Helen O’Callaghan

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Doctor on call: GP Phil Kieran's no-nonsense guide to dealing with childhood ailments

Though he’s had to bring one of his own children to A&E due to a virus, Dr Phil Kieran believes kids for the most part are resilient and bounce back quickly after an illness. He talks to Helen O’Callaghan

Doctor on call: GP Phil Kieran's no-nonsense guide to dealing with childhood ailments

Though he’s had to bring one of his own children to A&E due to a virus, Dr Phil Kieran believes kids for the most part are resilient and bounce back quickly after an illness. He talks to Helen O’Callaghan

When it comes to childhood illness, Phil Kieran works off the assumption that children get sick a lot and they get over it quite quickly almost all of the time.

It’s an attitude very likely caught in his formative years from his parents, Paddy and Mary, both doctors now retired, who were “very practical” about his and his three sisters’ health.

“They came at all of our childhood illnesses with the idea that most things get better. It gave me a nice calm example of how to deal with illness,” says Dr Kieran, whose GP practice is based in The Washington Street Medical Centre in Cork city.

His own two children — five-year-old Daragh who is in senior infants, and Max, three who has just started pre-school, are very different to each other.

“It surprises me, how much difference there is in their personalities. Daragh is very serious, very conscious about everything he does and quite careful. Max is more ‘do it and think about it afterwards’. He’s more spontaneous and self-willed. They’re both great. We’re very lucky with them,” he says.

Like most children, the boys have put himself and his wife, Claire, through moments of self-doubt: ‘will I get this checked out or will I let it run its course’.

When Daragh was 15 months old and Claire was pregnant with Max, the family ended up in A&E because Daragh had a “pretty horrible” virus that left him quite dehydrated. “I’d been monitoring him for about four days at home. He’d been quite sick with a really high, hard-to-control fever and he wasn’t eating and drinking.”

Daragh has his own GP so,feeling “some objectivity” was necessary, Dr Kieran took him to see her.

She agreed it was probably viral but that he was dehydrated and needed hospitalisation. He was in for about five hours. Once hydrated, he perked up really well.

About a week later, Daragh, who was walking very well, got very unsteady on his feet. “Every time he turned around he fell on his bum. I was pretty sure it was post-viral cerebellitis — swelling of the cerebellum at the back of the brain, which controls balance and co-ordination. It settles all by itself.”

Erring on the side of caution, Dr Kieran spoke to paediatrician friends who all recommended Daragh be checked out. “They had a good point. You’re not objective about your own kids. We did, and were told it was what I expected.It took about three to four weeks for his balance to come back.”

To see what seems like regression in your child would be pretty terrifying for parents who wouldn’t know what it was, I suggest. “It’s terrifying even if you do know,” he says.

Daragh also had concussion when he was three or four. “He was hugging another child. The two toppled over and Daragh fell backwards with the other child landing on him. He banged the back of his head on the ground.

"He became very groggy and drowsy afterwards. I was at a funeral in Dublin, Claire rang and I said take him to A&E. He was observed in CUH for four hours and then let home.”

While Daragh is the child who has especially put his parents through their paces around illness, Max has had rotavirus (“torrential diarrhoea for eight days, I was pretty sure it was rotavirus, it has a very distinctive smell”) — he was born three months before children began to be vaccinated against it in 2016.

“Before the vaccine, it was incredibly common. Ninety per cent of children would get it by age five. It’s the most common cause of children being hospitalised for dehydration in the western world.”

Connecting with parents

Dr Kieran, who co-presented RTÉ series You Should Really See a Doctor, alongside Pixie McKenna, finds it hard when he suspects the child’s illness is something best not intervened with.“It’s easier to treat than to wait.

If you’re deciding not to do anything, you’re worrying that mightn’t be the right thing. It’s the same with children I see in the practice. But you have to make the best decision you can and trust your knowledge and training.”

The medical advice he gives parents hasn’t changed much since he became a parent but his method of delivery has.

“It has changed dramatically. I’m much more understanding of what they’re going through and how scary it is.”

There’s a story he often tells when children are brought in with a cough. “When I was working in the emergency department in Crumlin, one consultant would pat parents on the shoulder and say ‘listen, a cough like that never killed anyone’.

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"At the time, I thought: what a brilliant, succinct, reassuring phrase. The first time I sat awake all through the night listening to Daragh cough, I thought how incredibly patronising it was. I wasn’t worried the cough would cause him any long-term damage, all I wanted to know was what I could do to make it better for him.

“Children cough a lot and at night too. There’s usually nothing you can do about it. I tell parents this and I also tell them I’ve sat awake at night on the stairs listening to my child cough.”

Role of antibiotics

He sees antibiotics as “absolutely phenomenal” when necessary but has a no-nonsense approach to prescribing them. “I’m very happy that Max has never needed antibiotics and Daragh has been on them maybe twice.”

Pointing out that the vast majority of children’s illnesses are viral, he says our immune system’s well capable of getting rid of these illnesses by itself.

Antibiotics will not help and may make you feel worse.

Ear infection, for example, might resolve slightly quicker with antibiotic but pain relief’s much more important for what’s a very sore condition.

Parents’ attitude to antibiotics is changing a little, he says. “More are coming in saying ‘I hope he doesn’t need an antibiotic’, but the majority still do look for antibiotics for their children.”

Parents worry a lot about children, he says, and not just about their health: What if I miss something? Am I going to inadvertently disadvantage my child further down the road? He wishes parents knew just how robust their children are.

“We forget just how strong and resilient they are. We want to protect them from everything. But life’s not like that. If all the challenge has been taken from them, it’ll be difficult when they get to 18 and the realities of the world are too overwhelming.”

Stressed children

As a doctor, he finds it difficult to see children with emotional problems, with depression or anxiety. “Childhood anxiety is more common than we realise and it’s difficult to recognise. Primary schoolchildren often tend to have physical symptoms: recurrent abdominal pain can be a manifestation of stress.”

He sees a lot of children around exam time, as well as children with social issues — school refusal, selective mutism, where they refuse to speak in certain public settings like school.

In scenarios like these, he always remembers what he was taught at the very outset of his paediatric training: ‘You’re usually treating three patients — the child and the two parents’.

“So you need to get the parent involved in teaching the child strategies they can use to help them relax and manage some of what’s causing the stress.”

This could include, for example, teaching the parent not to tip over into over-reassuring/over-comforting the child. “It’s about acknowledging what’s going on for the child without making it bigger. That’s a tight-rope walk.”

Does he think the healthcare system treats children well? “Very well mostly, but as with all branches of the health system, it’s working because of the goodwill of the frontline staff, who are all doing more than they should be expected to. That’s what’s giving the good service.”

He enjoys treating children. “They’re very blunt when you ask them questions, which makes things easy to figure out. They bounce back so quickly, it’s a pleasure.” And they’re funny, he says — which is an extra bonus.

Dr Phil Kieran starts a new eight-week column on childhood illnesses today.

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