Don't Forget the Bubbles

Last year, at DFTB17, Katie Reeves started a conversation around the management of wheeze in infancy. This year were were very privileged to have a world leading researcher give us her take on it.

Meredith Borland is a founding member of the PREDICT collaborative and has led a number of key studies in the field of paediatric emergency medicine. In this talk she goes through the recent PREVIEW (Prednisolone Response Evaluation in Viral Induced Episodic Wheeze) study.

Foster SJ, Cooper MN, Oosterhof S, Borland ML. Oral prednisolone in preschool children with virus-associated wheeze: a prospective, randomised, double-blind, placebo-controlled trial. The Lancet Respiratory Medicine. 2018 Jan 17.

There are a number of controversies in the management of pre-school kids with wheeze, not least the challenge in making a diagnosis. A lot of parents might bring their child to the ED thinking that their offspring has asthma but bronchodilator responsive wheeze is incredibly common and not all of these children go on to be formally diagnosed as asthmatic.

So what do we do in this middle group that don’t have bronchiolitis and don’t have asthma. Listen to Meredith Borland to find out what she recommends.

One of the things we loved about our first conference in Brisbane was the diversity of the audience. We met health care providers from all over the world. We met people involved in every part of the patient journey. We met those that were yet to start their career and those that were nearing the end of theirs. One of the most memorable characters that we met was Larry Budd. Dr Lawrence Budd graduated from the University of New South Wales one year after Andy Tagg was born and has been a paediatrician in Coff’s Harbour since 1981. We immediately recognised that there was an untapped wealth of information that we would never be able to glean from textbooks – the lived experience of our predecessors.

In this panel discussion, hosted by Deb Shellshear, we hear from five distinguished clinicians. Whether talking about the rise in presentations of children with behavioural issues or about how you should really aspirate meconium we challenge you not to be so exceedingly grateful of what they, and their counterparts, have brought to the profession.

Our panel are:-

Larry Budd

Julie McEniery

Annie Moulden

Ian Shellshear

Jannie Geertsema is a Child and Adolescent Psychiatrist working at the Queensland Children’s Hospital. He recognises that the ability to work as a paediatrician can come at a considerable cost to the clinicians involved. One of the major challenges faced in the field of paediatrics is recognising who we are treating – is it the child, the parent, or something in between? Nowhere is this more obvious than in the realm of child and adolescent mental health.

So what is treatment behaviour? It is how we, as doctors, treat our patients…And treatment failure is affected by illness behaviour and the sick role.

In this great talk Jannie will make you think about how you interact with your patients and perhaps, just perhaps make you change your behaviour.

Professor David Coghill is the Foundation Chair of Developmental Mental Health at the Royal Children’s Hospital in Melbourne. As one of the editors of the Oxford Handbook of Attention Deficit Hyperactivity Disorder David is passionate about translating science into action.

ADHD is not a new condition. It has been around at least from the time of Der Struwwelpeter (1845) where Heinrich Hoffman tells the tale of Fidgety Phil (Zappel-Phillip) – The Boy Who Couldn’t Keep Still.

In this fascinating talk Professor Coghill reminds us that the true incidence of ADHD is not really increasing but the administrative diagnosis is. Why are more children in the US diagnosed and treated? Listen to the talk and find out.

Katie Tinning is a staff specialist in the emergency department at Lady Cilento Hospital in Brisbane. In this talk from she talks about a challenge faced by every parent – trying to work out a baby is crying…all…of…the…time.

Katie reminds us to consider the crying itself, the patient and the caregivers. Whilst the majority of crying is completely normal it is up to us to identify the sick child and provide reassurance when needed, ideally backed up with science. No matter how much you may want to, it is important not to roll your eyes but see the importance of this visit for the parents. Nobody wants to come to the hospital in the middle of the night – most of us would rather stay in bed.

Shabs Rajapaksa is a general paediatrician working in Ballarat, Victoria. In this talk, from the first day of the conference she takes a look at a skill that scares many of us.  Despite not being a specialist neonatologist or paediatric anaesthetist Shabs points out the importance of maintaining the skill set, including some of the challenges that this might present to the rural practitioner.

Pooled data from over 8000 neonatal intubations showed, as one might expect, that intubation success depended on level of experience. But surprisingly even consultants had a mean first pass success rate of around 60%.

David Tickell is general paediatrician working in rural Victoria. He has recently taken on the role of Clinical Director Specialist Clinics, Women’s & Children’s Health in Ballarat. In this talk he talks about what is normal and what should makes us concerned.

A lot of what we see in the department or in outpatients may often be the medicalisation of normality. For example crying, arching the back up and drawing up the knees are NOT related to reflux, and the prescription of PPIs is no better than placebo. But, David stresses, there are some things that require escalation.

Michelle Johnston is a part-time emergency physician, and full-time observer of life. Having spent many a day as a bit part player in the narrative of her patients lives she took a risk and wrote a book – Dustfall.

Dustfall tells a story of lives laid bare by medical error, of lives ruined and remade amidst the backdrop of the scorched earth of Western Australia. But this talk isn’t about her novel, it is about the importance of stories, the ones we tell and the ones our patients tell us.

Margie Danchin is a general paediatrician working at the Royal Children’s Hospital in Melbourne. She has a special interest in immunisation and vaccine hesitancy and it is this that she shared with the audience at DFTB18.

By suggesting that vaccines were linked to autism, Andrew Wakefield and his colleagues kicked off a vaccine scare that has yet to fade away and still sees many children succumb to diseases that are highly preventable and highly fatal. So what is the actual level of risk?

Mariam Issa arrived in Australia in 1998 with four small children and a fifth on the way. Having escaped a war-torn Somalia she sought out a new life for her and her family. Adapting to a new life and a new culture she moved on from seeing herself as a victim to seeing herself as someone that could make a difference. Now she strives to make life better for refugees through her work with Resilient Aspiring Women and the Asylum Seekers Resource Centre. In this powerful talk she shares the story of her life, and how such stories have the power to inspire growth.