Activity & Service
Our department is committed to the provision of a patient-centred, seamless, comprehensive and quality general paediatric service to the children of Hong Kong Island. The general paediatric wards located on the seventh floor of the K-Block of Queen Mary Hospital have 37 in-patient beds and 8 day-beds.

With the recent outbreak of avian influenza and severe acute respiratory syndrome (SARS) in Hong Kong and Asia, the general paediatric wards have been extensively refurbished to contain 9 negative pressure rooms for isolation of patients admitted with suspected and confirmed diseases requiring airborne isolation. Patients with fever are admitted to ward K7N while afebrile patients are admitted to K7S after triage. Stringent infection control measures are enforced in ward K7N and cohort nursing practiced for patients requiring droplet, contact and airborne precautions. Gowning and showering facilities are available on the seventh floor in case of future outbreaks of emerging infectious disease like SARS.

Strength & Development
General Paediatric Service
A comprehensive quality paediatric service is critical for undergraduate paediatric training and providing appropriate experience for trainees in the postgraduate paediatric training programme supervised by the Hong Kong College of Paediatricians. The undergraduate and postgraduate training in paediatrics are ably undertaken by the paediatricians working in the general paediatric service. The paediatricians of the general paediatric service are also involved in the supervision of trainees in the Family Medicine Training Programme rotating through our department.

The staff of the general paediatric service manages patients admitted with acute paediatric disease including those with cardiac, respiratory, neurological, renal, endocrine and adolescentproblems. In the past 5 years, the number of acute admission has been around 9,000 to 10,000 cases annually and the number of out-patient attendance has been between 24,000 to 28,000 cases per year.
In the future planning of the general paediatric service in our department, we have to take into account of the declining birth rate, changing pattern and epidemiology of diseases, emergence of new disease entities and the development of paediatric sub-specialties. There will be a shift of emphasis to day care and ambulatory care of children with acute paediatric problems.

Adolescent Medicine
With the extension of the age of admission to 18 years, we are seeing more adolescent patients with chronic illness complicated by psychosocial issues. The adolescent service is involvedin providing assessment and management of adolescent in-patients with eating disorders, drug overdose, attempted suicide, pseudoseizures, emotional or behavioural disturbances. A bio-psychosocial approach and close liaison with other health care professionals, social services, schools and family is crucial.
The Adolescent Clinic was first established in November 1994. Paediatricians work closely with clinical psychologists and social workers to provide an out-patient multi-disciplinary health service to adolescents aged between 10 and 19 years presenting with medical, health and/or developmental concerns. Patients with psychosomatic disorders, eating disorders, stress related disorders, adjustment issues to chronic illnesses and physical developmental concerns such as growth and pubertal disorders are also seen. Expert gynaecological service is also provided on a consultative basis by Prof Grace Tang.
The adolescent team is also actively involved in providing consultative medical services to the Youth Health Centre of the Family Planning Association of Hong Kong, health education to schools and training to social workers. The team also works in close collaboration with the University of Hong Kong Family Institute in the assessment and management of children and their families with complex psychosocial problems.

Respirology Service
Most children with acute respiratory problems are managed in the general paediatric wards. Respiratory infections and asthma account for a significant proportion of the workload. Viral respiratory infections due to respiratory syncytial virus, parainfluenzae viruses, adenovirus and especially influenza virus have been shown to be an important cause of hospitalization in Hong Kong. The rate of admission for influenza far exceeds similar infections in most developed temperate countries.

The prevalence of asthma has been on an increase in Hong Kong. The respiratory service provides lung function test, allergy testing and out-patient care of children with asthma and other chronic lung diseases.
New developments include measurement of exhaled nitric oxide as an indicator of airway inflammation and measurement of airway inflammatory cytokines from exhaled breath condensate of children with chronic lung disease.
Children and adolescents with obstructive sleep apnoea are investigated in the newly established Central Sleep Laboratory of Queen Mary Hospital. The general paediatric service also provides acute care for patients on chronic ventilatory support transferred from the Duchess of Kent Children's Hospital.

Gastroenterology Service
Children and adolescents with chronic disabilities are increasingly admitted to the general paediatric wards for assessments. The gastroenterology team members have an active interest in the care of children with chronic neurological disease and feeding difficulties. They provide 24-hour pH studies and advice on gastrostomy feeding. Occupational therapist, speech therapist and our surgical colleagues work closely in the management of feeding in these patients. Endoscopic examination service is provided weekly.

Nephrology Service
The staff of the paediatric nephrology service is responsible for the care of children with complicated urological problems, nephritis, nephrosis, renal tubular problems and chronic renal failure. Renal biopsies are regularly performed under ultrasonographic guidance.

Neurology Service
In addition to providing consultations to acute neurological admissions managed under the general paediatric service, the staff of the paediatric neurology service also provides 24-hour video-electroencephalographic monitoring and assessment of children with difficult seizure disorders. A video-EEG suite has been planned in one of the cubicles in ward K7.

Diabetic Service
A 24-hour diabetes hotline is managed by paediatric diabetes nurse educators and trained nurses in the general paediatric ward. The hotline provides advice to patients with diabetes and their parents under the supervision of the on-call paediatric endocrinologist.

Day Service
More and more patients with general paediatric problems are managed either as day-patients or out-patients. An average of 2,800 day-patients attended the general paediatric day service for investigations and assessments each year.

General Paediatrics in the future
In the era of paediatric sub-specialization, there is a need to define the role of a general paediatrician. An accurate balance between providing good integral general paediatric care and top of the line sub-specialist care is a challenge in the coming years.