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A-Z Services - Child Health

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Specialties

 

Whilst all our doctors are paediatricians we have many consultants who further specialise in particular areas. We have included some information below on these specialties in alphabetic order which explains what we do, and who provides that care. 

 

Allergy

We provide a holistic allergy service covering the complete range of atopic conditions run by three consultants, 2 clinical nurse specialists and a specialist dietitian. We care for children with all allergic disorders such as food allergy, drug allergy, urticaria and angioedema, eczema, hay fever and asthma and complicated situations involving non IgE mediated food allergies. We aim to improve quality of life for children and families across this spectrum. We offer skin prick and blood testing as well as food and drug challenges. We will offer immunotherapy for hay fever as appropriate and link in to schools and nurseries to ensure a smooth cover of care. We transition patients to adult care in Derriford hospital when appropriate and link strongly into the dermatology, respiratory and ENT department within our hospital.  

Benign Haematology

We offer an outpatient service for benign haematological conditions and work closely with adult haematology. Twice a year we run regional haemophilia clinics in conjunction with the Children’s hospital in Bristol.

Cardiology

The paediatric cardiology (children’s heart) service at the RDE is provided by three consultants, all of whom are “Paediatricians with expertise in cardiology”.  We are all trained to provide the clinical assessment of children with suspected or proven heart disease which has been diagnosed before or after birth.  We offer an acute inpatient service to infants, children and adolescents with heart problems as well as an outpatient service for those referred by their GPs.  In addition to clinical examination, we can analyse ECG’s, perform cardiac ultrasound (echocardiography) and perform and interpret specialist tests such as ambulatory ECG’s and blood pressure monitoring.  We liaise closely with the Children’s Heart Unit in Bristol.

Community Child Health

The Community Child Health team at the RD&E are a team of consultants, speciality doctors and clinical nurse specialists. We carry out work in the following areas:

Developmental assessment, investigation and diagnosis in pre-school children

  • On-going medical management of neurodisability in children and young people up to the age of 18 years (or school leaving age if at special school). e.g. Down Syndrome, Cerebral Palsy, Sensory Impairment, Neurofibromatosis, Tuberous sclerosis, Neuromuscular conditions and other congenital/inherited conditions in which health surveillance is required
  • Medical input to multidisciplinary assessment of school age children in whom there are neurodevelopmental concerns, and on-going management of ADHD as clinically indicated.
  • Medical input as per statutory requirements - Children in Care, Safeguarding, SEND

Community Paediatricians work closely with other health professionals and other agencies, as part of the multidisciplinary team. Clinics are held in locations close to child’s home or school. Special school clinics are vital in the on-going health surveillance and management of children and young people with complex needs by allowing easier access for parents / carers compared to a hospital based clinic, include all members of the multidisciplinary team and the child / young person does not miss school. In addition to scheduled clinic appointments, community paediatricians may attend Team Around the Child (TAC) meetings or Annual Review meetings, if necessary, and carry out joint consultations with other health professionals.

 

Devon’s SEND Local Offer is the education, health and social care services and support for children and young people with special educational needs and disabilities (SEND) from birth to 25. Visit the Devon.Gov website for more information.

 

Cystic Fibrosis

The RD&E is designated as a Cystic Fibrosis Centre, caring for over 80 children with CF from across Devon.

 

There is close liaison with adult CF services and many of our multidisciplinary team work with both adults and children. Our team comprises of clinical nurse specialists, dietitians, pharmacists, physiotherapists and psychologist. Our standings in the CF trust annual report was extremely good, with good overall readings on several parameters and excellent use of appropriate medications and access to clinical trials.

Diabetes

The Exeter Children and Young People’s Diabetes Service provides care for children < 19 years old with all types of diabetes in Exeter and surrounding areas. We are a friendly and enthusiastic multidisciplinary team, led by Dr Chris Moudiotis, with a high level of expertise and good clinical outcomes. We currently look after 200 children with Type 1, Type2, Monogenic and Cystic Fibrosis Related Diabetes with 30% on pump therapy (March 2016 data). Our core team consists of doctors, paediatric diabetes specialist nurses, a diabetes dietitian and psychologist. We have good working relationships with our adult colleagues during transition of care. Recent patient reported feedback included a Friend and Families test score of 9.7 out of 10 (versus 9.0 nationally for diabetes units). 

Endocrinology

The Exeter Paediatric Endocrinology Service provides care for children and young people with disorders of growth & puberty, the hypothalamic-pituitary system, the adrenal, thyroid and calcium axis, bone health and disorders of sexual development. We see children with extreme obesity in this clinic to rule out associated medical conditions but at present we do not have a commissioned childhood obesity service. We work closely with the Bristol Paediatric Endocrinology service and run joint clinics locally. We also provide endocrine expertise for the Paediatric Oncology and Cystic Fibrosis Network services and have a transition pathway in place with local adult endocrinologists.

Eating disorders and Young People’s Mental Health

This service provides an interface between the physical and mental health. It covers eating disorders, acute mental health crises including self-harm and medically unexplained symptoms. The team comprises of a specialist dietitian, and two specialist nurses who work closely together and with the Child and Adolescent Mental Health Service. This set up has been cited by NHS England as a national model for good practise. The team have developed a pathway of joint care for those children presenting acutely to hospital with mental health crises. They have also recently established a pilot service for young people with medially unexplained symptoms that affect their daily functioning and school attendance. This is a multi-disciplinary team comprising of paediatricians, physiotherapists, occupational therapist and CAMHS input.

Gastroenterology

We provide specialist gastroenterology services, including endoscopy, for local children and young people with gastrointestinal problems such as inflammatory bowel disease and coeliac disease. We have strong links with adult gastroenterology and local tertiary centres

Gynaecology

We provide a specialist paediatric and adolescent gynaecology clinic with a paediatrician and an adult gynaecologist to cater for the younger children who need gynaecology input.

Neurology

We have a strong neurology service at the Royal Devon and Exeter hospital. Three consultant paediatricians and an epilepsy specialist nurse run the epilepsy service for children and young people, and link closely to the regional epilepsy surgical service. We look after children who have vagal nerve stimulators and those on a ketogenic diet for their epilepsy. We care for a number of children and young people with headache and other neurological conditions, linking with good local neurophysiology and neuroradiology teams as well as the paediatric neurosciences centre in Bristol.

Nephrology

The Paediatric Nephrology service includes a weekly children's renal clinic seeing patients with problems that include recurrent urinary tract infections, nephrotic syndrome and congenital kidney problems. The team works closely with a nephrologist and urologist from Bristol Children’s hospital and jointly care for children with more complex kidney problems including those patients who have had a kidney transplant. They hold a joint clinic based in the Children's outpatient department at the RD&E every 3 months. The wider team includes support from an adult kidney specialist, specialist community nurses and dieticians. We also look after children with continence problems together with the specialist bladder and bowel nursing team based at Franklyn house in Exeter. The department has a strong research interest. We are currently taking part in the PREDNOS trials, contributing to the RADAR database and Nephros trials.


Further information for parents and carers about common children's kidney conditions is available at http://www.infokid.org.uk

Neurodisability

Children with neurodisabilities (such as cerebral palsy, neuromuscular disorders and physically disabling genetic conditions) have care coordinated through the Neurodisability Network. This is a collaboration involving RD&E paediatricians, surgeons, and therapists in close association with Vranch House school therapy team and Integrated Children’s Services staff. All aspects of children’s health, development and wellbeing are considered and supported. Outpatient clinics are frequently multidisciplinary and wherever possible held in locations convenient to the family such as regional health centres and special school clinics.


Some children with disabilities and additional needs need frequent and prolonged hospital admissions. We support these needs, recognise children as individuals. Individual care plans incorporate ‘All about me’ Health passports. 

Oncology

We are a level 3+ shared care oncology service, the largest in the UK. We offer chemotherapy and supportive care as well as long term follow up for North, South, East and Mid Devon. We are also a designated centre for Teenage and Young Adult (TYA) with Cancer. The team comprises of two consultants, a specialty doctor, 4 clinical nurse specialists, and a CLIC Sargent Social worker. We have 2 inpatient cubicles and a day care unit with 4 beds.

Rheumatology

We see children with features suggestive of inflammatory musculo-skeletal conditions as part of the informal South West paediatric Rheumatology network. We have strong links with the adult rheumatology service. There is no commissioned service for children with non inflammatory musculo-skeletal pain.

Respiratory

The paediatric respiratory service provides regular outpatient clinics supported by a respiratory nurse in which we undertake assessments of children with chronic cough, asthma and other breathing difficulties.

 

The service is linked to local allergy and immunology services and we offer screening for TB and BCG immunisation. Although the service can undertake basic sleep studies, we are not commissioned to manage severe sleep disorders of breathing or respiratory insufficiency.

Transition

We have a multidisciplinary team that are involved in the transition process supported by the steering group and uses the validated paperwork “Ready steady Go”.  Our transition service is for those children with complex medical needs who need to move from paediatric adult care. We work hard to ensure the transition is a smooth and seamless as possible.