Pediatrics

What our paediatrics unit covers — and who it is for

Paediatrics (pediatrics) is the medical care of children from birth to adolescence, and it is not adult medicine at a smaller scale. Children present differently, deteriorate faster, compensate until they suddenly do not, and cannot describe what is wrong — which is why so much of this specialty is examination, observation over time, and knowing what normal looks like at each age.

Most of what a paediatrician sees is self-limiting, and the central skill is separating the large majority of children who will be better in a few days from the small number who will not. A unit that treats everything aggressively harms children; a unit that reassures everyone misses the few. The whole discipline sits in that gap.

At Acıbadem International the work is organised into six strands.

• Acute illness — fever, rashes, breathing, vomiting and the paroxysmal events that frighten parents, most of which need explanation rather than treatment.
• Growth and development — plotting, milestones, feeding and the questions of whether a child is on their own track or has left it.
• Newborn care — neonatal intensive care, jaundice, feeding and the first weeks, where the margin for error is smallest.
• Chronic conditions — asthma, allergy, diabetes, kidney and heart disease in children, managed with the relevant paediatric sub-specialty.
• Prevention — immunisation, vitamin D, nutrition, safety and the screening that catches what has no symptoms yet.
• The child with a diagnosis nobody has reached — recurrent fevers, unexplained pain, faltering growth, where the work is systematic rather than fast.

Where the borders sit. Operations on children — hernia, undescended testis, pyloric stenosis, intussusception, hypospadias and appendicitis — belong with pediatric surgery. Children’s skin, including eczema in babies and birthmarks, belongs with dermatology, which has its own paediatric section. Ear tubes and tonsils belong with otorhinolaryngology, and the pregnancy that precedes a birth with perinatology. This unit covers the medical care and coordinates the rest.

What a paediatrician (pediatrician) actually does

A pediatrician — in British and most international usage a paediatrician — is a physician trained specifically in the diseases, development and normal variation of children. Three things distinguish the consultation from an adult one.

The history comes from someone else. Parents describe what they observed, filtered through fear and through what they have read, and a large part of the skill is extracting the actual sequence of events from that — what the child did, when, for how long, and what they were like between episodes. The phrase that carries the most weight in paediatrics is not a symptom at all: a parent saying this is not like my child is one of the strongest predictors of serious illness there is, and it is taken seriously rather than reassured away.

The examination is opportunistic. Children are examined in whatever order they permit, often on a parent’s lap, starting with whatever is least invasive and leaving the throat and ears until last. A child who is playing, making eye contact and distractible is telling you something no investigation will.

And normal is a moving target. Heart rate, respiratory rate, blood pressure, haemoglobin (hemoglobin), sleep, speech and behaviour all have age-specific ranges, and applying an adult threshold to a child produces either false alarm or false reassurance. That is the single commonest error made by clinicians who do not see children regularly.

Fever in children

Fever in children is the commonest reason a child is brought to a doctor and the source of more unnecessary anxiety than anything else in paediatrics. Several things are worth stating plainly.

Fever is a response to infection rather than a disease in itself, and in the great majority of cases the infection is viral and self-limiting. The height of the temperature correlates poorly with how serious the illness is: a child with a temperature of 40°C who is alert, drinking and playing between peaks is usually less concerning than a child at 38°C who is drowsy, refusing fluids and not interacting. How the child looks matters more than what the thermometer says, and that is the principle the whole assessment is built on.

Antipyretics are given for comfort, not to bring the number down. They do not shorten the illness, do not prevent febrile seizures, and alternating two medicines to chase a temperature is a practice that has been abandoned. Whether to give anything, and which, is a decision for the doctor looking after your child — nothing here is a dose or a schedule.

What changes the assessment is age and appearance rather than degrees. A fever in a baby under three months is investigated thoroughly regardless of how well they look, because the immune response at that age gives so little away. Beyond that, what is looked for is the pattern of behaviour, hydration, breathing, circulation and rash, and the duration — a fever lasting beyond five days moves the differential away from simple viral illness and towards the conditions covered further down this article, including Kawasaki disease.

Fever without an obvious source in an otherwise well child is common and usually viral, and the sensible response is observation with a clear description of what to watch for, rather than reflexive antibiotics or a full battery of tests.

Febrile seizure

A febrile seizure is a convulsion occurring with fever in a child between roughly six months and five years, without an infection of the brain and without a previous seizure unrelated to fever. It is common, affecting a meaningful percentage of children, and for parents it is among the most frightening things they will ever witness.

The reassuring facts are substantial and are usually delivered too late to help. A simple febrile seizure is generalised, lasts under fifteen minutes and does not recur within the same illness. It does not cause brain damage. It does not affect intelligence or school performance. It is not epilepsy, and the great majority of children who have one never develop epilepsy — the risk is only slightly above the background risk. Around a third of children who have one will have another during a later illness, and having one does not mean the fever was managed badly. Antipyretics have been shown not to prevent them.

A complex febrile seizure — focal, prolonged beyond fifteen minutes, or recurring within the same illness — is assessed differently, and so is a seizure in a child who looks unwell between episodes, because meningitis and encephalitis present this way. A prolonged seizure is a medical emergency and is treated in hospital. Investigation is directed at finding the source of the fever rather than at the brain: routine EEG and imaging after a simple febrile seizure change nothing and are not performed. Where seizures are recurrent or prolonged, a rescue medication plan is agreed with the doctor who prescribes it, and parents are taught what to do — which is the intervention that actually reduces harm.

The childhood rashes, and telling them apart

Most childhood rashes are viral, self-limiting and diagnosable by pattern and timing rather than by testing. A few are not, and the difference is worth knowing.

Roseola

Roseola is the one that produces the most confusion, because the rash appears when the child is getting better. Three to five days of high fever, often with very few other symptoms, and then the fever breaks and a fine pink rash spreads over the trunk and neck just as the parents were about to give up hope. It is caused by human herpesvirus 6, needs no treatment, and by the time the rash appears the child is no longer particularly unwell. It is also one of the commoner causes of a febrile seizure, which is why those two sections belong together.

Hand, foot and mouth disease produces painful mouth ulcers with blisters on the palms, soles and around the mouth, and its real problem is not the rash but the refusal to drink — the assessment is about hydration rather than about the spots. Nail shedding weeks later is common and alarming and means nothing. Chickenpox appears in crops of lesions at different stages simultaneously, which is what distinguishes it. Slapped cheek disease produces bright red cheeks then a lacy rash on the limbs, and matters mainly for its effect on pregnant contacts and on children with certain blood disorders. Scarlet fever produces a sandpaper-textured rash with a strawberry tongue and follows a streptococcal throat infection; it is bacterial, it is treated with antibiotics, and this is the one where a swab changes management.

The rash that is different from all of these is a petechial or purpuric rash — small red or purple spots that do not fade when pressed. In an unwell, feverish child this is the presentation of meningococcal disease, a medical emergency treated in hospital immediately, and it is the one rash that is never watched overnight. In a well child it has other causes, including the condition in the next section.

Henoch-Schönlein purpura (Henoch Schonlein purpura)

Henoch Schonlein purpura — IgA vasculitis — is the commonest vasculitis of childhood and it deserves a section because it is frequently misread in both directions. A raised purple rash appears symmetrically over the buttocks and the backs of the legs in a child who is usually not very unwell, often following a viral upper respiratory infection. Joint swelling and abdominal pain accompany it in a majority.

Two things determine the outcome and neither is the rash. The abdominal pain can be severe and, uncommonly, signals intussusception, which needs surgical assessment with pediatric surgery. And the kidneys are involved in a proportion of children, sometimes weeks after the rash has faded and entirely without symptoms — which is why urine is checked at diagnosis and then repeatedly on a defined schedule for months afterwards, even in a child who has completely recovered. Missing that follow-up is the main avoidable harm in this condition, and it is the reason a discharge from this unit comes with a urine testing schedule rather than a reassurance.

Kawasaki disease

Kawasaki disease is a vasculitis of unknown cause that damages the coronary arteries if it is not treated, and it is the reason a fever lasting five days or more in a young child is looked at differently. The diagnosis is clinical: prolonged fever with a combination of red eyes without discharge, red cracked lips and strawberry tongue, a rash, changes in the hands and feet including later peeling, and a swollen neck lymph node.

It matters because treatment within a defined window from the onset of fever substantially reduces the risk of coronary artery aneurysms, and because incomplete presentations — particularly in infants — do not show the full combination and are the ones that get missed. Echocardiography with paediatric cardiology is part of the assessment rather than a later confirmation. A child with prolonged unexplained fever is reassessed rather than re-reassured, and this is the specific reason why.

Croup, bronchiolitis and the noisy breathing

Breathing problems in children are assessed by the sound and its timing, because the sound localises the obstruction.

Croup is inflammation of the upper airway, usually viral, producing a barking cough like a seal, a hoarse voice and a harsh noise on breathing in. It typically appears at night, frightens everyone, and improves substantially with a single dose of corticosteroid given by a doctor — one of the most effective and cost-effective treatments in paediatrics. Cold night air helps in practice while nobody has proved why; steam has been shown not to and carries a real scald risk, so it is no longer recommended.

Bronchiolitis is a lower airway infection of infants, usually caused by respiratory syncytial virus, producing wheeze, a wet cough and difficulty feeding. It is the commonest reason for admission to hospital in the first year of life. What matters is that almost nothing treats it: bronchodilators, steroids, antibiotics and chest physiotherapy have all been shown not to help in typical bronchiolitis, and the treatment is oxygen and feeding support where needed while the illness runs its course over one to three weeks. Parents deserve to be told that plainly rather than given a prescription to feel that something was done. Preventive monoclonal antibody protection is available for infants at risk and is arranged before the season.

Wheeze in a preschool child is not automatically asthma. Viral-induced wheeze is a distinct pattern, and the diagnosis of asthma in children under five is made over time rather than at one visit — which is why a trial of treatment is reviewed for effect rather than continued indefinitely. Asthma in children is managed with pulmonology, where inhaler technique and the same principles that apply to adults are covered in full.

Otitis media, ear infections and glue ear

Acute otitis media is inflammation of the middle ear and is extremely common in the first three years. The important shift in practice is that most cases resolve without antibiotics, and delayed prescribing — a prescription given with instructions to use it only if things have not improved after a defined interval — reduces antibiotic use substantially without worsening outcomes. Antibiotics are given without delay in children under six months, in those who are systemically unwell, and where both ears are affected in a young infant.

Glue ear — otitis media with effusion — is fluid behind an intact eardrum without acute infection, and it is different: it causes hearing loss rather than pain, it is easy to miss, and its consequence is on speech and learning rather than on the ear. It resolves spontaneously in most children over months, which is why the standard approach is watchful waiting with a hearing test rather than immediate intervention. Where it persists with significant hearing loss, ventilation tubes are considered with otorhinolaryngology. Any child with delayed speech has their hearing tested — that is a rule rather than a preference.

Growth, and what a centile actually means

Plotting growth is the single most informative thing done in a well-child clinic, and it is routinely misread. A growth chart shows where a child sits relative to a reference population, and a child on the third centile is not failing — three per cent of entirely healthy children are, by definition. What matters is the trajectory rather than the position: a child who has tracked the tenth centile since birth is almost always well, while a child who has crossed downward from the seventy-fifth to the twenty-fifth over a year needs explaining.

Two corrections are worth making because they generate a great deal of unnecessary worry. Breastfed and formula-fed infants grow along different curves in the first year, and using the wrong reference makes healthy breastfed babies look as though they are faltering at around three months. And preterm infants are plotted using corrected age until at least two years — plotting them by birth date makes normal growth look like failure.

Faltering growth and failure to thrive

Failure to thrive — increasingly called faltering growth, because the older term reads as an accusation — means weight gain that has fallen away from the expected pattern. The assessment is overwhelmingly about intake rather than about disease: what is actually going into the child, how it is offered, how long feeds take, and what mealtimes look like. In the large majority the cause is inadequate intake rather than malabsorption or an underlying illness, and a feeding history taken properly is worth more than a panel of blood tests.

Where investigation is warranted, it is directed rather than broad: coeliac (celiac) disease, cow’s milk protein allergy, urinary infection, iron deficiency, and in this region vitamin D deficiency. A short, thin child with normal energy, normal development and small parents is usually genetically short and needs no investigation at all.

Short stature and precocious puberty

Short stature is assessed against the parents rather than against the population: mid-parental height gives the range a child is expected to reach, and a child growing along a centile consistent with that is normal however low the centile is. What prompts investigation is height well below the expected range, a fall across centiles, or a growth velocity that is too slow when measured over six to twelve months — which is why a single height measurement answers almost nothing and a repeat measurement six months later answers a great deal. Bone age radiography and, where indicated, growth hormone testing are arranged with paediatric endocrinology.

Precocious puberty means pubertal changes before eight in girls and nine in boys, and it matters for two reasons: it can be the first sign of an underlying condition, and early puberty closes the growth plates early, so a child who is tall for their age now may end up shorter than they would have been. Assessment includes examination, bone age, hormone testing and, in specific situations, imaging of the brain. Treatment to pause puberty exists and is used selectively, with the decision made on predicted final height and psychological impact rather than on the finding alone.

Development, milestones and speech

Developmental milestones are described as ranges rather than dates, and the range is wide. Walking anywhere between about nine and eighteen months is normal; single words from around twelve months, with enormous variation. What is followed is the pattern across four domains — gross motor, fine motor and vision, speech and hearing, and social — because a delay confined to one domain means something different from a delay across all four.

Two findings are never watched and always assessed. Loss of a skill a child previously had is a red flag at any age. And a persistent asymmetry — consistently using one hand before twelve months, or one side moving less — is abnormal and is investigated rather than attributed to handedness.

Speech delay is the commonest developmental concern raised by parents, and the first step is always a hearing test, without exception, because undetected hearing loss is the most common reversible cause. Beyond that, the distinction that matters is between a child who understands but does not speak, which carries a better outlook, and a child who neither understands nor speaks. Bilingual exposure does not cause speech delay — that belief is widespread and wrong, and children raised with two languages reach communication milestones on the same schedule when both languages are counted together. Referral to speech and language therapy is made early rather than after a period of waiting to see, because the intervention works better the earlier it starts, and it is delivered with rehabilitation.

Where the concern includes social communication, restricted interests or sensory differences, assessment for autism is multidisciplinary and takes time — and a child does not need a completed diagnosis before support begins.

The newborn

The first weeks carry the smallest margin for error and generate the most questions.

Neonatal jaundice is extremely common and mostly physiological, appearing after the first day and settling over one to two weeks. Three things move it out of the normal category and each is checked rather than eyeballed: jaundice appearing in the first twenty-four hours, jaundice that is deep enough to require measurement rather than inspection, and jaundice persisting beyond two weeks in a term baby. Visual assessment of severity is unreliable in every skin tone, which is why a transcutaneous or blood measurement is used and plotted against a threshold chart by age in hours. Treatment is phototherapy, and exchange transfusion in rare severe cases. Prolonged jaundice is investigated because a small number are caused by biliary atresia, where the operation works far better if it is done early — and pale stools with dark urine in a jaundiced baby is the finding that must never be dismissed.

Feeding dominates the first weeks. Weight loss of a small percentage in the first days is expected, with birth weight regained by around two weeks. Breastfeeding support is a clinical service rather than a courtesy, and most difficulties are positioning and attachment rather than supply. Tongue tie — ankyloglossia — is assessed when feeding is genuinely impaired rather than because a frenulum looks short: many babies with a visible tie feed perfectly well, and division is offered for a functional problem, not for an appearance. Where it is indicated, the procedure is quick and the baby can feed immediately afterwards; it is performed with pediatric surgery.

Reflux in babies and colic

Reflux in babies is nearly universal to some degree, and posseting in a thriving, comfortable baby is a laundry problem rather than a medical one. It is treated when it causes faltering growth, distress or feeding refusal, and acid-suppressing medication is used far more often than the evidence supports. Colic — prolonged crying in an otherwise well, growing baby — has no reliably effective treatment, resolves by around four months, and the honest conversation is about support for exhausted parents rather than about another remedy.

Preterm and sick newborns are cared for in the neonatal intensive care unit, where the medical detail is beyond the scope of a page like this, and where the most important thing for families to know is that parents are part of the care rather than visitors to it.

This region: vitamin D and nutritional rickets

This is where paediatrics here differs most from paediatrics in northern Europe or North America, and it is a genuinely regional problem rather than a general one.

Vitamin D deficiency is common across Turkey, the Middle East and North Africa despite abundant sunshine, and the reasons are behavioural and cultural rather than geographical: limited skin exposure to sun, extensive covering, indoor living, high skin pigmentation, air pollution reducing effective ultraviolet, prolonged exclusive breastfeeding without supplementation, and maternal deficiency during pregnancy which leaves the newborn deficient from birth. Deficiency in the mother reliably produces deficiency in the baby.

Its severe form is nutritional rickets — softening of growing bone producing bowed legs, a widened wrist, delayed closure of the fontanelle, delayed walking, bone pain and, in infants, hypocalcaemic seizures that present as a neurological emergency in a baby with no fever. Rickets is a disease that most Western paediatricians will see rarely and that units here recognise, and it is entirely preventable.

Turkey has run a national vitamin D supplementation programme for infants for many years, providing free supplementation through the first year, and it substantially reduced the incidence of rickets — which is exactly why it is worth naming: the answer is known, cheap and already in place, and the failures are failures of continuation rather than of knowledge. Families arriving from countries without such a programme are frequently unaware that supplementation is recommended at all. Whether your child needs supplementation, and at what dose, is decided by the doctor seeing them; what can be said here is that it is asked about as a matter of routine rather than only when something is wrong.

Two related regional points. Iron deficiency without anaemia (anemia) is common and affects development before the blood count changes, which is why iron status rather than haemoglobin alone is considered in a pale, tired toddler with a milk-heavy diet. And beta-thalassaemia trait is common around the Mediterranean and is a frequent explanation for a persistently low mean cell volume that does not respond to iron — treating that child with iron indefinitely is a recognised and avoidable error, and the distinction is made with hematology.

Immunisation and the vaccination schedule

The vaccination schedule differs by country in timing and in which vaccines are included, which is the practical problem for families who move or travel. Two questions come up constantly and both have clear answers.

A child who has fallen behind does not start again. Catch-up schedules exist for every vaccine and the doses already given still count, however long the gap — the immune system does not reset. Bring the record, in whatever language, and the schedule is reconciled against it.

A mild illness is not a reason to postpone. A child with a runny nose, a mild cough or a low-grade temperature who is otherwise well can be immunised, and deferring for minor illness is one of the commonest reasons children fall behind. Genuine reasons to delay are specific and few.

Live vaccines are handled separately in children who are immunosuppressed, and vaccination of the household protects the child who cannot be vaccinated — which is the entire logic of protecting an immunocompromised sibling. Children who have had a transplant, are on chemotherapy or are starting biologic therapy have their immunisation status reviewed before treatment begins wherever possible, with infectious diseases, because live vaccines cannot be given once immunosuppression has started.

Constipation, diarrhoea and the gut

Constipation in children is common, under-treated and frequently mismanaged, and the pattern is nearly always the same: a painful stool leads to withholding, withholding leads to a larger and harder stool, and the cycle establishes itself over months. By the time a child is brought in, the rectum is often loaded and the presenting complaint is soiling — which parents read as behavioural and which is actually overflow around impacted stool. Treating that as naughtiness rather than as constipation is the central error.

Effective treatment has two phases and both are longer than parents expect: clearing the impaction first, then a maintenance phase lasting months, because stopping as soon as things improve reliably reproduces the problem. The medicines involved are prescribed and adjusted by the treating doctor. Alongside them, sitting on the toilet after meals as a routine rather than only when the urge arrives is the behavioural half of the treatment.

Acute diarrhoea (diarrhea) and vomiting is usually viral and the entire treatment is fluid. Oral rehydration solution is more effective than water, juice or fizzy drinks, which can worsen it, and the assessment is of hydration rather than of the number of episodes. Antidiarrhoeal medicines are not used in young children. Prolonged diarrhoea, blood in the stool, weight loss or growth faltering move the assessment towards coeliac disease, cow’s milk protein allergy, inflammatory bowel disease or infection, and are investigated with gastroenterology.

Bedwetting is common well beyond the age most families expect, occurring in a meaningful proportion of five-year-olds and resolving spontaneously in most. It is not laziness and it is not psychological in the great majority. Constipation is a frequent and correctable contributor and is looked for in every case. Where treatment is wanted, alarm training and medication are both effective in different ways, and punishment and fluid restriction at bedtime are neither. Daytime wetting is a different problem and is assessed properly rather than lumped with it.

Chronic conditions and the paediatric sub-specialties

Children with long-term conditions are managed by paediatric sub-specialists rather than by adult specialists seeing a smaller patient, because dosing, growth, development, school and the eventual transition to adult services all change the management.

A heart murmur in children is the clearest example of something that sounds alarming and usually is not. Innocent murmurs are common, occur in healthy children, are often louder during a fever, and have recognisable characteristics — soft, systolic, no other symptoms, normal pulses. What prompts referral to paediatric cardiology is a murmur with any additional feature: a diastolic component, feeding difficulty or poor growth in an infant, breathlessness, cyanosis, an abnormal pulse or a family history. Echocardiography settles it definitively and reassurance from a normal echocardiogram is permanent rather than provisional.

Type 1 diabetes in children presents with thirst, excessive urination, weight loss and tiredness over weeks, and it is missed often enough that it is worth naming: a child with those symptoms needs a glucose test that day, because presentation in diabetic ketoacidosis is preventable and remains common. Care is shared with paediatric endocrinology.

Urinary tract infection in a young child is confirmed with a properly collected sample rather than diagnosed on a bag specimen, and a confirmed infection in an infant prompts imaging to look for underlying anomaly, with paediatric nephrology and urology. Recurrent unexplained fevers with no source, particularly with abdominal pain and a family history, raise familial Mediterranean fever, which is markedly more common in this region and is managed with rheumatology. Childhood cancers, chronic kidney disease, epilepsy and asthma are each managed with the relevant paediatric sub-specialty listed in the team section.

Flat head, torticollis and the musculoskeletal questions

Flat head syndrome — positional plagiocephaly — became common after back-sleeping was correctly adopted to reduce sudden infant death, and it is a cosmetic condition rather than one affecting brain growth or development. It improves substantially with repositioning, supervised tummy time while awake, and alternating the direction the baby faces in the cot, and it continues improving as the child begins sitting and standing. Helmet therapy is used for selected severe cases within a defined age window and is not required for most.

The important associated finding is torticollis — tightness of the neck muscle on one side, which keeps the head turned consistently one way and causes the flattening in the first place. Treating the flattening without treating the torticollis does not work, so the neck is examined in every baby with an asymmetric head, and physiotherapy is started early because it is far more effective in the first months.

Two other common questions. Bow legs are normal in toddlers and knock knees are normal in early childhood, both correcting spontaneously with growth — what is not normal is asymmetry, pain, or a deformity that is worsening rather than improving with age. And limp in a child is never dismissed: transient synovitis after a viral illness is the commonest cause and settles, but septic arthritis, Perthes disease and slipped upper femoral epiphysis all present this way and each is time-critical, so a limping child is examined and imaged rather than watched, with orthopedics.

What paediatrics will not do

• Treat a number instead of a child. The height of a fever, a position on a centile line and a wheeze on its own are all data. How the child looks, feeds and behaves is the assessment.
• Give antibiotics to close a consultation. Most childhood infection is viral, most ear infections resolve without antibiotics, and bronchiolitis responds to none of the treatments commonly given for it. Saying so is the job even when it disappoints.
• Investigate a well child broadly. A short child with normal growth velocity, normal development and short parents needs no blood tests, and a wide screening panel in a well child mostly generates incidental abnormalities to chase.
• Dismiss a parent who says this is not like my child. That sentence is one of the strongest predictors of serious illness in paediatrics, and it is acted on rather than reassured away.
• Divide a tongue tie because it looks short. Division is for a functional feeding problem, not for an appearance, and many babies with a visible tie feed perfectly well.
• Promise a developmental outcome. Where a delay is real we say what is known and what is not, and we start support before the diagnostic process is complete rather than after it.

Your multidisciplinary team

The general paediatrician holds the whole picture — growth, development, immunisation, acute illness and the coordination of everyone else — and in children that coordinating role matters more than in adult medicine, because a child with a chronic condition may otherwise see six specialists and nobody looking at the child. The neonatologist leads newborn and intensive care. The paediatric nurse does the clinical work that determines whether a child tolerates the visit at all. The play specialist is not a comfort service: preparation and distraction measurably reduce distress and the need for sedation during procedures. The dietitian and the speech and language therapist carry a large share of the outcome in faltering growth and in developmental delay respectively.

Around them: pediatric surgery for anything operative, cardiology for murmurs and congenital heart disease, endocrinology for growth, puberty and diabetes, neurology for epilepsy and developmental neurology, nephrology and urology for kidney and urinary problems, pulmonology for asthma and chronic lung disease, gastroenterology for coeliac disease and inflammatory bowel disease, hematology and medical oncology for blood disorders and childhood cancer, infectious diseases for immunisation before immunosuppression, rheumatology for juvenile arthritis and familial Mediterranean fever, dermatology for children’s skin, otorhinolaryngology for ears and tonsils, ophthalmology for vision screening, medical genetics for inherited conditions, and rehabilitation for physiotherapy and speech therapy.

The international patient journey

Families travel with children for three reasons, and they need different things.

The first is a second opinion on a diagnosis — a developmental assessment, a cardiac diagnosis, a growth problem, or a chronic condition where the family wants the plan reviewed before committing to years of it. Much of this is done remotely. What is needed is the growth chart itself rather than a summary of it, because the shape of the curve is the information; the immunisation record in any language; imaging as files; and where the concern is developmental or paroxysmal, video — thirty seconds of a child’s actual movement, seizure or behaviour is worth more than any description.

The second is a defined episode of care: an assessment block, a procedure, or the initiation of a treatment that then continues at home. For children this is planned around school terms and around the practical reality that a child who is unwell travels badly, and the plan states who continues the care at home and at what interval.

The third is a family already living here or arriving for a longer stay, needing routine paediatric care in a language they share with the clinician. That is a continuity relationship rather than an episode, and reconciling the immunisation record is usually the first task.

Three practical notes specific to children. Bring the child’s own health record book, whatever country issued it — it contains the growth points, birth details and immunisation dates that would otherwise take an hour to reconstruct. Medicines for children are dosed by weight, so an accurate current weight matters more than it does in adults and is measured rather than reported. And tell us in advance if your child has had a difficult experience with hospitals: preparation and a play specialist change how the visit goes far more than anything we can do on the day.