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We are a specialist paediatric respiratory service and helped pioneer the development of the specialty in the UK. We diagnose and treat infants and children with all types of respiratory breathing problems, and specialise in complex illnesses. We see children referred by local GPs as well as by hospitals in south London and south east England.

Our outpatients clinics include general respiratory, asthma, difficult asthma, tuberculosis, non-CF bronchiectasis, ventilation NIV and invasive , and a weekly rapid access clinics.

We have a fully equipped paediatric lung function laboratory, a bronchoscopy investigation suite and a full range of diagnostic facilities. We work closely with the Regional Cystic Fibrosis and Adolescent Centre , and give advice and support to services such as general paediatrics and critical care. We are also an accredited training centre and we do research into many areas of paediatric respiratory medicine and cystic fibrosis. Please bring any medications, including inhaler devices, which your child may be using, to the appointment.

There is an increasing spectrum of nurse practitioner roles identified in pediatric care that have been evolving for many years. While some areas of respiratory care, such as asthma 53 , 54 and cystic fibrosis, 55 , 56 have well established nurse practitioner roles, these roles may not be that easily identified in the management of children with acute RTI in the hospital environment. Community neonatal nurses supporting infants and families after discharge from neonatal intensive care units is another established area of practice where specialist nurses deliver respiratory care.

Emergency departments and pediatric assessment units are seeing changes in medical practice with the emerging role of the advanced pediatric nurse practitioner. Advanced pediatric nurse practitioners are trained to a level where they can autonomously assess and manage children to the level of a medical professional, including ordering investigations, planning medical and nursing care, and prescribing medications, while also undertaking nursing care. While it is important that antibiotics are prescribed with caution, as discussed previously, all prescribers, including non-medical prescribers, must have an understanding of where such prescriptions are likely to be beneficial.

However, the final decision regarding prescription of antibiotics lies with the clinician, and will be decided depending on the clinical condition of the patient. Figure 6 highlights the antipyretics commonly used in clinical practice and also the rationale for using single antipyretic agent. Figure 5 Pathway for deciding antibiotics in respiratory tract infections. National Institute for Health and Clinical Excellence. This figure is an adaptation of content from CG69 Respiratory tract infections โ€” antibiotic prescribing: Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care , published by the National Institute for Health and Clinical Excellence The original publication is available from www.

This adaptation has been reproduced with permission of NICE.

Respiratory care services career at Children's Hospital of Wisconsin

Figure 6 Antipyretic use in children. RTIs in children are common in clinical practice.


Health professionals in the community play an important role in managing children with reassurance, guidance on symptomatic management, and referring early where escalation of care is necessary. Nurses in the hospital environment need to deliver a holistic care package whereby both medical and emotional aspects are addressed. The role of nurse specialists is being increasingly recognized in some areas of respiratory care, and needs further expansion both in primary and secondary care.

Included in this expanding role is the value of health promotion to educate families, thereby improving uptake of immunization, which has a role in preventing serious RTIs, such as epiglottitis and pneumonias. Schaad UB. Prevention of paediatric respiratory tract infections: emphasis on the role of OM Eur Respir Rev.

Effective management of lower respiratory tract infections in childhood. Nurs Child Young People. Paediatric Clinical Examination Made Easy. London, UK: Churchill Livingston; NHS Choices. Respiratory tract infection. Accessed June 20, British Thoracic Society guidelines for the management of community acquired pneumonia in children: update Scottish Intercollegiate Guidelines Network.

Bronchiolitis in children.

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SIGN guideline Diagnosis and treatment of respiratory illness in children and adults. Accessed September 3, Gestational age, birth weight, and risk of respiratory hospital admission in childhood. Epidemiology of community-acquired pneumonia in children seen in hospital. Epidemiol Infect. Treating pneumonia in children.

Independent Nurse. Finn R. To X-ray or not in child with signs of pneumonia. Thomson A, Harris M. J Pediatr.

Pointers for pediatric respiratory assessment?

Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Paul SP. The assessment and management of an infant with bronchiolitis. Journal of Health Visiting. Whelan B. Nurse role in RSV management. Early Hum Dev. McDougall P. Caring for bronchiolitic infants needing continuous positive airway pressure. Paediatr Nurs. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. Eur Respir J.

Nursing Shared Governance | Children's Hospital of Philadelphia

Antibiotics for bronchiolitis in children. Nagakumar P, Doull I. Current therapy for bronchiolitis. Arch Dis Child. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Preschool wheeze is not asthma: a clinical dilemma. Indian J Pediatr. Viral lower respiratory tract infection in infants and young children. Bhatt JM. Recurrent wheeze in pre-school children. British Journal of Family Medicine. Croup in children. Narayanan S, Funkhouser E. Inpatient hospitalizations for croup.

Hosp Pediatr. Tibballs J, Watson T. Symptoms and signs differentiating croup and epiglottitis. J Paediatr Child Health. Bacterial tracheitis: a therapeutic approach. Groothuis JR, Makari D. Definition and outpatient management of the very low-birth-weight infant with bronchopulmonary dysplasia.

Adv Ther. Follow-up care for infants with chronic lung disease: a randomized comparison of community- and center-based models. Multicentre validation of the bedside paediatric early warning system score: a severity of illness score to detect evolving critical illness in hospitalised children.

Crit Care. Accessed June 24, Management of sore throat and indications for tonsillectomy โ€” a national clinical guideline. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care.


Br J Nurs. New paradigms in the pathogenesis of otitis media in children. Front Pediatr. Otitis media in Indigenous Australian children: review of epidemiology and risk factors. J Laryngol Otol. Factors associated with antibiotic prescribing in children with otitis media. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Otitis media โ€” acute. Accessed May 7, Paul SP, Wilkinson R. The importance of recognising mastoiditis in children.

Nurs Times. Craven V, Everard ML. Protracted bacterial bronchitis: reinventing an old disease. Paul SP, Hilliard T. Contact us.

Additional documentation

Bristol Royal Hospital For Children. Paediatric Respiratory Medicine Description of service This is a comprehensive specialist service for the management of all Paediatric Respiratory conditions in children excepting lung transplantation. Areas of excellence Paediatric Respiratory Medicine including asthma, allergy, cystic fibrosis, complex respiratory infections, flexible bronchoscopy, respiratory complications in patients with neuromuscular conditions, TB, sleep and long term ventilation.