ADHD ( My chid is having trouble focussing and/or learning at school)
ADHD shared care with GPs (Once my child is on treatment for ADHD is there another way of having ADHD medication with my GP?)
Allergic rhinitis (My child has runny nose all year round , or during pollen season; what can I do about it?)
Anaphylaxis (My child has a food allergy , insect allergy, or environmental allergy, how does my doctor make the diagnosis, I know if it is life threatening, what teatments do I need to have for my child)
Asthma ( non acute asthma, asthma in the GP rooms or outpatient rooms, starting a preventer and monitoring asthma)
Behavioural concerns in children
Bone and joint infections in children
Congenital muscular torticollis
Developmental concerns in children
Eczema ( atopic dermatitis) Eczema ( finger tip units for steroid ointments)
Enuresis (day and night wetting)
Fever (for GPs)
Foetal alcohol spectrum disorder
Gastroenteritis (vomiting +/- diarrhoea +/= abdominal pain in children)
Head injuries in children (PIC)
Heart murmurs in children and adolescents
Learning difficulties in children
Unsettled behaviour ( infantile colic , excessive crying in babies)
For Dubbo Paediatric Outpatient bookings:
Team A : Dr Dominic FitzGerald
Outpatient bookings Mondays/ Tuesdays and Wednesdays
Skin prick testing and oral food challenges by arrangment with Ms Anwar
Secretary is Ms Ayesha Anwar on 6809 7083 Ayesha.anwar@health.nsw.gov.au
Team B : Dr Jacky Askwith
Outpatient for general paediatrics
Bookings for paediatric diabetes : Fortnightly on Mondays in Diabetes centre
Secretary and team leader : Ms Kareena Neville 6809 7081 Kareena.Neville@health.nsw.gov.au
Team C: Dr Jenny Gatenby
Outpatients for paediatrics
Secretary is Ms Ayesha Anwar on 6809 7083
Team D: Dr Geoff Hardacre
Has Monday clinics
Outpatient bookings
Locum paediatricians Dr Robyn Shaw and Dr Carolyn McLennan are visiting Dubbo, please ask our staff if you would like to see if there are appointment available with our locum paediatricians
Outreach Paediatric Clinics to Ms Natasha Bush
Bourke- On hold due to staff shortages; but Virtual Clinic through the Bourke Public School for behavioural issues is still going
Brewarrina
Lightning Ridge
Nyngan
Mudgee- on hold for now due to staffing shortages
Coonamble- on hold for now due to staffing shortages
Front reception for outpatients : : 6809 7080 (if you are running late, let her know)
Team leader Ms Kareena Neville
OUTPATIENT BOOKINGS
There are two ways to see a paediatrician:
1) if you baby was in the Special Care Nursery (or had tests to followup), or was seen in the Paediatric Ward or seen by the Paediatric Department in the Emergency, you can book a Hospital Review with the appropriate secretary.
2) If you and your GP wish for your child to have a medical, surgical or developmental problem reviewed by a paediatrician in the Outpatients, your GP can fax (+/- email) a referral .
The best pathway is a E-referral which is uploaded onto NSW Health Outpatients Database
Your GP can fax a referral to the Outpatients on 02 6809 7280
Your GP can email a referral to one of the secretaries.
Note an emailed referral , to one of the secretaries above, is generally quicker to process, and there is a time log for when it was received.
A general email can also be sent WNSWLHD-Dubbo_PaedOutpatients@health.nsw.gov.au
but this is an extra step removed from the direct email to the secretaries.
Once the fax is through, you can call your paediatrician to confirm appointments with the appropriate secretary.
Postal Address:
Paediatic Outpatients Department
Dubbo Health Service
170 Myall St
Dubbo NSW 2830
It is reasonable to refer a surgical problem directly to a surgeon, or you could consider referring to the paediatricians, who review the problem and considering referring to a surgeon.
Paediatric General Surgeons
Dr Gideon Sandler: For appointments and referrals
Paediatric orthopaedic surgeon
Dr Ben Milne
Dubbo general surgeons
Behavioural/Developmental
1. ADHD (school aged 5-18)
Initially a School Counsellor assessment or private psychology assessment both can diagnose ADHD. Further management can be undertaken by an Occupational Therapist or behavioural Practitioners. If medication is required after assessment a Paediatric Psychiatrist or Paediatrician can medicate.
2. Autism Spectrum Disorder
Initially a clinical psychologist can make the diagnosis.
Other tertiary centres can assist with diagnosis and management (Royal Far West & ASPECT)
3. Anxiety and/or depression
Initially a psychologist or behavioural therapist can make diagnosis. Initial management should be behavioural therapy. Additional medication can be supported by General Practioners/Psychiatrist/General Paediatrician.
4. Anger Management /Aggression
School counsellor can assist in addition to behavioural therapist/psychologist. Parenting course should be recommended.
5. Obsessive Compulsive Disorder/Oppositional Defiant Disorder
Psychologist, Psychiatrist (Royal Far West / Dr Sanjay Sinha/CAMHS)
6. Self-Harm/Suicidal Ideation
In an emergency dial 000 or sent to ED
Non urgent cases should be referred to CAMHS
7. Speech Delay / Regression
Please refer to Speech Therapist (most children it is in isolated problem & Paediatrician input is not required). Dubbo Community Health, ACTT, or private.
Medical Issues
1. Gastroesophageal Reflux in infants
Advise adding thickener to formula or swapping formula to AR (anti-reflux). Please consider prescribing Losec 5mg BD
Additionally a trial of cow’s milk free formula / diet – see link below
https://sites.google.com/view/dubbokidshealth/kids#h.60imppo5qz6v
2. Rashes
Have a look on dermnet.NZ, a very useful resource. If this is not helpful or you have further concerns please refer to VMO Dermatologist Dr Deshan Sebaratnam in DHS Ambulatory Clinic.
3. Hip dysplasia other orthopaedic issues
At this time please refer to Dr Benjamin Milne in Orange Hospital
Ph: 6361 8880 Fax: 6361 4991
4. Surgical Problems
Please refer to Dr Gideon Sandler in Orange (private clinic).
Fax 80887420 email referral@drgideonsandler.com
5. Urological problems (hypospadias etc)
Please refer to Dr Aniruddh Deshpande the Children’s Hospital at Westmead
6. DCJ Checks
Routine checks can be done by General Practioners. Any concerns refer on to Paediatrician to be triaged.
7. Obesity
Refer to Nepean Weight Management Clinic if BM is 99th percentile, dietitian. Enrol in Go4fun online if aged 7-13.
8. Recurrent Tonsillitis, Ear infections / Adenoids / Grommets
Please refer direct to ENT (Dr Ridha or Dr Sirigiri). Refer for hearing test as well.
9. Epilepsy
Querying please organise EEG through DHS EEG Department (6809 6006 ) & forward referral & result once received. If <2 years old refer to Orange Central West Neurology and Neurosurgery fax 63620129 email neurology@cwnn.com.au
10. Functional constipation
Trial regular stool softeners like Movicol, Osmolax, or Parachoc.
c) Statewide hearing screening
f) Tonsillitis and sore throat
a) Baker's or popliteal cyst in children
b) Bow legs
d) Curly toes
e) Flat feet
f) Developmental dysplasia of the hip
i) Knock knees
Paediatric General Surgical Conditions
ii) umbilical hernia in children
e) Penis and foreskin problems in children
f) Scrotal pain or swelling in children
g) Undescended testis in children
Kids & Families - First 2000 Days
The First 2000 Days of life spans from conception to starting school.
This includes actions to:
Assist parents prepare for pregnancy and birth
Provide safe, evidence-based birthing and maternity care
Support the transition from postnatal care through to parenthood in the early years
Increase preventive health actions in the first 2000 days
Build District-wide, system-wide capacity to improve the first 2000 days and beyond
For more information please contact Debrah Davis.
Evidence shows that certain interventions in the first 2000 days of life can make a significant improvement to children’s early life experiences, health and development.
There is a growing body of evidence that shows resilience is an important factor in mediating the impact of risk factors. Just as risk factors have a cumulative impact, increasing resilience factors will also have a cumulative effect. The best outcomes will be achieved when we work in two ways to improve outcomes – when we increase resilience, and reduce risks. The evidence also shows that by working together and directing our efforts to better support children and their families, we can make a big difference. For example:
The Raine Study from Western Australia has shown that there is a dramatic rise in problematic behaviour in 14 year olds whose mothers experienced five or more major stressors in pregnancy.
Examples of these stressors include:
Substance abuse
Relationship stress
Domestic and family violence
Unemployment
Financial stress
Unstable mental health conditions
Physiological stress
Post traumatic stress
Health conditions (pre-existing or related to pregnancy)
Homelessness
By identifying maternal stressors early in pregnancy and reducing them, we can have a positive impact on the outcomes for the child as well as the mother.
A growing body of scientific evidence tells us that emotional development begins early in life, that it is a critical aspect of the development of the overall brain architecture, and that it has enormous consequences over the course of a lifetime.
Social and emotional skills, sometimes called “soft skills” are as important as cognitive skills in determining success in school, work and life. These skills are developed during children’s earliest years.
There is no known “safe” dose of alcohol that can be consumed during pregnancy without risking damage to an unborn child. Antenatal alcohol exposure is the leading known cause of preventable brain damage.
Behavioural and neurological problems associated with antenatal alcohol exposure may lead to poor academic performance as well as legal and employment difficulties in adolescence and adulthood.
The baby is most at risk early in pregnancy, often before the mother even realises she is pregnant. The safest option for any woman who is planning a pregnancy, is pregnant, or who is breastfeeding is to not drink alcohol at all.
Psychosocial risk factors
High quality, strong parent-infant emotional attachment has been shown to have a positive impact on children’s mental health, and their physical and social development. Attachment and resilience are related. There are a range of issues that can interfere with a parent’s ability to develop a strong, healthy attachment with their child, including depression or anxiety in pregnancy and in the months or years after their baby is born and exposure to family violence.
High quality, strong parent-infant emotional attachment has been shown to have a positive impact on children’s mental health, and their physical and social development. Attachment and resilience are related. There are a range of issues that can interfere with a parent’s ability to develop a strong, healthy attachment with their child, including depression or anxiety in pregnancy and in the months or years after their baby is born and exposure to family violence.
Psychosocial risk factors are ideally identified and addressed early, through screening during antenatal care and postnatal care and referral to support and treatment services.
Evidence shows that certain interventions in the early years can make a significant improvement to a person’s life experiences, health and development.
These interventions include:
Access to comprehensive antenatal care
Regular child health and development check ups from birth until age five
Sustained nurse home visiting for targeted populations
Breastfeeding support
Supporting women to complete their school education to Year 12
Immunisation
Oral health services
Population parenting programs
Attending 600 hours of quality early childhood education in the year before school
School engagement
Specialised programs for Aboriginal people, refugees and migrant populations