. Last night I was reading Matilda (Roald Dahl) to my five-year-old and we got to the section where Miss Honey reveals that the evil Miss Trunchbull is in fact her aunt.
Emily went really quiet, and as I tucked her into bed she finally said, “mum I can’t believe that just happened, my mind is blown!!!”
Last year the Royal Children’s Hospital in Melbourne conducted a study asking Australian parents about the impact of screen based devises on their children.
The results were striking, with parents reporting half of all toddlers and preschoolers use screen based devices without supervision and nearly all Australian teenagers and most primary school age children now have their own smart phones.
On average parents reported that kids spend over 32 hours a week on screens at home (not including homework). Teens spent over 44 hours a week on screens.
There is no doubting that screen usage is a big part of life for Australian families today but it there is increasing evidence of a detrimental impact on vision and eye health, weight gain, sleep and the mental health and well being of children.
In the survey parents reported almost half of Australian children use screens at night, leading to sleep problems. Parents also reported many children experiencing online bullying and decreased physical activity due to screen use.
Tech elites such as Bill Gates, Steve Jobs and other Silicon Valley parents recognised this red flag on technology early and seldom let their children use the very technology they created.
By now most parents are aware of the danger that technology poses. And yet is it one of the hardest challenges of modern parenting. We sat down with some Leading Steps Paediatricians and discussed how they manage these challenges with their own families.
Dr Eta Raicebe has two teenage boys, Dr Annelise Wan has four boys aged between 2-12, Dr Dylan Wilson and Catherine Stewart have four children aged between 3 -13, and Dr Victoria Matheson has three preschool aged children.
How do you manage the time your children spend on screens?
Dr Dylan Wilson:
We have some family rules – no screen time during the week, no screens in bedrooms or at the dinner table and no social media accounts.
The older two children are allowed up to an hour a day on the weekends depending on how much physical activity they have done, and whether they have done their homework. Usually on a Sunday they will have been at Nippers for two hours running on the beach and swimming in the ocean so we don’t have an issue with the older kids having an hour on a screen after that.
We encourage our kids to be busy, sporty, active and outside a lot. We live in a street where they play with the other kids for hours on the weekends, so a bit of time on a screen here and there seems reasonable, but we don't let it get out of hand and set time limits.
Dr Annelise Wan:
We also have a family media plan - no screen time during the week, no screens in the bedroom or dinner table, no surfing the net randomly and no social media accounts like Facebook or Instagram.
We set aside time over the weekend for recreational screen time for the older two boys, usually for an hour when the younger ones are asleep.
We include the older ones in the decision making process by asking them how long they want to play for and then we agree on a time. I give them a five-minute warning when time is up and that’s it.
Dr Victoria Matheson:
My children are still young so they don’t use any screen-based devices but they do watch one hour of children’s television a day, and we enjoy a family movie together on the weekend. The kids have never been allowed to play with our mobile phones. If the children are too restless while we are out doing something like eating a meal we will leave, rather than pull out a phone or device.
Dr Eta Raicebe
Our teenage boys are very much encouraged to be part of the decision making process about our rules around screen time and devices. Since they were tiny we’ve had a rule around no screen time during the school term except for homework. This year they agreed that this is a good rule to keep.
The boys look forward to using either their computer, PlayStation or watching a movie for two hours on the weekends. We like to watch a movie together, but inevitably these days they want to watch a rugby match instead.
Parents who use screen-based devices are more likely to have children with high levels of screen use. Do you have rules around your own screen use?
Dr Annelise Wan:
We are really aware of parental modelling, but I must admit we sometimes fail badly.
I am becoming more aware of how often we check phones and generally use them for things other than calling people.
Dr Dylan Wilson:
Annelise is right about modelling: breakfast is worst, I am usually reading my work emails (from Glenn), reading the news and eating breakfast at the same time. Could do better here for sure.
Dr Victoria Matheson:
I am trying to start with the no answering of phone rule at the dinner table now as a good grounding for when the kids are older. Of course this doesn’t work when either my husband or I am on call because we have to answer the phone.
What have you found hardest about encouraging healthy screen use?
Dr Eta Raicebe:
My oldest threw a few tantrums when he was around 10 years old because he wanted computer games, which I didn’t buy for him. I told him it was non-negotiable. He just had to get over it!
On the other hand I gave him other things that he could negotiate like choosing which sport he wanted to play and which music instrument he wanted to play.
Dr Annelise Wan:
Years ago I probably let my two older ones use it as a babysitter when they would wake early after I’d had a night shift. But it’s like red wine intake in some mothers, a slippery slope to too much, so now we make sure we set and keep family rules around screen usage.
Dr Dylan Wilson:
I will admit that we do have the TV on during the day in the background when there's important sport on. Or “sport”, as I call it. For example, the Australian Open was on regularly in our house recently. During the Super Rugby season, the kids often don't even get to watch their weekend movie, as I usually overrule and we watch rugby instead.
Dr Victoria Matheson:
I do feel for some parents as the need to have downtime and put your child in front of a screen can depend a lot on the personality of the child.
We are glad to have finished our sabbatical in the dark rainy UK with a tiny garden, no pool and no green space in even visible. In Australia with the properties we live in and outdoor space we are set up to succeed. Now we have returned to Australia we’re inspired to make the most the possibilities for a healthy lifestyle for the whole family.
What are your best tips for helping parents manage screen time so their children are happy and healthier?
1. Avoid screen use for young children (especially under two). This is time is extremely important for their cognitive, emotional and physical development and play, movement and interacting with humans is much more valuable.
2. Develop a family media plan and rules around screen use. Most children enjoy being part of the decision making process and this helps them establish good habits for their future lives.
3. Make rules about time and place for screen usage and watch with them and discuss what they see (joint media engagement). Ensure the games or shows are appropriate, interactive and high quality.
4. No screens in bedrooms or at the table (parents included!).
5. Talk to your children about cyber safety, cyber bullying and being good digital citizens. Keep communications channels open so are able to speak freely with you.
6. No social media accounts for preteens. When your child does use social media make sure you are familiar with the platform and that you and other family members are “friends” with your child online. A social environment where they are sharing information and photos with grandparents and aunties discourages poor choices.
7. Encourage free play and quiet time with a book. There is developmental value in children having some mental space be creative and to entertain and think for themselves.
Terri sat in the GP’s room for the second time that week, this time with her nine year old daughter Caitlin. It was a bit awkward because Terri had only recently bought her son in with boils, after a Google search showed it could be a sign of Type 1 diabetes.
So when Caitlin started drinking a lot and going to the toilet constantly Terri felt a bit embarrassed to turn up again, wondering if this time her daughter could have diabetes.
“I remember saying to the doctor, ‘I haven’t got Munchausen by Proxy (a condition where carers invent or exaggerate illness for attention). I did feel embarrassed going back with a second child I thought could have diabetes,” laughs Terri
At the time Terri was a teacher at Caitlin’s school. Caitlin would pass by Terri’s classroom if she ever went to the bathroom and she’d always stop and say a cheery hello to her mother on her way past.
“I started noticing she was going to the bathroom a lot, until it got to the point that cheerful hello was happening as she went past every 20 minutes or so.”
Caitlin had lost weight and had been lethargic over the last few weeks, and had started losing races she normally would win.
Terri had diabetes on her mind because her own mother had been diagnosed with type 2 at the same age Terri was now.
“I knew some of the symptoms from mum and it all started coming together in my mind,” says Terri.
One afternoon after school Terri rummaged through her cupboards to find her mother’s old testing kit.
When Caitlin’s finger prick test read “hi” she knew she had to go back to the GP, this time asking about her daughter and diabetes.
It didn’t take the GP long to send them straight off to hospital.
Terri says when they got the diagnosis they were relieved in some ways.
“Although we knew this was a serious condition, we were also relieved it wasn’t something more sinister. We thought, ‘ok we can deal with this’”.
A turning point came soon after diagnosis when Caitlin was due to play in a state Rep touch football tournament.
Terri called the coach to say she didn’t think Caitlin could play.
“The coach was adamant and said, “she’s playing.” It turned out she had coached other people with diabetes and knew it could be managed. That gave me a lot of confidence, and since then Caitlin has gone back to her sports and excelled.”
Caitlin self manages now very well, although her parents are always here for support.
“Now she is a teenager she has had some ups and downs, which is apparently common at this age. Dr Harte had to speak to her about it the other day and she is back on track after that.
“We have encouraged Caitlin to not let diabetes stop her life. It’s part of her life and she has to manage it.
“Caitlin is learning that when you do elite sport you need to be upfront about the condition with teammates and coaches. It’s hard for a teenager but she’s learning not to be embarrassed and have the confidence to speak up,” says Terri.
Life is busy for parents of toddler twin boys.
Ali and her husband had given up hope for a good night’s sleep and were already exhausted when 23 month old Finn started waking up even more.
Too little to communicate, Finn was waking up crying with thirst. He drank so much he was wetting through at least two nappies a night.
“I think we were already too exhausted to think straight – Finn seemed to want water at night, then we were changing his nappies and the sheets because he was wetting through his nappies,” remembers Ali.
It was at that time the family took their first trip, flying to Melbourne with the boys.
“When we had to change Finn’s nappy twice on the two hour flight, we knew that something was wrong,” remembers Ali.
After their holiday they went straight to the GP where the practice nurse performed a finger prick test.
“The result read ‘Hi’ and no-one knew what that meant. They thought there was something wrong with the machine so had to ring a hotline for advice.”
When they figured out his blood sugars were higher than the device could read, their GP sent them directly to Pindara, where Finn was officially diagnosed and started on an insulin pump.
“It’s a lot to take in. Our GP warned it that it’s like doing a 3-year degree in a month; there is so much to learn. Plus there is the grieving process that comes with a serious, life long diagnosis in a toddler,” remembers Ali.
Ali’s advice – connect with other parents, get used to speaking up and asking questions of your medical professionals, and find an older child with diabetes who is doing well and is a great role model.
Finn is five now and starting to ask questions that are difficult to answer.
“It can be heartbreaking when he says, ‘mummy I don’t like diabetes, I don’t want to have it anymore’. How do you deal with that? It’s heart breaking, so I ended up going to a psychologist to learn how to talk about it with him and how to frame it. This disease is never easy, but that has definitely helped.”
It was a humid January day when Rebecca realized something wasn’t right with her ten-year-old daughter Amelia.
Since Christmas she seemed increasingly lethargic and was drinking a lot of water during the long hot days.
She had lost weight too, but Rebecca put it down to a growth spurt.
Amelia had been looking forward to a trip to the local theatre to see a friend perform. One of the other mums there was Rebecca’s friend and Leading Steps Paediatrician Dr Catherine Wilson.
Catherine and Rebecca watched as Amelia drained her drink bottle before the performance then finished all her friends’ drink bottles between visits to the toilet.
“At the end the friend invited Amelia onto the stage and under the harsh stage lights I was horrified to see she looked like a skeleton,” remembers Rebecca.
Catherine walked them straight over to Leading Steps Paediatric Clinic where a finger prick test showed worrying levels of sugar in Amelia’s blood.
By that afternoon they had their bags packed and were admitted to Pindara Children’s ward.
“At the time I was very focused on getting to hospital before things got any worse. We all had to come to terms with the fact that Amelia now had a lifelong serious disease.”
These days Amelia is the happy owner of a pump and at 12 years old is becoming an expert in managing her diabetes (with gentle but steady oversight from mum and dad).
Her memories from that summer were of an unquenchable thirst and constant trips to the bathroom.
If Rebecca thinks back on it the classic signs of Type 1 Diabetes started a few weeks before diagnosis.
“Amelia was drinking a lot, and getting up at night to go to the toilet. She has lost weight and was increasingly lethargic – warning signs I would now recognize.”
The day Amelia was diagnosed she was already quite ill, but it happened slowly so her parents didn’t notice straight away.
“Amelia was due at a friends house for a sleep over that night. I often wonder what would have happened if she had gone. Without the proper treatment diabetes can be life threatening. We’re thankful we didn’t wait a minute longer before getting to hospital.”
Amelia and Rebecca say they try not to let diabetes control their life.
“You can still do everything, it just takes a bit more planning,” says Rebecca.
"It’s an ongoing process. We try not to stress when things aren’t perfect. Our motto is ‘the numbers are there just to tell you what to do.”
Looking back now Rebecca is grateful for the simple finger prick test that meant Amelia went to hospital rather then becoming dangerously unwell.
“If parents notice any of the signs of type 1 in their child a simple finger prick test is what they need to insist on when they visit their doctor, it will either rule it out or get them into hospital sooner therefore avoiding severe and life threatening illness,” says Rebecca.
This year's theme of National Diabetes Week is "It's About Time" - to raise awareness about the importance of early detection and early treatment for all types of diabetes.
It’s common for many children diagnosed with type 1 diabetes to end up seriously ill in the Emergency Department before they are diagnosed.
Max has a different story. His mother Melissa knew the signs and Max was diagnosed and on treatment before he developed any dangerous complications such as Ketoacidosis.*
Max is now 15 years old and an excellent student and athlete, but six years ago life seemed very different.
Max’s mother Melissa had just picked him up from a sleep over when the other mother remarked on how thirsty Max had been during the stay.
“It raised a red flag for me because my brother had recently been diagnosed at 39 with type 1 diabetes, and my best friend’s daughter had been diagnosed the year before,” says Melissa.
Still, Max seemed fine and he headed off for touch football with his dad. Melissa mentioned the comment to her husband and asked him to keep an eye on how much he was drinking.
Before the match had even started Max had chugged 2 litres of water.
Melissa had gestational diabetes when she was pregnant and still had the glucometer in a cupboard.
“When they got back from touch I did a finger prick test and the reading went straight to ‘HI’.
When I saw it all I could think was crap - he’s got diabetes!” remembers Melissa.
Melissa rang her friend whose daughter had recently been diagnosed and told her about his thirst and high blood sugar readings. They were patients of Dr Harte’s and had recently changed to a pump for diabetes management.”
“She said ‘go to hospital….. and make sure you get a pump.’”
Melissa took Max to Pindara Emergency and informed the somewhat bemused doctor that her son had just developed type 1 diabetes and she didn’t want to leave without a pump.
Max was officially diagnosed at 11am and had a pump by 1pm that day.
“At the time life felt frantic with four boys, especially because our one year old was born with congenital glaucoma and needed surgery and frequent visits to specialists in Brisbane. I just knew we had to make sure we had the best treatment and the best system that would work for Max,” says Melissa.
Melissa says the diagnosis of diabetes takes some getting used to. At first the information overload can be overwhelming, and life can seem complicated. But as time passes, it does get easier.
Melissa felt for nine-year-old Max as he came to terms with the changes.
“It felt like his childhood innocence was over. He had to grow up overnight and understand what was a pretty serious health condition. No more of his beloved sleep overs with friends, at least for a while,” says Melissa.
Since then Melissa and Max have learnt that diabetes “has to fit in with Max’s life, rather than being his life”.
“Lucky for us Max at 15 is very responsible with his diabetes. He knows he has to keep his blood glucose level below seven for optimal performance so he can achieve at school and sport. His HBA1C is in the 6’s and hopefully this will lead to a life without diabetic complications down the track.”
“He is a competitive athlete so he manages his pump for training and to prepare for races and games.
“He is very disciplined and responsible – not because we made him that way, but lucky for us, that is just the way he is,” says Melissa.
* Diabetic Ketoacidosis is a serious condition associated very high blood glucose levels in type 1 diabetes. It develops gradually over hours or days and leads to accumulation of dangerous chemical substances in the blood and urine called ketones.
This is a serious medical emergency and can be life threatening if not treated properly. If these symptoms are present, contact your doctor or go to hospital immediately.
By Dr Annelise Wan
MBBS BAppSc MPHTM FRACP
In paediatrics we often see families with multigenerational obesity and unhealthy attitudes towards eating. The conventional approach of dietary and exercise plans often yield no long-term rewards, which is disappointing and frustrating for the families involved.
In my practice I tend to come at things from a different angle and work less on food groups and calories and far more on the social behaviors that drive children to eat.
First the family has to recognise that there is a problem and decide to do something about it
It's very common to hear parents use language such as- well built, big boned, chunky, just like me, puppy fat, built for comfort not for speed. These terms can down play the problem and the impact on the child’s health now and in the future.
Once a child’s BMI gets to the 85th percentile or higher, we consider the child to be overweight.
While factors such as portion sizes, more exercise and veggies, less unhealthy fat, sugar and salt are important, my focus is to begin with lifestyle modifications that are much easier for parents to undertake, rather than instructions on healthy foods and exercise that they’ve probably heard many times before.
Instead of language describing a child “going on a diet” or “losing weight” its best to talk about being “too heavy for their current height”.
Below are some helpful lifestyle modifications that can be the first step to a healthier family.
1. Eat only at meal times and define what is a “meal time”.
Many families have lost the concept of mealtimes. It’s not uncommon to see families eating meals in food courts at 3 pm or 10 am. It can be challenging for some families who are busy or under pressure to stick to a good household routine with clear mealtimes, but this is necessary to prevent constant grazing throughout the day.
The concept of control and a period of fasting is often new in these days of instant gratification, and food is no different. Families may need reassurance that some feeling of hunger between meals is normal.
The first step is for the family to declare three proper meals a day, with nothing in between until the next declared meal. The only foods recommended between meals if ‘starving’ are carrots and celery.
When the family has established a routine and restricted eating to meals times topics like portion control and healthy food choices can then be broached.
2. All eating should be done while still.
Eating should take place at a table rather than walking or moving around. Screens should not be in view (including ipod, iPad, TV, games etc). Meals should be social, enjoyed with other people and conversation.
3. Only water to drink
Juice, sweetened milk, sports drinks and soft drinks are not a necessary part of a child’s life.
1. Once the family has made these simple lifestyle changes we can spend time exploring What, Why, When, How and Who of eating.
Why do you eat? Parents often begin to see reasons for eating (or allowing children to eat) other than hunger, such as loneliness, habit, or to pacify or please children.
When do you eat? Is the family still eating late at night? Or at times other than meal times?
How do you eat? Is eating rushed, consuming calories with little enjoyment or even awareness?• Who do you eat with? Avoid children eating alone and try to have someone there to chat while eating. This topic brings up many interesting discussions.
2. Kitchen Control
- Parents need to take control of their cupboards as well as meals.
- Little children should not have free access to kitchen contents.
- Parents need to be empowered to say ‘no’ to their children when they complain, especially straight after they have just eaten.
- The kitchen should be a “rubbish free zone” and parents need to be motivated to only bring healthy food into the house.
3. Organized sport and disorganized play
- As well as the food/meals/behaviour it’s important to recognise the need for organized sport and/or disorganized play.
- Not all children can or want to participate in organized sport, but given the opportunity for active (disorganized) play, especially in an environment with potential, most children will naturally enjoy the sort of activity they need to be fit. On the Gold Coast there are many parks and beached to explore for active play opportunities.
- Active play is essential for all children, regardless of their weight. Swapping one hour of screen time for one hour of active play or sport can be enormously beneficial.
4. Sleep and screens
Sleep and screen usage are huge areas for discussion. Healthy routines around quality and quantity of sleep and screen use are important for healthy weight and mental well-being.
Clearly weight prevention is much better than the cure. There is no one proven management strategy that will work once the child has become obese and often the only way to effect long lasting change is bariatric surgery.
A recent study in JAMA Pediatrics offered some evidenced based food for thought. The study compared conventional medical exercise and dietary treatment with bariatric surgery for adolescents who were severely obese with type 2 diabetes. The findings showed 70% of those who underwent surgery achieved a normal A1c at two years and had lost 30% of their initial weight, compared with only 3% body weight decrease in the medical treatment group.
Lifestyle and behavioural modifications are important to prevent a child becoming severely obese and it’s crucial for the whole family to be involved to ensure the most successful and happy passage through childhood into healthy adult life.
The take home message is that doctors and families should focus on identifying and acting early to avoid unhealthy weight gain and obesity in the first place, because conventional lifestyle and medical solutions, once the young person is obese, are very difficult with often disappointing results.
Newborn babies are a joyous and challenging responsibility. It’s reassuring to know that you have the guidance and support of your Paediatrician every step of the way.
Our priority is to ensure your baby has the best start to reach their full potential.
Although most babies are born healthy, a few babies have unexpected disorders and, occasionally, life threatening emergencies.
Leading Steps Paediatricians are on call 24/7 to provide the highest-level care if difficulties arise.
Your Paediatrician will carefully examine your baby and review their antenatal history, and then monitor their feeding and progress through their hospital stay. They will follow up any abnormal screening tests and provide advice and assistance.
At private hospitals babies are under the care of a private Consultant Paediatrician, so parents know their baby is receiving the highest quality care.
The Paediatrician will attend regularly to check the baby’s progress. Many parents take this opportunity to ask some of the many questions that come up once the baby is born.
Once home, new parents are encouraged to ring their Paediatrician directly if they have any concerns about their baby, especially during the first six weeks.
In Australia the Royal College of Physicians recommends well babies have a full check at birth, before discharge and then at six weeks.
The six-week check is an important time for the Paediatrician to look at growth and development as well as fully examining the baby. Cardiac problems often don’t become apparent until the baby is a few weeks of age. Much of the consult is devoted to helping with routines and settling.
Fees: Babies admitted to the Special Care Nursery are fully covered under their parent’s private health insurance. Leading Steps Paediatricians do not charge a gap for this care.
Babies who are not admitted to Special Care Nursery (those on the postnatal ward) are generally not covered by private health insurance funds but costs of consultations are partially covered by Medicare.
If families reach the Medicare Safety Net in a given year (often the case for patients who have paid a private obstetrician) the Medicare rebate covers 80% of private paediatric care.
For all enquiries including estimated fees please call the Leading Steps Paediatric Clinic on 07 5564 9668
After two decades as the Deputy Director of General Paediatrics at the Royal Children’s Melbourne, there isn't much in paediatrics that Associate Professor Lionel Lubitz hasn’t seen.
One thing that has concerned him over the years has been the issue of transition from paediatric care to adult care, particularly for vulnerable young people with Intellectual Disability and/or Autism and mental health issues.
Families with a child with long term health or development problems often develop a strong relationship with their paediatrician.
It can be daunting when the child is grows up and moves to care in the adult system.
Dr Lubitz spends his time between Leading Steps Paediatric Clinic and The Royal Children’s Hospital in Melbourne where he is supervising a major transition study for adolescents with autism, intellectual disabilities and mental health problems.
Dr Lubitz says this transition has been on the agenda for a while, and concerns were highlighted recently in a survey at Royal Children’s Hospital involving paediatricians and patients with ASD/ID who had transferred to adult care previously.
“It was overwhelmingly clear that most practitioners, patients and carers felt transition was inadequate at best and terrifying at worst,” says Dr Lubitz.
“It confirms what most doctors know about the risk of young people falling through the cracks without appropriate support once they graduate from paediatric care.
“We’ve embarked on this project to create a better, smoother transition from the cocoon of paediatric care to the adult system,” says Dr Lubitz.
According to Dr Lubitz a lot comes down to the natural difference in the way paediatricians and adult physicians manage their patients.
“Paediatricians tend to be family focused, developmentally attuned, involve parents in decision-making and utilize multidisciplinary teams. Adult care tends to be more patient focused, with expectations of independent consumer skills and fewer interdisciplinary resources,” says Dr Lubitz.
To improve the transition the team developed a program of shared care between the patient’s paediatrician and general practitioner starting from the age of 15 in a process of gradual transition to adult care.
“The GP will have direct access to the project paediatrician to enable support with practical issues that may arise in the consulting room,” says Dr Lubitz.
Other resources are being developed such as better paper and electronic communication and a GP tool kit to assist the GP in understanding the needs of patients with ASD/ID including coexisting medical and mental health conditions.
Dr Lubitz says the toolkit includes the use of and potential problems with medication, particularly in the management of challenging issues such as anxiety disorders and ADHD, as well as suggestions on behavioral management difficulties and other comorbidities that are commonly found in this group of patients.
“The plan is that by the time the patient reaches 18 it will be a seamless move from the paediatrician to adult based care,” says Dr Lubitz.
We hope that information gained from the transition study will improve the experience of all our patients who inevitably must transition to adult care.