Division of General Pediatrics

Asthma

Mission

To provide a comprehensive, multidisciplinary approach to the diagnosis, management and patient education of pediatric asthma in the ambulatory setting. To promote medical education and research on asthma. The Centre is comprised of pediatric specialist physicians, nurses and respiratory therapists who provide expert care, unique to the particularities of asthma during the pediatric age.

General Information

The Asthma Centre provides several services related to the management of children with asthma. The Asthma Centre provides the community with a multidisciplinary approach to the management of asthma in both outpatient and inpatient services, including medical diagnosis and treatment, patient education, and allergy and respiratory functional evaluation. The Centre also promotes physician education and research on asthma.

The Centre is integrated by several physicians, a nurse, a respiratory therapist, a clinic coordinator and a secretary. Among the physicians there are general pediatricians, allergists and respirologists. The allergists and respirologists are consultants to the Centre in their respective specialties, and several of them attend the clinics. Diagnostic allergy skin testing and pulmonary function testing are available on site.

Six outpatient asthma clinics are held weekly. In recent years, 2,000 to 2,500 patients have been seen per year. Because recurrent wheezing is more common in young children than at other ages, about 40% of patients seen in the clinic belong to that age group. Most of these children have episodic, viral-induced asthma -- a form of asthma particular to this age that tends to resolve gradually. Referrals to the clinic are accepted from community physicians, emergency rooms and inpatient services. The objectives of the first visit include diagnosis of asthma, assessment of disease severity, identification of precipitating factors, patient education and a therapeutic and preventive management plan. The nurse and the respiratory therapist give psychosocial support and provide patient education. After the initial evaluation, patients may be referred back to their primary physicians, to whom a report is sent. Short-term follow-up or feedback through telephone communication is also offered. Patients with more severe or complicated asthma, as well as those lacking adequate primary care, are followed regularly in the clinic.

The Montreal Children's Hospital, through the Asthma Centre, is one of the Asthma Education Centres (CEA) of the Quebec Asthma Education Network. The CEA provides individual education sessions to patients with asthma, to aid the patient and their primary care physicians in the day-to-day management of asthma. Referrals will be accepted from community physicians and health services (CLSC), emergency rooms, inpatient services and specialty services. The educational activity at the CEA is different from a clinic visit because it does not include a physician assessment. Education enables the patient to understand what asthma is, to improve their environment and avoid precipitating factors, to learn why, when and how to use their medications, to assess whether their asthma is under control or not, and to utilize an action plan when asthma deteriorates. The objective is to provide education to the patients and parents on the prevention and self-management of asthma. A report is sent to the physician providing medical follow-up to the patient.

The Asthma Centre promotes and is involved in clinical research. Recent, current and upcoming projects include clinical trials of pharmacologic treatments of asthma, impact of our interventions in asthma outcomes, and development of a province-wide, computer-based asthma database. Two outstanding upcoming projects are a multicentre trial to definitely determine the role of inhaled steroids in episodic, viral-induced asthma, and a comprehensive discharge plan from the emergency room. The Asthma Centre is part of the Quebec Network of Respiratory Health; several of the research projects originating at the Montreal Children's Hospital are done in collaboration with other partners of the network.

The Asthma Centre is at the forefront of pediatric asthma. The Asthma Centre is committed to providing a high standard of care and to promoting the acquisition of knowledge and the improvement of clinical practice of pediatric asthma through medical education and research.

Teaching

The Asthma Centre has been active in promoting medical education on asthma through several means: Continuing Medical Education activities, Grand Rounds, conferences to residents and medical students, rotations for trainees in the Asthma Clinic and Asthma Inpatient Service, and more recently as one of the partners of the Ambulatory Pediatric Group conference series. The Asthma Centre is committed to promoting knowledge and utilization of the most current, evidence-based clinical practice guidelines.

Asthma Centre at the Montreal Children's Hospital

Members

Child Protection Program

This program provides case management advice for children where child maltreatment is suspected. Inpatient clinical consultation for injured or severely neglected children, organization of out-patient evaluation, health record documentation and liaison to community-based agencies are available.  The Child Protection Committee provides expertise in Child Maltreatment through multidisciplinary case review. These services are for registered patients of the hospital and require a concomitant referral to Social Services.

Child Protection Program at the Montreal Children's Hospital

Members

Complex Care Service

The Complex Care Service (previously known as the Intensive Ambulatory Care service) at the Montreal Children's Hospital provides and coordinates multidisciplinsry care for children with complex healthcare needs on a sort-, medium- or long-term period in their homes of community.

The diverse team of health professionals works together to ensure a quicker, smoother transition from the hospital to the home and to provide the necessary support to maintain the child with complex medical needs at home. Last year, the Complex Care Service hd over 3600 treatment day visits and they anticipate  this number to grow as more and more children with complicated care needs will transition from hospital to home.

The mission of the Complex Care Service is to provide safe, effective and family-centered care to children with complex medical needs in their own home environment.

The Complex Care Service is comprosed of the following 10 programs:

• Cardiac Transplantation
• Home Total Parental Nutrition (IV and tube feeding)
• Bronchopulmonary Dysplasia or BPD (chronic lung disorders)
• Neuromuscular Disorders
• Immune Deficiency (inability to fight off infection)
• Tracheostomy and Home Ventilations (breathing machines)
• Long-term Intravenous (IV) Therapy
• Thalassemia (blood disorders)
• Coagulation Disorders
• A "Multiplex" Program for children with more general complex health care needs

Complex Care Service at the Montreal Children's Hospital

Members

Developmental Pediatrics

Multidisciplinary clinical teams assess children from infancy through school age in terms of developmental concerns and learning difficulties for the purpose of diagnosis, referral to appropriate community resources and in-hospital follow-up where applicable. The program is an entry point for children who are presenting with developmental concerns as noted by their pediatricians and family physicians.

Developmental Pediatrics at the Montreal Children's Hospital

Developmental Progress Clinic
A multidisciplinary team assesses pre-school-aged children referred for suspected global developmental delays (early developmental impairments).

Developmental-Behavioural Assessment and Continuity Clinic
Consultation for children regarding the following specific issues: attentional difficulties prior to school age, other complex behaviors, elimination disorders, and para/dyssomnias.

Gender Variance Clinic
Consultation for children whose physicians are consulting about developmental questions surrounding gender.

ADHD Clinic

Consultation for children from 6 to 18 years with already diagnosed ADHD but where there has been failure of treatment. | ADHD Clinic Website (Montreal Children's Hospital)

Members

In-Patient Wards and Short Stay Unit

Responsible for the care of infants: children and adolescents requiring non-ICU inpatient medical care, excluding patients admitted for previously diagnosed problems in hematology-oncology and cardiology. Patients are admitted with problems in the realms of: General Pediatrics, Nephrology, Adolescent Medicine, Rheumatology, Gastroenterology, Respirology, Endocrinology.

The most frequent diagnoses are: Asthma and bronchospasm, Pyelonephritis and other UTI's, Gastroenteritis, Global developmental delay, Pneumonia and bronchiolitis, R/O neonatal sepsis, seizures.

Members

Medical Day Hospital/Pediatric Medical Consultation Service

The Medical Day Hospital (MDH) of the Montreal Children's Hospital provides day treatment to children with on-going medical problems while reducing or avoiding the inconvenience, complications and expense of hospitalization.  It is an alternative to hospitalization for patients who do not require 24-hour medical and/or nursing monitoring and whose needs cannot be met by existing programs within the hospital or elsewhere in the present model of pediatric care in Quebec.

The Medical Day Hospital also provides an alternative to emergency department visits and /or

hospitalization for children referred from the community for diagnosis and/or multiple urgent subspecialty consultations. The Medical Day Hospital is open 7 days a week.

The Pediatric Medical Consultation Service of the Montreal Children's Hospital provides medical expertise to inpatients not admitted under a medical service but who requires a medical evaluation.  It also places the expertise of the MCH pediatricians at the service of the community it serves and of the McGill RUIS partners.  The service is available 24 hours a day, 7 days a week.

Medical Day Hospital Website at the Montreal Children's Hospital

Members

Northern and Native Child Health Program

The Nothern and Native Child Health Program provides consultation and liaison services for First Nations children in their communities and in Montreal. Staff are available in person in the 22 communities, and by telephone, email and telemedicine. For children who require tertiary and quaternary services in Montreal, the program's pediatricians engance liaison and organize follow-up in the children's communities.

Norther and Native Child Health Program at the Montreal Children's Hospital

Members

Palliative Care

The palliative care program offers resources for issues related to life-threatening illness in childhood including decision making, easing pain and symtoms, coordinating home care, as well as end-of-life care and bereavement.

Palliative Care at the Montreal Children's Hospital

Members

Pediatric Consultation Centre

The Pediatric Consultation Centre (PCC) is the major teaching site in an ambulatory setting of the Division of General Pediatrics. It is staffed by general consultant pediatricians who are excellent clinical teachers. The PCC serves the community by providing a consultative service for family physicians, community pediatricians, and other health care providers.  In addition to providing consultative services, the Pediatric Consultation Centre is also home for a variety of psecialized clinics including a multicultural/adoption clinic, a resident's continuity clinic, clinics specializing in the medical problems of autistic children, obesity, sleep disorders, Trisomy 21 and an outreach soncultation clinic at the Lakeshore General Hospital. The PCC has approximately 5000 patient visits per year encompassing a broad range of pediatric problems.

Pediatric Consultation Centre (PCC) at the Montreal Children's Hospital

Members

Residency Continuity Clinic

The Resident Continuity Clinic (RCC) is an important teaching site within the Division of General Pediatrics where residents, supervised by pediatrician preceptors, follow their own patients during their three years of core general pediatrics training. The RCC provides long-term primary care for over 1000 children, both well children and children with a variety of health care needs, as well as short-term general pediatric consultative support to patients referred from the community.

Members