Thank you to all APRN members who completed the 2010 APRN Multi-Topic Survey. The survey included 5 topics suggested by APRN members from around Australia:

  1. Long-term outcomes of ADHD
  2. Obesity management
  3. Learning problems
  4. Hearing screening
  5. Melatonin use

We also included questions about IT use in outpatient settings to inform planning for future projects. Below, we describe the survey outcomes.

Responder Characteristics:

  • 181 paediatricians (48% of APRN members) completed the survey – thank you!
  • Responding APRN members were more likely to work full time (61% v 29%) and be female (52% v 42%) than non-responders.
  • Most (70%) of responders were aged 35-54 yrs and their main practice location was similar to that of non responders i.e. 70% v 70% Metropolitan, Regional (26% v 24%) and Rural (4% v 6%).
  • 45% of responders were already involved in research.

Information Technology (IT) Use

What you told us:
40% of responders use a PDA or smart phone for work purposes. Although almost all reported access to a computer at work (97%) and a computer in each clinic room (85%), only 67% of clinics used a computerised patient booking/billing system, and only 28% of paediatricians were using computerised medical records in their rooms.

Of more than 10 different computerised medical systems, Genie was the most common (35% of those using computerised records). These paediatricians frequently used their computerised systems to write new/follow-up notes, receive results and record height and weight (all 71%-79%) but less frequently for ordering tests or writing scripts/referrals or patient letters (50%-60%).

APRN Actions and Plans:

  • We have published a letter to the Editor of MJA calling for the inclusion of the specialist secondary care sector into national e-health planning. For more information, please click this link to MJA's website.
  • We will further explore IT use in forthcoming annual Multi-Topic Surveys to better understand its use in the secondary care setting e.g. exploring paediatricians’ needs and/or barriers to IT uptake.
  • The results will inform the feasibility and planning of future APRN studies and trials – these may include IT components that are practical, user-friendly and benefit paediatricians and their patients.

Management of obesity and its comorbidities

What you told us:
Paediatricians generally felt competent to broach (98%), discuss (92%) and assess (89%) an obese child. However, only 66% felt very/quite competent in actually managing obesity and just 20% in making a difference to an obese child’s weight.

Responses to managing obesity-related comorbidities also varied. While many were confident about managing obstructive sleep apnoea (64%), depression (57%) and bullying (55%), fewer were confident about managing insulin resistance (32%), hypertension (45%), fatty liver diseases (22%) or dyslipidaemia (20%).

Overall, paediatricians had received relatively little training to help them manage this difficult condition. 53% reported some training in the assessment of obesity and 37% in its management. However, only 19% had received training in behavioural and formal problem-solving techniques to help families manage obesity, 14% in measuring and interpreting waist girth, and 12% in motivational interviewing.

Interest in research participation was high (71%) – the most popular areas were obesity itself (88%) and co-morbidities of obesity (65%).

APRN Actions and Plans:

  • We have published a paper combining these findings with data from the 2008 Children Attending Paediatricians Study (CAPS), highlighting training and research needs for management of childhood obesity and its comorbidities in the outpatient setting in the Archives of Disease in Childhood 2012. For more information, please click this link to Archives of Disease in Childhood website.
  • Several paediatricians around the country are starting to plan possible APRN obesity research projects

Congenital hearing loss

What you told us:
65% (n=108) of paediatricians had seen at least one patient with permanent hearing loss in the past three years, with the majority seeing between one and five patients.

Paediatricians nominated their main roles in managing children with permanent hearing loss as being involved in developmental surveillance and follow-up (73%), referring to other specialists (72%), supporting parents (69%), managing comorbidities (63%) and aetiological investigation (54%). The majority thought a paediatrician (developmental, general or with an interest in deafness) should take on coordination of care.

Paediatricians responses on how well informed they were about certain issues relating to hearing loss varied. Nearly two thirds of paediatricians reported that they were “fairly or very well” informed about the causes of hearing loss (63%), consequences of unilateral or mild hearing loss (60%) and the consequence of unilateral or mild hearing loss (63%). However, fewer paediatricians reported being “fairly or well” informed about education options (43%), family support services (37%), the genetics of hearing loss (33%) and medical (35%), audiological (34%), and early intervention (45%) options.

APRN Action and Plans:

  • We will compare these data with data from a similar survey conducted with ENT surgeons and Audiologists, as well as with data collected from such professional groups overseas.
  • These data will be made available for use in the development of guidelines and information for professionals relating to universal newborn screening and diagnosis and intervention for children with permanent hearing loss.

Learning problems

What you told us:
Most (78%) paediatricians reported that they see children with learning problems. Diverse practice patterns for assessing, referring and managing these children were reported.

In addition to a history and physical examination, the majority of paediatricians “often or always” use an audiology assessment (75%), a teacher questionnaire (65%), a parent questionnaire (60%) or contact with the teacher (51%) when assessing learning difficulties, but are less likely to “often or always” use medical investigations (40%), direct assessments (27%) or a visit to the child’s school (4%).

With respect to referrals, paediatricians “often or always” refer children presenting with learning difficulties to educational psychology (84%), special education (61%) or speech therapy (66%) services, and less often to occupational therapy (34%) or mental health (15%) services.

Finally, in their management of learning difficulties, between 66% and 76% of paediatricians provide a written report to the parents or the child’s school, recommendations for sleep hygiene and tutoring, while less than half provide handouts for school and home, or recommended dietary supplements or diet changes.

APRN Actions and Plans:
As these data show, there is no clear consensus in current paediatric practice regarding the care of children who present with learning difficulties. We have published a paper in the Journal of Paediatrics and Child Health that highlights the need for evidence-based guidelines for the paediatric care of children with learning difficulties. For more information about this article, click this link to the JPCH website

Assessment of children for ADHD

What you told us:
Most (78%) paediatricians reported seeing children with ADHD in their practice. On average paediatricians reported that they see about five (range: 0 to 25) children for a new ADHD assessment each week.

Most paediatricians almost always assess height (98%), weight (99%), and blood pressure (79%) as part of their assessment for ADHD. They almost always use parent (68%) and teacher (67%) questionnaires as part of their assessment. Paediatricians reported sometimes using self-report questionnaires (39%) and speaking with the child’s teacher (40%). Most (57%) paediatricians reported rarely visiting the child’s school as part of the assessment process. Only 14% reported that they “Often” or “Always” use medical investigations as part of their evaluation. 67% reported that they “Often” or “Always” refer to a psychologist.

Almost two thirds of paediatricians reported having read the revised 2009 National Health and Medical Research Council ADHD guidelines, and of these 86% reported that their practice has not changed as a result.

Interest in referring children into a longitudinal study of children with ADHD was high (74%).

APRN Actions and Plans:

  • We are writing a paper combining these findings with data from the 2008 Children Attending Paediatricians Study (CAPS), describing the ADHD assessment practices of Australian paediatricians.
  • We are planning a longitudinal study of Australian children with ADHD to look at the long term outcomes of their risk and protective factors. The APRN investigators will be in touch shortly with more details about this study.

Melatonin use

What you told us:
Just over half (56%) of paediatricians prescribe melatonin for children. Melatonin was prescribed for children of all ages (6 months to 20+yrs). Dosage also varied from 0.1mg to 3mg for infants, from 0.1mg to 10mg for children, and from 0.1mg to 12mg for adolescents, reflecting the uncertainty of optimal melatonin dosages in children.

Melatonin was often used for managing sleep problem in children including difficulty falling asleep (89%) and delayed sleep phase (66%) and appropriately less for night waking (31%). It was prescribed within a variety of child populations; autism (85%), developmental delay (76%), normally developing children with sleep problems/conditions (54%), ADHD (51%), behavioural disorders (43%), visually impaired children (41%), anxiety disorders (26%) and other populations (9%) such as children with chronic fatigue syndrome and cerebral palsy.

Prior to prescribing melatonin most (84%) paediatricians tried alternative medications and strategies. Strategies and medications varied depending on the condition/problem. For example the most commonly used strategies for sleep initiation were anxiety relaxation techniques (74%) and limit setting (58%) with clonidine (48%) and Vallergan/phenergan (29%) the most commonly prescribed medications. For disrupted overnight sleep the most commonly used strategies were controlled crying (51%) and limit setting (41%) whilst use of medication was uncommon (45%).

APRN Actions and Plans:

  • We have published a paper on the pharmacological and non-pharmacological management of sleep disturbances in children in Sleep Medicine (2013). For more information on the article, please click this link to the Sleep Medicine website
  • Use these data to develop educational support for paediatricians