Allergies

General information
Childhood allergy is becoming more of a problem, and our services have had to keep pace. The number of children with one or more allergic problems is increasing, but fortunately so is our understanding of these problems and their treatment.

A useful general resource is Allergy UK

We work closely with our colleagues to provide a full range of services including

  • Allergy testing
  • Asthma management
  • Anaphylaxis advice and support
  • Eczema management

Allergy testing
There are a lot of misconceptions about allergy testing. It is important that before a child is allergy tested, it is clear what is being asked and why. This needs to be discussed with a specialist before being undertaken. We are able to do skin prick testing, food challenges and blood tests for allergies.

Asthma
Most children are looked after by their general practitioners and asthma nurses. However paediatricians get involved, either as an emergency, or when children are struggling to control their day to day symptoms. Management needs to look at the child's symptoms in the context of what they want to be able to do, and getting their management personalised accordingly. This is done in line with national guidelines from the National Institute of Clinical Excellence (NICE) and the British Thoracic Society (BTS), whilst for more practical advice, go to the Asthma UK site.

Anaphylaxis
This is a rare condition caused by a severe allergy to drugs, food or other substances in the environment. It can affect breathing and can cause shock and very rarely death.

Those with severe allergies need to be diagnosed and if they have a severe form of the allergy then they will be given injectable adrenaline (Epipen) to carry with them to use if necessary. They will be trained in the use of the Epipen and will be reviewed in the clinic as required. In addition they will be prescribed antihistamines to use when needed.

We provide a full service including the diagnosis of allergies, prescribing medications, training parents, carers, nursery and school staff and provide clinic supervision and advice.

For further information visit the website of the anaphylaxis campaign, as well as the Epipen website

Cerebral palsy

This is a condition where the muscles of the body become stiff as a result of an episode causing brain damage. The list of causes is very long and the paediatrician will investigate using brain scans and blood and urine tests.

The parents will be given information about the condition, the prognosis, treatments available and genetic implications. The child will start treatment as soon as the diagnosis is made.

We offer the full range of treatments such as physiotherapy, occupational therapy, speech therapy, audiology, vision exercises, squint treatment, aids to sitting and walking, orthotic devices, special chairs, helmets, botox injections, surgery as appropriate, etc.

The doctors and therapists work very closely with specialised nurseries and schools. We support the parents to obtain financial support through various allowances.

The children may be seen in special clinics where the doctor and physiotherapist assess together.

The most useful link for further information is SCOPE

Child development and learning difficulties

Children may be delayed in their skills such as in walking, speech, understanding, hand function, coordination, handwriting, and learning.

We provide a full range of assessments because we work with a paediatric team of physiotherapists, occupational therapists, speech therapists, psychologists, audiologists and a Consultant ophthalmologist. We can carry out specialised assessments such as the Griffiths Developmental Assessment.

When appropriate we can arrange blood and urine tests, brain scans and other investigations to determine the cause of the delay and provide treatment.

Useful links include Cerebra and Contact a Family.

Children's cancer

Hearing that their child may have cancer is the news that all parents dread. 

Once the diagnosis is suspected, we discuss this with the family, and then talk to our colleagues in Southampton. The childrens oncology (cancer) ward there is called Piam Brown Ward, and the team there look after children from around the region.

A decision will be made about what needs to be done striaght-away, and then when the family will be going to Southampton for further investigaions and to start treatment.

All children receiving treatment for cancer in the UK do so on a nationally (or sometimes internationally) organised trial, to ensure that all children receive the best available treatment. This is co-ordinated by the UK Children's Cancer and Leukaemia Group.

A cornerstone of this way of organising care is the idea of "shared care". Although the centre will do most of the tests and treatment, there will be many things that are best done more locally. This may be clinic appointment or treatments in hospital, or visits at home. 

Useful Links:

Wessex Cancer (Local Cancer Charity)

Children's Cancer and Leukaemia Group

Clicsargent (Childhood cancer charity)

Constipation

Constipation is very common in childhood. It is almost invariably not caused by an underlying illness. If the child is not gaining weight or growing normally, is unwell, is very hard to control with good doses of laxatives for a sustained period, has had problems from early infancy, or has associated medical problems, they are more likely to have an illness,. Paediatric assessment may then be required.

More information can be found here 

Cystic fibrosis

Cystic Fibrosis is a rare inherited illness, causing many problems, particularly to the lungs and digestion. On average 1 to 2 children a year are born in our area with this illness. Because it is hard to diagnose initially, it is now one of the illnesses screened for on the newborn heelprick test.

The Cystic Fibrosis Trust provides a wealth of information and support for families and children.

Diabetes

Diabetes is one of the more common serious illnesses that we see in childhood. Our multi-disciplinary team look after many children with diabetes and provide a comprehensive service for them and their families.  

Basingstoke and Alton services
Dr Ed Hind, Lead Consultant for Diabetes
Chris Wilgar,  Diabetes Specialist Nurse
Andrea Malone, Diabetes Specialist Nurse 
Dr Rema Abraham, Associate Specialist.

Clinics
Clinics are run weekly in Basingstoke, and bimonthly in Alton (where the clinic is run by Dr Priesemann).  Dr Hind and Dr Turner (Adults) run the transition clinic jointly for teenagers.

Contact details for the Basingstoke Team: 01256 313693

New Referrals should be sent directly to Charlie’s Day Unit on 01256 313697

 

Winchester and Eastleigh Services
Dr Eleri Williams, department lead for diabetes
Vicky Houghton, Diabetes Specialist Nurse
Caroline Spence, Diabetes Specialist Nurse
Dr Max Priesemann works on both the Winchester and Basingstoke sites.

Clinics
Clinics are provided in Winchester, Andover (Dr Williams) and Eastleigh (Dr Priesemann) and a transition clinic for teenagers is provided (Dr Priesemann and Dr Cleland (adults)).

Contact details for the Winchester team: 01962 824283

All new referrals should be seen the same day; referrals are made directly to the on call paediatric team and will be seen in Sophie’s Place assessment unit (01962 824223)

The lead for Dietetics is Felicity Beresford, supported by Vicki Charlton.  The lead for Clinical Psychology is Suzy Gray.  These members work across both sites.

Useful links

Diabetes UK
British Society for Paediatric Endocrinology and Diabetes

 

Eczema

Eczema is simply an inflammation of the skin. This may happen as part of a specific allergic response, or a more general "over-sensitivity" of the skin. Either way it can be extremely difficult to control, and although most eczema can be very well managed in General Practice, some eczema requires the attention of a paediatrician, or a skin specialist.

Useful links include:

Enuresis (Wetting problems)

Night-time enuresis (bedwetting) is a very common condition affecting 15% of 5 year olds and 7% of 7 year olds. It tends to improve spontaneously, but we can help alleviate the problem in many cases. We have a range of treatments such as advice, bladder training, medication and enuresis alarms. Parents can ask their GP to refer to the Enuresis Clinic. We only treat children over the age of 7 years because enuresis is such a common problem in younger children. Many children with wetting problems are seen by one of the paediatricians in the clinic. An initial assessment will be done on your child, including physical examination, blood pressure and urine testing.

Depending on the assessment a variety of treatments can be used. These include drug therapies, behavioural programmes and alarms. Unfortunately demand for alarms is high and we ask that they are returned to us as soon as they are no longer required.

We advise all patients and families to access the ERIC (Education and Resources for Improving Childhood Continence) website. This website contains information and support.

Epilepsy

Epilepsy is a relatively common childhood condition. It is the tendency to have recurrent episodes known as fits or convulsions,. It can develop at any age. We provide an assessment service which looks at the child’s birth history, health and development, history of illnesses or accidents, family history of fits, schooling, growth, etc.

A full examination is carried out which includes development and speech and language. Investigations may include an EEG (Electroencephalogram). Other investigations may be required such as blood and urine tests and brain scans. Once a diagnosis has been made medication is given and advice, support and regular supervision is provided.

Follow this link to Epilepsy Action, a support and information organisation

Heart problems in childhood

Although small numbers of children will develop heart problems later in life, most childhood heart problems are there from birth. This is called "Congenital Heart Disease". Of all children with an inborn problem with their heart, the majority are more straightforward problems. Many don't cause a problem, and only need monitoring.

Children with suspected heart problems will normally be seen by one of our consultant paediatricians who will make an assessment. This may include an ultrasound of the heart (echocardiogram), as well as other tests such as an x-ray of the chest or an electrical recording of the heart rhythm from the skin (ECG).

Once this is done, it may be that further expertise is needed. The child would be referred to a children's heart specialist (Paedatric Cardiologist). They are based in the Cardiac Unit in Southampton, but also do clinics within our Trust.  

Useful links:

British Heart Foundation
Children's Heart Federation

Kidney problems in childhood

Paediatric Nephrology is small sub-specialism of paediatrics, although many children have some form of urinary tract problem. This may include wetting problems, and urinary tract infections. These are seen by all general paediatricians, although there is a specialist  wetting (enuresis) service, and some complex infection problems end up seeing a nephrologist, or even urologist (urinary tract surgeon).

In our region, the children's nephrologists and urologists are based in Southampton. In addition to the usual height and weight, a urine specimen will be required, and the child's blood pressure will be checked during an appointment. 

Nerve and neuromuscular problems

There is a very wide range of problems that fall into this group. Many are seen by general paediatricians. Some are more complex and get referred on to a paediatrician with a special interest in neurological problems. 

The more common problems that we encounter in paediatrics include;

 

Rheumatology

Rheumatologists deal with inflammatory conditions affecting the bones, joints and muscles. These conditions are fairly rare in childhood.  

Further useful information about these conditions can be obtained from the Arthritis Research Campaign web site. 

Spina bifida

This condition is now fortunately rare because of folic acid supplementation in pregnancy and improved screening, but we do still occasionally see it. The problem is incomplete formation of a section of the back bone and skin over it. This leads to local problems with the skin and bone in the affected area, and nerve problems.

There can be damage to the nerves serving the bowel, bladder and legs. These problems require a large team of specialist to work co-operatively to ensure that the best outcome is obtained.

The Association for Spina Bifida and Hydrocephalus can support parents

Tongue tie

Tongue tie (or ankyloglossia) is common condition affecting 3-4% of the population to some degree. The bridge of skin between the bottom of the tongue and the floor of the mouth is normally very thin, elastic and does not extend to the tip of the tongue or the front of the mouth. In some children this is not the case, and for many of these children, there will be no effect on feeding or speech. However for a smaller percentage of babies, it causes problems with feeding, particularly breast feeding. For this reason, we take referrals for children who seem to have tongue tie and feeding difficulties.

For further information on the procedure, the National institute for Health and Clinical Excellence has brought out guidelines and information for parents, whilst for breast feeding support, the NCT (national or local branch) offer support in addition to that which your health visitor and midwife can offer