- Paediatric experts Dr Nikhil Thapar and Dr Paul Aurora talk to local and international experts about management of childhood constipation in the UAE, and respiratory conditions respectively
11 November 2017, Dubai, UAE: Today at the International Paediatric Medical Congress, hosted at the Conrad Hotel in Dubai, consultants from Great Ormond Street Hospital in London (GOSH) are bringing their expertise in paediatric respiratory conditions and paediatric gastroenterology to the UAE.
Dr Nikhil Thapar, Honorary Consultant Paediatric Gastroenterologist at GOSH, is discussing the topic of childhood constipation and abdominal pain at the conference. GOSH treats 1,500 children from the Middle East every year and half of Dr Thapar's patients at GOSH come from the Middle East.
According to Dr Thapar, both constipation and abdominal pain are common disorders for children, with one in five of children affected worldwide. “We are getting emerging data from the Middle East now that problems with abdominal pain and constipation are as common as everywhere else and also possibly increasing. This is because diets are changing and there have also been changes in breastfeeding practices which can impact on early life programming. Childhood development and programming in early life sets the scene for whether you pick up diseases later on.”
In Dubai, Dr Thapar will be discussing early life programming and the importance of understanding what happened in a child's life before, even in pregnancy. For example, early use of antibiotics, or the type of method of delivery at birth (caesarean vs natural delivery) can pre-dispose a child to developing abdominal pain many years later. Dr Thapar also comments that in the Middle East, there is a rise in allergic conditions, including food allergy and allergic conditions of the bowel.
“The key message is that the earlier you step in, the more effective the treatment. Also, the better understanding you have, the most likely you are to succeed in managing these conditions. You need to treat the whole package. Understanding what has happened in a child's earlier life can determine whether a child goes on to have severe diseases later on and can help us prevent diseases in children,” said Dr Thapar.
Dr Thapar explains that at GOSH, consultants treat children with these types of conditions as a whole using the biopsychosocial model. This means there are often biological changes in the body, which contribute to disease but they can also be impacted by psychology and social aspects too. For example, even the microbiomes, or the ‘bugs', in the bowel can be impacted by factors such as stress or use of antibiotics.
Dr Paul Aurora, Consultant in Paediatric Respiratory Medicine and Lung Transplantation at GOSH, will be speaking to local and international experts about asthma in children, as well as the specialised area of pulmonary graft-versus-host disease.
Speaking on pulmonary graft-versus-host disease, Dr Aurora said, “A significant proportion of children who have bone marrow transplantation will get lung complications afterwards. This is called pulmonary graft-versus-host disease. This is a very specialised area which is very difficult to assess and treat properly. If not treated properly, it can rapidly become fatal. A number of children from the Gulf are referred to GOSH for bone marrow transplantation, and when they get respiratory complications, I support in treating the condition. It's therefore helpful for me to explain to doctors in the region what I am doing so they can develop their understanding of the condition when the children return to the Gulf.”
Later in the conference, Dr Aurora will be chairing a discussion with local experts on the topic of asthma in children. Asthma is the most common chronic medical condition of childhood in Gulf countries, affecting between 10-20% of children in the region. Recent research has estimated the annual cost of asthma treatment to be USD 160million per annum in Oman, and more than USD 200 million per annum in Kuwait. The conference discussion will focus on the best means of preventing asthma attacks in children so that admissions to hospital are minimised. Dr Aurora explains that in London specialist hospitals, they provide an advice and teaching role in the treatment of asthma.
“The vast majority of asthma care is provided by family doctors and by general paediatricians, and this is how it should be, as they know the child and family best. The key to good asthma management is for the family to understand the condition, and to be able to act early to prevent exacerbations before they become serious. In this way hospital admissions can be reduced.”
For both consultants, sharing knowledge is key at this conference. Dr Thapar explains that one size does not fit all when it comes to managing health conditions in children. “I think one of the things we need to make sure we don't do is to take certain European guidelines and say this is how we've got to do it everywhere in the world. As doctors in the UK, we ensure that we collaborate and exchange ideas with physicians in the Middle East. Whenever I visit the Middle East, I always get a sense of what's happening here and what needs to happen, and then tailor my talks and workshops to fit in with what may be available in the region,” concludes Dr Thapar.
Dr Nikhil Thapar's advice to parents who are concerned that their children are suffering from constipation:
- It's not a behavioural problem: A lot of children who have constipation may soil or are incontinent and it's often hard for families to understand why children are doing that. It's not that the children are actually doing it at all, it's just a change in the body sensation, so we need to reassure families that it isn't a behavioural problem. It's not that these children are behaving badly, it's just a change in the way the bowel is worked.
- It's treatable: The outcomes for children with constipation and abdominal pain are actually good, as long as we recognise it and step in early enough with treatment. For constipation, most of the treatment is laxative treatment. People can be worried about using laxatives as it is a common misconception that laxatives can affect the bowel. In fact, not treating constipation often damages the bowel. They need to be given alongside giving them a normal diet and a normal amount of fluid intake.
- It's very common: It's probably more common than parents realise. One quarter of all school age children will get constipation, but sometimes parents feel very isolated that their child has a problem that no-one else has.
- Seek medical help early: Take your child to a local healthcare professional as early as possible.