Follow-up by the paediatrician

Standard follow-up of development and vaccinations are arranged for by Child and Family (Kind & Gezin). A few children who are in need of extra care or follow-up (premature babies, children with developmental delays or another medical problem since/shortly after birth) will be followed up by a paediatrician. To limit the number of consultations for these children slightly, we try to combine these check-ups with vaccinations.

If the examination around the baby’s seventh day does not reveal any problems either, then we traditionally only see children in case of disease or health problems (see below). If multiple consultations or long-term treatment are required, we will endeavour to have this performed by the same paediatrician of your preference. In many of these situations, an appointment can be booked in advance and said paediatrician will be available.

Read more about your baby’s or child’s vaccination here.

This test (termed ‘heel prick’ in the past) is used to detect 11 congenital disorders.

This involves disorders that are present before birth but only become manifest later on. These diseases are rare but often very serious. Early detection and timely treatment can prevent serious disabilities and chronic disease. The 11 diseases can be divided into four main groups:

• Disorders of protein building blocks metabolism (PKU, MSUD, MMA/PA, IVA, GA1)
• Disorders of fatty acid metabolism (MCADD, MADD)
• Disorders of the recycling of the vitamin biotin
• Hormonal disorders (thyroid, adrenal glands)
• Mucoviscidosis (cystic fibrosis)

From 72 to up to a maximum of 96 hours after birth, a few drops of blood are collected on a special card. This is then sent to a laboratory that has been designated by the Flemish government. This test can take place in the hospital or after you have gone home. In the latter case, a midwife will perform the test at your home. An adapted schedule is used for premature and ill babies.

If you have not heard anything in three weeks, that means that the results are favourable. In case of abnormal results, your physician is informed and a second test is necessary. That usually takes place no later than two weeks after the first blood test. The physician will decide which treatment is required based on the second result. The test is not mandatory but is strongly recommended.

The costs of the test are paid by the Flemish government. Therefore, participation in the screening programme is free of charge. In case of an abnormal result, additional consultations and further tests may be required. As all other regular medical services, these are not free but are reimbursed to a certain level by the mandatory health insurance.

Since 1 January 2019, verbal consent by one of the parents is required before blood samples for this test may be collected. The midwife will ask for consent and make a note of this on the back of the blood spot card. If no consent is given, this refusal must be confirmed in writing by one of the parents.

The blood spot cards are kept for five years. They are only used for the Population Screening Programme, but may also be used for diagnostic investigation in the interest of the child, in response to a written request of the attending physician and if accompanied by written consent by the parents or guardian of the child involved. Although the blood spot cards are not kept for the purpose of scientific research, a researcher may use the blood spot cards provided they have obtained permission from an Ethics Committee, Privacy Committee and provided they have obtained written consent from the parents.

For further information we would like to refer you to www.aangeborenaandoeningen.be.

Sudden illness

You will usually be able to consult the physician of your preference, preferably by advance appointment. In case of sudden illness, the situation is different. You may not be able to see the physician of your preference immediately or at your preferred time. Each paediatrician schedules slots in his or her diary every day, but these are limited in number. Additional slots are reserved every day too for dealing with sudden illness. In that case, consultations are with a paediatrician in training but always under the supervision of and in consultation with a paediatrician, who you will see too.

Many cases of sudden illness can often be treated by your GP. If the GP wants our advice, they will refer you to us. In urgent cases, your GP will contact us by telephone.

If your child suddenly appears very seriously ill, you must of course go to A&E. In extreme cases, call the emergency number 112.

Fever

One reason why parents want to have a prompt consultation is fever in their child. It is important to realise that in such cases, urgency is only required in a minority of cases and that all paediatricians are appropriately trained to take suitable measures. Paediatricians consult with each other regularly, and we all work based on the same medical records.

Fever refers to a body temperature of above 38 °C. You can measure temperature in a good many different ways. The most reliable method remains using a thermometer in the stools, especially for young children. A strip thermometer or ear thermometer are not always that accurate.

It is important to realise that fever is a symptom and not a disease in and of itself. Fever is usually a natural, in itself harmless reaction of the body to an infection, to promote the recovery process of tissue and cells. It is therefore a sign that the body’s own immunity system is acting in defence against an infection. An infection may be caused by bacteria or viruses. In most cases, fever is caused by a viral infection that generally disappears of its own accord, such as the common cold. The degree of ‘being ill’ is more important than the height of the fever - a 40 °C fever in itself is not a reason for panic. The duration of the fever may vary (a few days to, on occasion, ten days). Half of children with a fever will be fever-free after four days.

What is important when assessing a child with a fever is how high the risk is that a serious (bacterial) infection is causing the fever. This means that account is taken of the maturity of the immune system, vaccination status, the risk of dangerous microbes and the presence of other disease symptoms.

In other cases, you may consult your GP first for a fever, unless the following applies too:

• Abnormal level of consciousness: drowsiness (alert only after physical stimulation)
• Abnormal behaviour: inconsolable crying, groaning, sudden inability to do things they were capable of doing before, feverish shivering
• Abnormal movement: bizarre position of a limb, convulsions
• Abnormal breathing: nasal flaring, retractions
• Signs of dehydration
• Fever lasting longer than four days
• Abnormality of one or several joints: swelling of the joint or decreased use
• Abnormal colouring: mottling, grey, white or a dark red/purple/blueish skin rash that does not fade when pressure is applied locally
• Bulging fontanelle

Children in whom a specific heart disorder or immunity disorder has been diagnosed will receive specific advice to follow in case of fever.

The A&E Department is there to help patients who are in need of urgent medical assistance. It is not possible to visit the department by appointment, since a heart attack for instance cannot be predicted.

You may need to wait at the A&E. It may also happen that a person who arrived after you is seen sooner than you, or that the emergency doctor is called away. Read more here about waiting times at our A&E Department.

It can be overwhelming for a child to go to A&E. We would like to give you a few tips to help you prepare your child.

Non-urgent communications (growth data, reports, prescription requests, communicating an update, as agreed with the attending physician) contact by e-mail.

Have urgent questions about an acute illness? Contact by phone.

Did you know that it is often not possible to provide reasoned advice without having actually examined your child. This means that a consultation is necessary, especially for those patients who have not been seen for several months.