Paediatrics

All children will be admitted to either a single room or to a room shared with only children. Children will never share with an adult patient. 

All children will be admitted to the same ward area, to which the dedicated paediatric nursing team will be assigned. 

Parents or guardians are encouraged to stay with their child at all times. 

When your child is staying overnight, accommodation will also be available for the parent/guardian.

At Mater Private Network we provide treatment for children with a range of common conditions. Most of these are available on a day case basis. Day case procedures are fully covered by a range of health insurance plans. Patients with no insurance cover also have access to Mater Private Network and will be given a procedure cost estimate in advance of treatment. 

Inpatient procedures fully covered by many plans include tonsils, adenoids, sinusotomy, ethmoidectomy, nasal septum repair, rhinoplasty, and timpanoplasty. 

At Mater Private Network we are happy to help you understand what, if any cost, you may incur for any procedure. To do this there are a few simple steps: 

• Check the name of your plan 
• Check your plan number 
• Confirm the procedure name with your consultant 
• Call us on 01-885 8856 with the above details 

Dermoids are usually non tender and mobile under the skin. Because of the likelihood of enlargement over time, we recommend resection. The procedure is performed as an outpatient. If the cyst becomes infected, the patient is given antibiotics and the cyst is excised when the infection resolves. 

Skin mole (congenital nevus) 

These dark skin lesions are usually present from birth but can develop in the first two years of life. The lesions are one of several known risks factors for the possible development of a serious type of skin cancer called melanoma. The number of children under the age of nine with skin cancer is very, very low. 

Congenital nevi have been divided into three groups according to size. Small nevi are less than 1.5cm in greatest diameter, medium nevi are 1.5-19. cm in greatest diameter, and large or giant nevi are greater than 20 cm in greatest diameter. Giant nevi may require more than one surgery for complete resection. 

Removal of congenital nevi is performed either to improve the appearance of the patient or to reduce the likelihood of developing cancer in the lesion. If a patient has many lesions, removal is reserved for lesions that are changing. 

Existing moles should be checked if there is a change in size, shape, colour, or elevation (if it becomes raised). Pain, itching, ulceration, or bleeding of an existing mole should also be checked. A commonly used list of symptoms is referred to as the “ABCD guidelines”: 

• Asymmetry: one side of the mole does not look like the other. 
  
• Border irregularity: margins may be notched or irregular. 
  
• Colour: melanomas are often a mixture of black, tan, brown, blue, red, or white. 
  
• Diameter: cancerous lesions are usually larger than 6mm across (about the size of a pencil eraser), but any change in size may be concerning. 

The nasal septum is the wall between the nostrils that separates the two nasal passages. It supports the nose and directs airflow. The septum is made of thin bone in the back and cartilage in the front. A deviated septum occurs when the cartilage or bone is not straight. A crooked septum can make breathing difficult. The condition also can lead to snoring and sleep apnoea. 

The septum can bend to one side or another as a part of normal growth during childhood and puberty. Also, the septum can be deviated at birth (congenital) or because of an injury, such as a broken nose. 

Surgery to straighten the septum is called septoplasty, submucous resection of the septum, or septal reconstruction. The surgery may be done along with other procedures to treat chronic sinusitis, inflammation, or bleeding, or to correct sleep apnoea. 

Ear deformities such as prominent bat ears (otoplasty). 

Otoplasty, otherwise known as ear surgery, is usually performed on prominent ears in order to set them back closer to the head or to reduce the size of large ears. Ear surgery is performed under local or general anesthesia. In children the best age to perform an otoplasty is from five to ten years. An elastic bandage is worn on the head after the procedure that covers the ears. 

The structure of the ears is very complicated in terms of shapes and anatomy. They have the same effect on the general face appearance as the eyes, nose or mouth. Ear surgery allows us to try and give the ears a more natural shape while adjusting height, width and inclination, if needs be.

Abnormally shaped ears or deformities can be either genetically predisposed or gained (result of injury, previous operation, etc). The most often requested surgery is to set prominent ears back closer to the head with possible ear shaping or modification of size.

Grommets are used for the treatment of middle ear infection (otitis media). Middle ear infection is very common in early childhood and occurs when the middle ear cavity that is supposed to be filled with air gets filled with fluid (mucous or pus). The Eustachian tube (a small tube in the middle ear) drains fluid out of the middle ear cavity but if it is not working, the fluid gets stuck and can cause an infection. A grommet is a plastic tube used to provide a temporary or extra Eustachian tube to help bacteria and fluid to drain from the middle ear. 

Grommets will usually fall out of their own accord after a number of months and the child will not even be aware that this has happened. If they do not fall out spontaneously within 18 months, they will be removed by the ENT surgeon in a simple and painless procedure. 

Grommets work by ventilating the middle ear, reducing secretions and allowing better eardrum vibration “function” and giving the middle ear a chance to recover from infections. 

Common symptoms 

The main reason for insert of grommets are: 

• Persistent “glue ear”. This may cause considerable hearing loss “deafness”, and sometimes earache and slight imbalance. 
• Recurrent otitis media “middle ear infections”. These are painful recurrent ear infections, which may be accompanied by a high temperature, poor appetite and general lethargy. 

A grommet is then inserted through the “hole” made in the eardrum to keep middle ear ventilated and healthy. In a child, if adenoids are enlarged and the child is having the second or third sets of grommets inserted, the surgeon may also remove the adenoids. 

After the surgery your child will go to a recovery room to be monitored closely. After your child is fully awake and doing well, the paediatric nurse will bring your child back to the day surgery area. At this point, if everything is going well, you and your child will be able to go home. 

Caring for your child after surgery 

• Avoid getting water into the ears as this may easily cause infection in the ears. This applies to showers, bathing, washing hair as well as swimming. Swimming is only permitted after the follow-up appointment has given the all clear. Earplugs must be used for all these activities. Alternatively, cotton wool heavily smeared with vaseline is an excellent and sometimes more comfortable alternative. 
• Avoid diving with a grommet in the ear. 
  
• There may be a bloodstained discharge after the surgery for a couple of days. If ear discharge persists, smells foul or there is increased pain contact your GP as this suggests infection and treatment with antibiotic eardrops will be required. 
• Pain is normally fairly minimal and can be controlled with simple painkillers. 
  
• Avoid using ear buds to clean the ear, instead use a damp cloth around the outside. 
• Grommets usually fall out of the ear in about 9 months. They spontaneously grow out and are ejected by the eardrum and therefore very rarely have to be removed. Usually they fall out of the ear and may be found on the pillow upon awaking. The eardrum usually heals up where the grommet was sited. 
  
• Sometimes repeat sets of grommets are needed if the fluid re-accumulates. A hearing test will indicate if this is the case. 

In 99% of cases where grommets have been inserted there is usually a dramatic improvement in hearing. 

Can children swim with grommets? 

There is no hard and fast rule on this. Some children with grommets are advised not to swim or to go underwater in the bath, while others are allowed to swim with ear plugs and are advised to exercise caution. Discuss this with your doctor. 

The tonsils are small, round pieces of tissue that are located in the back of the mouth on the side of the throat. Tonsils are thought to help fight infections by producing antibodies. Previously tonsils were thought to be a site of infection as opposed to a barrier against infection. 

Routine tonsillectomies are rarely performed on children who suffer from swollen tonsils. It is only after recurrent bouts of acute tonsillitis or persistent ear infections that surgery (tonsillectomy) will be considered. 

Common symptoms 

The symptoms of tonsillitis vary greatly depending on the cause of the infection, and can occur either suddenly or gradually. Each child may experience symptoms differently. The most common symptoms of tonsillitis include: 

• Sore throat and painful swallowing 
  
• Fever >37 °C 
• Headache 
• Decreased appetite 
• Generally feeling unwell 
• Nausea and vomiting 
• Stomach aches 
• Visual redness or drainage in the throat 
• Each case is individual and a surgeon will assess the need for surgery, however common reasons include: 
• Sleep apnoea or periods at night when your child stops breathing 
• Trouble swallowing 
• Bleeding from the tonsils that cannot be stopped 
• Significant blockage of the nasal passage and uncomfortable breathing 

Bad snoring, sinusitis, constant mouth breathing, frequent coughs and colds are not generally considered as a reason for tonsillectomy. 

The surgery 

In most cases, after the surgery your child will go to a recovery room to be monitored closely. After your child is fully awake and doing well, the paediatric nurse will bring your child back to the ward. 

Caring for your child after tonsillectomy 

Tonsillectomy patients lack energy for several days and may be restless at night. This will improve over the next 5 to 14 days. 

Following surgery: 

• Increase fluid intake 
• Use pain medication, as advised 
• No heavy or rough play for a duration of time recommended by the surgeon 

Breathing: snoring and mouth breathing are normal after surgery because of swelling. Normal breathing usually returns 10 to 14 days after surgery. 

Pain: throat and ear pain can be severe after a tonsillectomy and may last for up to two weeks after surgery. Ear pain is “referred pain” from the tonsil area and does not mean that anything is wrong with the ears. (Note: You can use paracetamol or ibruprofen to relieve pain, as appropriate). 

Nausea and vomiting: it is not unusual for a tonsillectomy patient to feel sick following a tonsillectomy. Introduce fluids slowly. If the vomiting persists the day after surgery, contact your GP. 

Voice changes: there may be a nasal quality to the tonsillectomy patient’s voice after surgery. This is normal and may last for several weeks. Encourage talking, as it helps with the healing process.