department is committed to the provision of a patient-centred, seamless,
comprehensive and quality general paediatric service to the children
of Hong Kong Island. The general paediatric wards located on the seventh
floor of the K-Block of Queen Mary Hospital have 37 in-patient beds
and 8 day-beds.
With the recent outbreak
of avian influenza and severe acute respiratory syndrome (SARS) in Hong
Kong and Asia, the general paediatric wards have been extensively refurbished
to contain 9 negative pressure rooms for isolation of patients admitted
with suspected and confirmed diseases requiring airborne isolation.
Patients with fever are admitted to ward K7N while afebrile patients
are admitted to K7S after triage. Stringent infection control measures
are enforced in ward K7N and cohort nursing practiced for patients requiring
droplet, contact and airborne precautions. Gowning and showering facilities
are available on the seventh floor in case of future outbreaks of emerging
infectious disease like SARS.
comprehensive quality paediatric service is critical for undergraduate
paediatric training and providing appropriate experience for trainees
in the postgraduate paediatric training programme supervised by the
Hong Kong College of Paediatricians. The undergraduate and postgraduate
training in paediatrics are ably undertaken by the paediatricians working
in the general paediatric service. The paediatricians of the general
paediatric service are also involved in the supervision of trainees
in the Family Medicine Training Programme rotating through our department.
The staff of the general
paediatric service manages patients admitted with acute paediatric disease
including those with cardiac, respiratory, neurological, renal, endocrine
and adolescentproblems. In the past 5 years, the number of acute admission
has been around 9,000 to 10,000 cases annually and the number of out-patient
attendance has been between 24,000 to 28,000 cases per year.
In the future planning of the general paediatric service in our department,
we have to take into account of the declining birth rate, changing pattern
and epidemiology of diseases, emergence of new disease entities and
the development of paediatric sub-specialties. There will be a shift
of emphasis to day care and ambulatory care of children with acute paediatric
With the extension of the age of admission to 18 years, we are seeing
more adolescent patients with chronic illness complicated by psychosocial
issues. The adolescent service is involvedin providing assessment and
management of adolescent in-patients with eating disorders, drug overdose,
attempted suicide, pseudoseizures, emotional or behavioural disturbances.
A bio-psychosocial approach and close liaison with other health care
professionals, social services, schools and family is crucial.
The Adolescent Clinic was first established in November 1994. Paediatricians
work closely with clinical psychologists and social workers to provide
an out-patient multi-disciplinary health service to adolescents aged
between 10 and 19 years presenting with medical, health and/or developmental
concerns. Patients with psychosomatic disorders, eating disorders, stress
related disorders, adjustment issues to chronic illnesses and physical
developmental concerns such as growth and pubertal disorders are also
seen. Expert gynaecological service is also provided on a consultative
basis by Prof Grace Tang.
The adolescent team is also actively involved in providing consultative
medical services to the Youth Health Centre of the Family Planning Association
of Hong Kong, health education to schools and training to social workers.
The team also works in close collaboration with the University of Hong
Kong Family Institute in the assessment and management of children and
their families with complex psychosocial problems.
children with acute respiratory problems are managed in the general
paediatric wards. Respiratory infections and asthma account for a significant
proportion of the workload. Viral respiratory infections due to respiratory
syncytial virus, parainfluenzae viruses, adenovirus and especially influenza
virus have been shown to be an important cause of hospitalization in
Hong Kong. The rate of admission for influenza far exceeds similar infections
in most developed temperate countries.
The prevalence of asthma has been on an increase in Hong Kong. The respiratory
service provides lung function test, allergy testing and out-patient
care of children with asthma and other chronic lung diseases.
New developments include measurement of exhaled nitric oxide as an indicator
of airway inflammation and measurement of airway inflammatory cytokines
from exhaled breath condensate of children with chronic lung disease.
Children and adolescents with obstructive sleep apnoea are investigated
in the newly established Central Sleep Laboratory of Queen Mary Hospital.
The general paediatric service also provides acute care for patients
on chronic ventilatory support transferred from the Duchess of Kent
Children and adolescents with chronic disabilities are increasingly
admitted to the general paediatric wards for assessments. The gastroenterology
team members have an active interest in the care of children with chronic
neurological disease and feeding difficulties. They provide 24-hour
pH studies and advice on gastrostomy feeding. Occupational therapist,
speech therapist and our surgical colleagues work closely in the management
of feeding in these patients. Endoscopic examination service is provided
The staff of the paediatric nephrology service is responsible for the
care of children with complicated urological problems, nephritis, nephrosis,
renal tubular problems and chronic renal failure. Renal biopsies are
regularly performed under ultrasonographic guidance.
In addition to providing consultations to acute neurological admissions
managed under the general paediatric service, the staff of the paediatric
neurology service also provides 24-hour video-electroencephalographic
monitoring and assessment of children with difficult seizure disorders.
A video-EEG suite has been planned in one of the cubicles in ward K7.
24-hour diabetes hotline is managed by paediatric diabetes nurse educators
and trained nurses in the general paediatric ward. The hotline provides
advice to patients with diabetes and their parents under the supervision
of the on-call paediatric endocrinologist.
More and more patients with general paediatric problems are managed
either as day-patients or out-patients. An average of 2,800 day-patients
attended the general paediatric day service for investigations and assessments
Paediatrics in the future
In the era of paediatric sub-specialization, there is a need to define
the role of a general paediatrician. An accurate balance between providing
good integral general paediatric care and top of the line sub-specialist
care is a challenge in the coming years.