In this section
Australia has one of the highest incidences of asthma in the world and asthma remains the most common disease in childhood. One in four Australian children will have at least one episode of asthma per year. The department cares for over 600 children with
asthma, the majority of which are outpatients.
The management of asthma in children cannot be directly extrapolated from adult care due to the differences in the pattern of asthma, the natural history, the potential for side effects, mechanisms for drug delivery and anatomical factors. For the majority of children, asthma will either resolve or at least
improve with age and to date there is no evidence to suggest that treatment influences the natural history of asthma. There is a large variation in the pattern and severity of asthma in childhood. Optimal asthma management is very rewarding, allowing a child to achieve normal quality of life, normal levels of cardiopulmonary fitness and normal growth. Children are more
susceptible to side effects of long-term medication, therefore it is important to ensure that a balance is achieved between the intensity of the treatment and the severity of the asthma.
Wheeze in infancy may be due to a number of diseases such as bronchiolitis, cystic fibrosis, gastroesophageal reflux, an inhaled foreign body, viral illness or congenital lung abnormalities. If it is persistent or severe, referral to a tertiary centre should be
considered for investigation and treatment.
EIA is common in children, affecting up to 90% of children with asthma. Children with asthma may be unfit because EIA limits their endurance. However, with appropriate management and training, children with asthma can achieve normal levels of fitness. Children
should be encouraged rather than discouraged from participating in normal sporting activities.
Cystic Fibrosis is a genetic illness without a cure. In Victoria it is usually diagnosed in the first 2 months of life through the newborn screening programme (commenced in 1989). CF primarily affects the lungs, pancreas, liver, reproductive organs and sweat
glands. The management of a patient's cystic fibrosis is a multidisciplinary team approach, with close cooperation and collaboration with the patient and their family. This involves a high level of commitment from families with the need for regular treatment at home which includes daily chest physiotherapy, oral
antibiotics, a special diet, enzymes, salt tablets and nebulizer treatments. It is impossible to predict the outcome for any individual with CF but over the last few decades the outlook has improved significantly and continues to do so as a result of
multidisciplinary and increasingly standardised care in specialist CF centres.
Most patients with CF are required to take enzyme capsules before they eat a meal or snack so that their food is digested normally and can be absorbed. The dose of capsules varies according to each patient's individual needs however, the dose usually
increases as the patient grows older. Patients also require a high fat, high calorie and high salt diet with approximately one and a half times the amount of calories per day compared to a person without the disease.
As an outpatient, patients are reviewed by the CF multidisciplinary team every two to three months to assess their medications, diet, chest physiotherapy and psychosocial needs. If there is a significant decrease in lung function and an increase in symptoms, an admission to hospital is usually required. This is
usually for a period of 10-14 days for intravenous antibiotics, intensive chest physiotherapy, and daily review by the physiotherapist, dietitian, medical consultants and CF counsellor. Oral antibiotics will be continued for at least a week after discharge from hospital.
RCH cares for 300 children with CF and complies with nationally and internationally recognized infection control protocols for outpatient consultations and inpatient admissions. When visiting the outpatient clinic patients with different bacterial strains of
infection are reviewed on separate days to decreases the risk of cross-infection. In the hospital, a patient with CF is never nursed in the same room as another patient with CF, and they are nursed in a single room if one is available. Cross infection measures are
closely followed by all staff in relation to hand washing, cleaning of equipment and staff allocation.
The aims of treatment are to allow people with CF to live a normal life with a minimum of lung disease and optimal growth. Most males and some females with CF are infertile however, IVF techniques now offer the possibility of parenthood for people with
CF. Please do not hesitate to contact me if you require further
For more detailed information regarding the management of children with cystic fibrosis at the hospital please refer to the
Cystic Fibrosis Management Handbook (PDF 1.3 MB)
A sleep study or polysomnography involves the continuous monitoring of sleep and breathing patterns throughout one full night. The test is a non-invasive test but requires a number of sensors and electrodes to be attached to you/your child before they go to sleep. The
attachment of these sensors to the skin of the head and body is safe and will not hurt.
A sleep study is used to investigate respiratory and sleep disorders including:
Other sleep disorders including:
The department provides nursing support for parents and hospital staff caring for children requiring
The complexity of care for these children has increased in recent years and with improved techniques is likely to increase further in the coming years. A close working relationship with the Melbourne Children's Sleep Unit and the Chronic Ventilation Service
at the Austin and Repatriation Hospital is established to assist with the care of these patients into adult life.