I am now well and truly almost 2/3rds of the way through medicine. In my fourth year of medicine this year, I had the pleasure of experiencing the rotation of Paediatrics for my first 9 week block. We had one week of orientation lectures, followed by 4 weeks at the Angliss Hospital and 4 weeks at Maroondah Hospital.

The Angliss Hospital paediatrics department is the larger of the two. It consists of a Short Stay Unit, where patients up to 18 years can stay up to 36 hours. The Angliss also has a Special Care Nursery for the babies in its maternity ward that require some extra care, such as resuscitation, or who are experiencing poor growth, feeding, or other issues. On the other hand, Maroondah Hospital has no maternity ward, and therefore no nursery. Its paediatrics department is purely its SSU. Both sites also have paediatrics outpatients clinic for patients requiring follow-up over the long term. Box Hill, the other major hospital in the Eastern Health sites, was only for Deakin patients. However, I did have one clinic at Box Hill because our tutor, who was based in Box Hill, invited us there. In fact, the Angliss had to shut off maternity and special care nursery services during covid around 2 years ago because the lift was broken.

At the Angliss Hospital especially, I got to experience a vastly different patient demographic compared to the Alfred Hospital last year. Obviously, the patients were children compared to only adult patients at the Alfred, but I’m talking about the patient’s parents and other factors like their socioeconomic status, racial backgrounds and whatnot. Patients in general at the Angliss were likely to be less well off. Patients were also more likely to be Anglo – compared to patients at the Alfred where there a much larger proportion of people from different ethnic backgrounds like Russians, Jews etc. However, at both these hospitals, as peripheral hospitals with unspecialised paediatrics departments, the demographic of presentations were quite generic. Most patients in the SSU had relatively simple presentations like bronchiolitis, croup, viral-induced wheeze, and asthma. Patients in the rapid review clinic, who are seen in the SSU to follow up patient concerns from a few days earlier, also had issues like rashes and constipation. There were very few patients above the age of 10 that we saw – most were neonates (in the SCN), infants or young children.

However, the most interesting thing was being able to learn how to approach children and their parents. Adult patients are quite different to children – who themselves are split into multiple groups. There is little issue dealing with neonates and young infants apart from the anxiety that parents often have – with some parents refusing to let students interact and examine the baby. However, for patients above the age of maybe 3 or 4, it was important to include the patient in the interaction as they would be able to describe their own symptoms, and would more likely be compliant to examination if they felt comfortable with the examiner. For patients in their teens, they were the main focus of the patient interaction on the most part, with parents helping them answer questions if they had trouble.

From an academic perspective, one theme that was commonly said are that ‘children are not just small adults’. However, from my experience in the paediatrics wards, I feel like medical paediatric conditions are on the whole, simpler than adult conditions, at least from a fourth year medical school exam-focussed perspective. There aren’t many conditions that children come in for, and they are in general, weller than adults. They have had less time to develop conditions that come from lifestyle factors, such as obesity. I also accept that the hospitals I am at have not given me a look into the range of conditions – in fact, I did not see many patients outside of the respiratory system. I did not see any Diabetes Type 1 or 2 patients, very few congenital cardiac abnormality patients, just to name a few. I also have not been involved in the developmental side of paediatrics as much, which is one major difference to adults. Children are so much more impressionable from a health perspective, so much more malleable, with the proper management within the first few days, weeks, and months of life being so crucial for the long term health of the patients. It is also very difficult to predict conditions that come about later in life, some of which are caused due to issues as slow growth in the early years of life – but in many cases, these issues also resolve.

Anyway, the management of patients seemed more straightforward compared to adult patients, with a smaller range of drugs used, preset algorithms on the Royal Childrens’ Hospital’s Clinical Practice Guidelines, which is an excellent resource for clinicians, parents and patients alike. The diagnosis can often be made on a clinical basis, especially conditions like bronchiolitis, croup and early asthma.

After this rotation, I feel like I would not want to do paediatrics as a specialty. The staff were amazing – which makes sense – they were fun, bubbly and very enthusiastic doctors who had a way with kids, but were also very friendly to us students. Kids are adorable and dealing with them is fun – and perhaps I did not have to deal with more serious conditions – but adult medicine just seems more interesting to me, at the moment.