Hello Paeds-and-Feed blog followers!

It has been a really loooong time between articles hasn’t it?

Well I am back, albeit for as many articles as I can write in 2 days, because I have a bit of leave to work on material before it’s back to the grindstone! Let’s talk about some stuff, let’s learn what we can and hopefully have a bit of a chuckle together too!

My aim is to work my way through the suggestions you have all posted me on my Facebook page (thank you so much all of you for the inspiration), starting with the topics that I feel will be the most helpful, and also reposting topics that I have already written about and that have been re-requested!

Developmental concerns in children are common, and the demand for paediatric opinion and therapy is high.  One of the fantastic recent suggestions from a blog follower that I want to write about today is about “What to do whilst we are waiting for a child’s paediatrician appointment?”

This is a fabulous question because the answer is “LOTS!”  And the more you get done before your appointment, the more streamlined it will be for the paediatrician to figure out what is going on for the child, and how to formulate a path forwards. 

The wait time for a paediatrician appointment is generally (and unfortunately) long.  In my public practice, I was recently told that (after a few staffing issues we have had over the last 12 months or so) the wait for school age children for developmental assessment now exceeds 2.5 YEARS (*face palm*).  Even in my private practice, the minimum wait is around 8 months (unless you are really lucky and get in very quickly when a new paediatrician starts).  Many of our paediatricians are already at capacity and cannot take new patients on – mostly because we cannot guarantee quality and continuity of care for our existing patients if we keep seeing new ones, and we really want to be able to do that.

So what can/needs to be done depends on your role in the child’s life. 

The list of jobs is different depending on if you are the child’s parent versus being their teacher/guidance officer, general practitioner or allied health professional.  I could talk on these points for hours really, but have tried to keep it simple for the purposes of this article.

I have tried to simplify some of these things into lists below.

PARENTS:

1.  Get your child’s hearing and vision tested
2. Hearing testing:  this can be done at a number of places like Attune, Hearing Australia, Neurosensory or even at a public hospital/Community Child Health Clinic.  The type of audiometry test done will depend on your child’s developmental age. I am looking for PURE TONE AUDIOMETRY only in school aged kids and advise parents against “behavioural audiometry” or “Central Auditory Processing Disorder testing” as these tests are not evidence based.
3. Vision testing:  for the purposes of developmental assessment, I ask parents to go to their local optometrist and to request standard vision testing.  I do not recommend “behavioural optometry” as it is non-evidence based (and is often quite expensive).
4. Fill out your rego/pre-assessment forms and return them before your appointment.
5. Some clinics have pre-assessment forms, some do not.  If they do, it helps immensely to fill these in and return them BEFORE your appointment, to give the paediatrician an idea of what the concerns are for your child.
6. Get a letter of observations/concerns from your child’s teacher
7. If you don’t have pre-registration forms to fill out, a LETTER from your child’s CLASS TEACHER outlining their concerns is very helpful.  If they don’t have any concerns, then a letter that details their observations of your child (eg social interactions, ability to follow instructions, complete tasks, academic level of achievement etc) will still be useful.
8. If your child has learning difficulties, talk to the guidance officer/deputy principal at the school about appropriate testing that can be completed prior to your appointment.  For example, if your child is failing their subjects, a cognitive assessment (or “IQ test”) or formal speech and language assessment (or both) could be organised. This will help speed the process of formulation up with the paediatrician.
9. Bring along your child’s last 3 report cards (and earlier if you have them) as well as any past reports from speech pathologists/occupational therapists/psychologists for any past formal assessment done on your child.
10. IF your child has behavioural difficulties, consider meeting with the school to negotiate a behaviour support plan for your child at school, and consider enrolling/completing a parenting course/support program like Triple P (widely available online), Circle of Security or 1,2,3-Magic.  Else you could see your GP for a Mental Health Care Plan for your child to see a psychologist.

SCHOOL/TEACHERS/GUIDANCE OFFICERS:

• Some services have forms for teachers to fill out, some don’t
  • If possible, fill out and return on time
  • If no forms – a LETTER with your observations of the child to the paediatrician, outlining your specific concerns would be very helpful; class, playground re: behaviour, conduct, attention, observations on the nature of social interactions, academic performance, strengths and difficulties
  • Forwarding the last 3 report cards for the child (with the parents’ consent) can also be helpful.
• Advise parents to have HEARING and VISION tests before the appointment
• If there are behavioural issues, point the child’s parents in the direction of a locally accessible parenting course:  Triple P, Circle of Security, 1,2,3 Magic – these are all helpful.
• Mobilise all possible educational supports for the child as you see appropriate eg speech pathologist input/assessment, small reading groups, visual cues, preferential seating etc
• Apply a common-sense approach to psychometric assessment:
• If a child is failing literacy-based subjects
  • Think about queuing the child for a formal speech assessment (eg CELF-5), phonological awareness testing (eg SPAT-R, C-TOPP)
  • Think about tests of achievement (eg WIAT-3)
• If a child is failing subjects across the board (sometimes multiple years in a row)
  • Think about formal cognitive assessment (eg WISC-V) +/- formal speech assessment
• If there is a sudden deterioration in performance/attention/behaviour/social skills
  • Think about what might be going on for this little person in
    • Home life:  ?parental separation, death of a family member/pet, DV, abuse, poverty, sleep issues
    • School life:  ?bullying (at school/online), building anxiety about learning difficulties, poor self-esteem etc
    • TALK to the little person/parent (in confidence if necessary) and ask

GPs, and other health professionals:

• Ensure the child has had HEARING and VISION tests
  • Pure tone audiometry
  • Visual acuity (optometrist)
• GPs – may consider thinking about
  • Testing for various medical conditions: eg thyroid conditions, iron deficiency, anaemia, chronic disease (eg renal, hepatic), nutritional deficiencies
  • Referral to a psychologist/occupational therapist (for emotional/behavioural issues) on a Mental Health Care Plan
  • Referral to a speechie/physiotherapist (depending on the developmental concern)
  • Manage aggravating conditions like sleep disturbance, constipation, excessive screen time etc
  • Refer to a local Community Health Centre for parenting programs, parental behaviour/sleep support

I hope that this article is helpful for parents, teachers and health professionals alike.

It makes sense to make the most of the time you spend waiting for your paediatrician, as it means the sooner the information is available, the sooner a plan of management and moving forward can be devised.

I will ask a small favour of you in return for reading this article – PLEEEEASE give me a LIKE, COMMENT and SHARE to help me to help as many parents (and in this case, other paediatricians) as possible!