We understand you want to know as much as possible about your child’s gastro complaints, so please have a list of questions you may want to ask your specialist during your online telehealth appointment. We also have lots of information on our services, patient info and fact sheet pages.
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What if my child doesn’t want to (or can’t) talk?
That’s perfectly fine! You’ve heard their complaints as the parent, so you’re in the best position to relay this information to us. Most of the time, the parents do all the talking; however, we ask that your child is present. We also know what questions to ask to help us understand what may be happening to your child.
Do I need a referral for all telehealth consultations?
You will need a current doctor’s referral to see one of our Paediatric Gastroenterologists and to make you eligible for Medicare reimbursement. However, if you’re seeing one of our Physiotherapists or Dieticians, you won’t need a referral. You may qualify for a Care Plan entitling you to a Medicare reimbursement, so please check with your doctor.
Are gastroenterology procedures safe for children?
As with any procedure (for people of all ages), gastroenterology procedures may have small risks. But you can rest assured that as highly-skilled Paediatric Gastroenterologists, we’ve successfully performed these routine procedures for many years and are very gentle with our young patients.
What if my child needs further investigation?
With gastro complaints, further investigation is often needed. We regularly have specialists visiting regional areas to see patients, or we may ask you to visit our specialist centre in Melbourne. We understand it’s not always easy to travel. During your online telehealth appointment, we can discuss the best options for you and your child.
Do Medicare or Private Health Funds cover telehealth appointments?
Medicare rebates are processed after your consultation (if applicable), and the benefit is assigned directly to our specialists. Please note that if you choose to claim through Private Health, you can’t claim the Medicare rebate. However, Private health funds generally don’t make payments for outpatient clinic appointments (please check with your provider).
What’s the cost of a telehealth appointment?
Most telehealth appointments will cost the same as a face-to-face consultation. If you’re eligible for a rebate, they are processed after your appointment. Our office will call you before your online telehealth appointment to take your payment over the phone.
Are Blastocystis and Dientmoeba anything to worry about?!
The pathogenic role of Blastocystis has not been proven, particularly in immunocompetent individuals. Recent data shows the overall prevalence in a local test population to be 17%. Individuals may be colonised with this organism and do not need treatment. It can be acquired by contact with animals including pets or contaminated water. Potentially pathogenic or animal strains cannot be differentiated by the current available tests. Screening for clearance of the organism or testing of family members is not recommended.
The pathogenic role of Dientamoeba has not been established either. Recent data shows the overall prevalence in local population to be 16.2% with more than 50% of children aged 5-10 testing positive. A randomised double blinded placebo controlled clinical trial does not support routine metronidazole treatment for children with chronic gastrointestinal symptoms with this organism. Treatment may be harmful resulting in unnecessary adverse reactions, disruption of the normal gut flora and contribute to the development of anti microbial resistance of faecal microbiota. Screening for clearance or testing of asymptomatic family members is not recommended.
For individuals with chronic abdominal symptoms, other causes for symptoms should be considered and investigated accordingly if required.
For parents and carers of children with continence problems
If you have brought your child for help with a bladder and/or bowel problem the following points are written to help gain an understanding of the process of assessment and treatment.
- There is a range of severity of continence problems in children and symptoms can be mild through to severe. Usually there is some bladder and/or bowel dysfunction. Lack of bladder and/or bowel control in your child is not his/her fault – or yours!
- Assessment is aimed at identifying this dysfunction and the causes and you will be asked to help by assisting your child to complete some charts and diaries at home. This information is essential to give a good understanding of the best course of action and treatment for your child. Because we are dealing with children this may take some time and commitment to regular attendance is important.
- It is common that children with continence problems have some behavioural issues resulting from their distress – even apparent indifference can be a defence mechanism. Often as the incontinence improves so does the behaviour. We all have different personal resources to meet challenges in life and if it is felt that your child needs some extra emotional help and support to deal with his/her problem, this will be discussed with you.
- In medical terms, a chronic condition is one that exists for longer than six months and most childhood continence problems are, by definition, chronic. As a general guide, successful treatment takes months also, and in some children with more severe problems, it may be years. Earlier success is more likely if the measures suggested are consistently implemented. This will take continuous effort by you and your child and is difficult for some children until they mature a little more. But the benefits are great. We know that self-esteem and quality of life will improve as incontinence resolves.
- Our aim is to ensure that incontinence and bladder and bowel dysfunction are well assessed and treated. We need to identify any potential risk factors for ongoing problems such as kidney disease and work together with your child’s GP or specialist to maximize the health outcome for your child.
FODMAPs and your Child
An apple a day may not keep the doctor away…
Over the past 6 years, there has been exciting research undertaken at Monash University looking at possible dietary triggers for Irritable Bowel Syndrome (IBS). The result of this research is the discovery of a group of dietary sugars which, when ingested by susceptible individuals, causes a range of gastrointestinal symptoms associated with IBS. This group of sugars is called FODMAPs (Fermentable Oligo-saccharides, Di- saccharides, Mono-saccharides and Polyols) and it has changed the face of IBS management around the world.
When you think of IBS, you will often think about adults, but more and more children are now presenting with a history of months and sometimes years of gastrointestinal complaints such as:
- Tummy pain,
- Bloating or visible abdominal distension,
- Excessive wind,
- Diarrhoea +/- associated nappy rash and/or
- Constipation +/- soiling.
The symptoms of IBS are similar to those of other conditions, such as Coeliac Disease, Inflammatory Bowel Diseases (Crohn’s Disease and Ulcerative Colitis) and Bowel Cancer, and as such, it is crucial that these conditions are investigated prior to making any changes to a child’s diet.
The diagnostic test for FODMAP malabsorption is a breath test. The test involves the ingestion of a specific dose of the FODMAP being tested (currently only able to test for Fructose, Lactose and Sorbitol) followed by half hourly breathing into a special bag (for up to three hours) to check the levels of hydrogen or methane produced in the breath. The presence of either of these two gases is indicative of malabsorption of that FODMAP by the gut.
In a nutshell, someone with FODMAP malabsorption is unable to adequately absorb one or more FODMAPs in their small intestine, leaving too much of those FODMAPs to travel further along the digestive system where they are then fermented or broken down by bacteria present in the large intestine, which can results in a range of gut symptoms (as listed earlier).
In young children, the breath test is not always possible due to their inability to blow into the bag adequately to get an accurate reading. As such, in the absence of these results, a process of elimination and challenge under the guidance of an experienced dietitian is required.
When seeing a dietitian for guidance regarding a low FODMAP diet for your child, a comprehensive diet and symptom history will usually be taken to determine the most likely FODMAPs that may be causing your child’s symptoms and guidance regarding the avoidance of those FODMAPS for a STRICT 4 week period will be provided.
Following this 4 week period, and assuming a complete resolution of your child’s symptoms has been achieved, a challenge process will be recommended to pinpoint the exact dietary triggers for your child and to determine their threshold for the problematic FODMAPs. In most cases, the ongoing dietary restrictions are very small when challenges are undertaken in a systematic way.