Clinical services

OPD services – Room No 22 – Main OPD Block
An average of 150-200 children are seen daily in OPD. Pediatric out-patient service is provided at room number 22 of the out-patient block from Monday to Saturday between 9 am and 2 pm. All children aged between 1 month to 18 years will be taken care of by trained pediatricians. Services include comprehensive preventive as well as diagnostic modalities. Preventive services include growth plotting and monitoring, breast feeding counselling, nutritional advice, immunization, and screening for developmental delay. Infants requiring immunization are seen as a priority in well baby clinic in the same premises. Team of consultants includes senior professors, associate, and assistant professors with wide experience in common childhood diseases and handling complicated/rare diseases. After checkup, possible diagnosis, investigation and treatment plan and a follow up plan will be discussed with parents. Sick children requiring immediate care will be seen on a priority basis and shifted to emergency room for initiating treatment. Cross consultations from other specialties’ will be taken if need arises.

Well baby services
Department of pediatrics and nursing provide comprehensive baby services at pediatric outpatient department from Monday to Saturday between 9Am – 1pm. Services include, growth plotting and monitoring, breast feeding counselling, nutritional advice, immunization, and screening for developmental delay. Pediatric resident and a junior consultant will be manning the clinic, which will be supported by senior consultants. Vaccination will be administered by well-trained nursing personnel within the premises of pediatric OPD. Mothers and infants requiring additional help for breast feeding will be referred to lactation clinic which is handled by trained counselors. Same services can be obtained between 4-6 pm in the evenings as a part of special consultations.

Speciality clinics:
Teen Clinic
Patient type: Adolescents 12-18 yrs
Venue: Unit of Hope Building, Room 1, ground floor
Time: 10 am - 1 pm
Days: Every Tuesday only
Faculty In - Charge: Dr. Chitra Dinakar
M.B.B.S., D.C.H., D.N.B(Paed), P.G.D.A.P (Adolescent Paed)
Professor of Paediatrics,
Contact: Ph 080-22065950 for appointment (phone between 9am -5 pm only)
Background: Adolescents (10-19 yrs) are transitioning both physically and psychologically to don adult roles. Many teenagers undergo much stress in coping with these changes. They have unique health needs, and the Teen clinic is a one-stop center to address their health concerns. The clinic offers ‘Teen friendly services’ with attention to privacy and confidentiality, to especially address sensitive issues impacting adolescents’ health and well-being.
Services offered:
1. Assessment of physical (ex. height) and pubertal changes (ex. delayed changes, menses related) during adolescence.
2. Overweight/obesity /eating disorders.
3. Adolescent behavioral and emotional problems requiring counseling.
4. Coping Skills to handle chronic illnesses (requiring prolonged medication and multiple hospital visits with any other department)
5. Sexuality related issues
6. Drug use and abuse issues
7. ‘Risky behaviors’ related counseling.
8. Guidance to parents on adolescent parenting
9. Adolescent immunizations
10. Medico-social support to vulnerable adolescents
11. Group sessions for ‘Life skills’ training (ex. Problem solving, handling emotions, coping with stress, effective communication etc) with assistance of MSW
12. Opportunity for teens to volunteer as Peer leaders.
13. Linkages with Child guidance clinic

Academic and research objectives:
1. Training of undergraduate and postgraduate students in Adolescent friendly health service (AFHS) and approach to an adolescent patient
2. Rotational posting for fellows in child psychiatry from Department of Psychiatry
3. Research opportunities on Teen health issues.

Resources available:
1. Adolescent growth charts
2. Reference charts for Tanner staging
3. Orchidometer
4. Menstrual calendar
5. Screening questionnaire for HEEADDSSS

Pediatric Endocrinology Services:
Venue -Pediatric Opd .Room No:22
Time – 2 -4PM
Day – Wednesday
In charge – Dr Poornima
Assisting Person – Senior resident by rotation

Primary Objectives
1. Clinical and holistic care for endocrine patients
2. Diabetes clinic on 2nd Wednesday of the month
3. Medical social work Team support grp creation for diabetic children
4. Nutrition consult for chronic endocrine patients with a Point person in nutrition dept
5. Cross consults across the depts for the chronic patients
6. Diabetes day celebration

Secondary Objectives
1. To Teach Post graduates and Senior residents in the clinic
2. Data storage
3. Research,Thesis topic in endocrine subspeciality
4. Interesting cases to be presented in dept/CME/Conferences
5. Posters/oral papers in Pediatric endocrine subspeciality for Post graduates
6. Difficult cases to be discussed within the dept in association with Adult Endocrine dept
7. To share the activities of the Clinic within the dept periodically.
8. Self update of knowledge and recent aspects of management with online courses/attending Conferences and CME
9. To represent as faculty in conferences and CME
10.To conduct CME in the campus for undergraduates/Post graduates/ practicing Pediatricians

Materials in OPD/IP ward
1.Growth Charts
2. Obesity Panel
3.Diabetes Care – Target GRBS Range; Insulin dosing adjustments. Tips of Ambulatory care at home information Sheet
4. Stress dosing of steroid in adrenal crisis information sheet

Paediatric TB clinic
Venue: Paediatric Outpatient Department (OPD), Room no: 22
Time: 2 pm - 4 pm
Days: Every Wednesday only
Faculty
Incharge : Dr. Sushma
Assisting persons: Senior Residents by Rotation
Primary Objectives of Clinic (patient related)
1. Registration of all children diagnosed with TB in department of pediatrics across units
2. To provide holistic treatment for all forms of childhood TB including resistant TB
3. Linkage to TB care centre for Treatment , counselling and referral to nearest DOT centres.
4. To monitor adverse effects
5. Screening of family members to detect source of infection
6. Screening of siblings and Provision of prophylactic therapy.
7. Counselling for the illness and adherence
8. Medico-social support for vulnerable children and families.
9. Interdepartmental referral – Pediatric Pulmonology,ophthal, pediatric surgery etc
Secondary objectives (Training and research related)
1. Teaching of postgraduates and undergraduates
2. Data entry and storing
3. TB related research (publications , presentations, PG dissertation)
4. Sharing data and activities of the clinic with other faculty and HOD once once in 3 months in departmental meeting. .
5. Presentation of interesting/ difficult cases in unit presentations (as part of PG teaching schedule)
Materials / literature available in the clinic (soft and hard copies)
1. RNTCP forms
2. Ready reckoner comprising Algorithms, Guidelines and phone numbers ( in the form of PPT)
3. Latest guidelines for drug sensitive, drug resistant and latent TB.

Paediatric HIV and PPTCT clinic
Venue: Paediatric Outpatient Department (OPD), Room no: 22
Time: 2 pm - 4 pm
Days: Every Wednesday only
Faculty
1. Dr. Chitra Dinakar, M.B.B.S., D.C.H., D.N.B (Paed), P.G.D.A.P (Adolescent Paed) Professor , Overall in charge
2. Senior residents in rotation Contact: Ph 080 -22065003/22065004/22065008 for general information For appointment: Ph 080- 22065034 (phone between 9am -5 pm only) Clinical services for infected:
1. Clinical care rendered by Dr. Chitra and SRs by rotation. Post graduates posted by rotation.
2. Holistic care supplementing care available at ART centre pertaining to living with a chronic disease.
3. Annual routine medical checkup and review of physical health, mental health , labs and medication especially ART, weight band adjusted.
4. Growth, puberty evaluations, immunization catch up
5. Psychological development with focus on coping with challenges
6. Adolescent development appropriate counseling on disclosure of HIV status, adherence to ART, transmission prevention strategies, sexuality related guidance, mitigating risk taking behavior and substance use.
7. Counseling support by referral to ART centre counselor for identified problems
8. MSW referral for educational/career support
9. Linkages to ART centre and DOTS centre for collection of ART/TB medication and selected investigations like CD4 count, HIV viral load, Geneexpert etc.
10. Parents/family counseling
11. Transition to adult physician care as patients approach age of 18 yrs.

Clinical services for prevention of parent t to child transmission:
1. Followup of infant born to HIV infected mother till 18 months of age, till infection ruled out
2. Feeding choice and support for exposed infants.
3. Followup and treatment of infected infants.
4. Provision of ART prophylaxis to infant till 6-12 weeks of life, Co-trimox prophylaxis till 18 months of age or till HIV ruled out.
5. Linkages with PPTCT services antenatally and ART services postnatally for infected mother
6. Coordination with Neonatal department for routine newborn care

Academic activities:
1. Training Post graduates in routine care of HIV infected child/adolescent and PPTCT components by exposure to clinic services.
2. Interesting case presentation/seminar opportunity at Paediatric department academic program/ART centre /Integrated session with General medicine
3. Visit to ART centre, PPTCT/VCTC centre in the hospital
4. Facilitate PG presentations at conferences

Research activities:
1. Facilitate data capture through case files
2. Support research activities and provide linkages for same.
3. Publications pertaining to PPTCT and HIV

Resources available:
1. Hard and soft copies of latest guidelines.
2. Treatment algorithms
3. Case report forms and files.

Pediatric Asthma Clinic
Venue: Pediatric OPD Room No: 22
Timings: Thursday 2 to 4pm
Faculty in Charge: Dr. Ranjini Srinivasan
Assisted By: Senior Residents in rotation
Primary Objectives
Patient related
1. Registration of all children with uncontrolled or poorly controlled asthma across all units in the asthma clinic. A detailed file is maintained for each patient in the form of hard copy as well as an excel document.
2. To recognize asthma and provide optimum long-term care to all patients
3. To address all other coexisting allergies and comorbidities in children with asthma
4. To maintain long term, follow up both remotely by tele consults and in person at the clinic.
5. To educate and counsel caregivers and patients on asthma and asthma control with the help of audiovisual aids, information booklets and airway models.
6. To emphasize on importance of compliance and adhering to treatment, to check all aspects related to drug, delivery and device.
7. To have a written asthma action plan (short term and long term) for every patient.
8. Interdepartmental discussion and referral: Pediatric Pulmonology, Pediatric surgery etc.

Secondary Objectives: Training and Research Related
1. To organize and conduct asthma training modules and workshops for training of undergraduate students, interns, postgraduate students and faculty.
2. Data Entry and storage
3. Conduct research in asthma including publications, conference presentations and dissertations.
4. To discuss difficult cases with other faculty in the department as well as experts in the field of asthma outside the institute as well.
5. To report the activities of the clinic every quarter to the HOD and other faculty.

Materials Available
● Asthma patient Information Booklet, self-monitoring asthma symptom sheet
● Asthma patient file
● Various drug delivery devices, medications, peak flowmeters to use for demonstration along with placebo medications which can be used for teaching and training purpose as well.

Genetics clinic

Venue: Unit of Hope building, ground floor
Timings: Friday 9am to 1pm
Faculty in Charge: Dr. Jainy N
Assisted By: Senior Residents/PGs in rotation

● Genetics services was initiated in the Paediatric department since October 2021 and outpatient clinic was started on 4th February 2022 by Dr Jainy N Aim:
● To evaluate children with suspected genetic diseases or rare diseases and to provide clinicians with guidance for diagnosis and management of genetic conditions. Scope of the services:
● Children with metabolic disorders, dysmorphism, developmental delay or autism, skeletal dysplasia, any congenital abnormalities.
● Patients are referred from Paediatrics department and various others departments like NICU, Developmental Paediatrics, PICU, Neurology, Paediatric nephrology, Paediatric hemato-oncology, endocrinology, pulmonology or Paediatric orthopedics.
● Coordinate with genetic diagnostic laboratories – Cytogenetics or molecular diagnostics.

The Unit of Hope
The Unit of Hope, St. John’s Center for Children with Special Needs was started in August 2004.
Venue: Unit of Hope building, Ground floor
Timings: All days 9am to 1pm
Faculty in Charge: Dr. Maria Lewin, Dr.Nelia Mathew
Assisted By: Dr.Shilpa S and PGs in rotation
Types of patients seen
There is a large range of children with developmental disorders seen at the Unit of Hope. These include children :
● Global developmental delay,
● Autism Spectrum disorder,
● ADHD and other behavioural disorders
● Intellectual disability
● Cerebral palsy and associated comorbidities
● Cerebral visual impairment
● Speech and language delays
● Metabolic disorders
● Genetic disorders
● Neuromuscular disorders
● Seizure disorder

Services offered
● Screening, assessment, detailed evaluation and comprehensive health care focusing both on optimizing the developmental potential and management of all associated medical co- morbidities in children with developmental concern or disability
● Care of the child in emergencies and during admissions for intermittent medical problems
● Co-ordination of multidisciplinary intervention services and case conferences.
● Counselling parents and family on status and progress
● Teaching and training of medical students and health care staff regarding developmental concerns
● Liaison with professional services as required among experts, clinical assessments, developmental assessments, treatment of patients and planning diagnostic services.

Pediatric Chest clinic:
started since 16th November 2022
Venue: Silver Jubilee Block (A wing) Room No: 21
Timings: Wednesday 2 to 4pm
Faculty in charge: Dr.Saurav Jain (Pediatric Pulmonologist)
Assisted By: Senior Residents/PGs in rotation.
Services rendered:
1. Managing children with chronic respiratory conditions such as chronic suppurative lung diseases (cystic Fibrosis, Primary ciliary dyskinesia), Difficult to treat/Therapy resistant childhood Asthma, Interstitial lung diseases, Primary immunodeficiency with Lung involvement admitted/attending OPD as well as referrals from other institutions across Bangalore/peripheral (mission) hospitals attached with St. Johns.
2. Pulmonary Rehabilitation services-Training parents/caregivers of children different modes of chest physiotherapy (manual) as well as use of various devices-like Acapella,cough assist etc in children with chronic suppurative lung diseases with poor airway clearence mechanism.
3. Managing respiratory complications in children referred from other subspecialities (Pediatric Neurology-neuromuscular patients,aerodigestive problems,Pediatric Hemato oncology-disease and chemotherapy related complications as well as post BM transplant),Genetics (syndromic children) that are already well functioning in the institute.
4. Managing children with sleep related disorders such as Obstructive sleep apnoea,syndromic children such as Downs dyndrome,Praderwillias well as sleep related hypoventilation disorders in neuromuscular diseases and decision regarding initiation of home ventilation (CPAP/BIPAP) for such patients.

Services to be started soon :
1. Interventional Pulmonology services (EBUS,Foreign body removal,cryobiopsy,in children in collaboration with Department of Pulmonary Medicine.
2. Sweat chloride estimation (Gold standard test for diagnosis of Cystic Fibrosis).
3.Pediatric Allergy clinic and Allergy test (skin Prick) and allergen immunotherapy in children.
4. Nasal nitric oxide testing and High speed velocity microscopy for Primary ciliary dyskinesia.

Materials Available
● Cystic Fibrosis Information Booklet (in local languages) for parents.
● Bronchoscopy information sheet (in local languages) for parents.
● Pediatric chest clinic file-both for new and follow up patients.
● Various drug delivery devices, medications, peak flowmeters to use for demonstration along with placebo medications, physiotherapy devices which can be used for teaching and training purpose as well.

Counselling services:
Offered at
● Teen clinic- for adolescents health problems
● Pediatric ID clinic-children with HIV and TB regarding disease, Drug adherence
● Unit of Hope-for parents and caregivers of children with developmental disorders
● Pediatric Endocrine clinic-children with Diabetes and other hormone related disorders
● Genetics clinic-genetic counselling for parents of child with genetic disorders.
● Pediatric Chest clinic-for children and their caregivers regarding chronic Respiratory
conditions such as cystic Fibrosis, adherence to treatment, chest physiotherapy.
● Pediatric Asthma clinic- regarding disease, drugs adherence, environment, Triggers.

Outreach activities:
● The Unit of Hope conducts out-patient clinics at the Community Health Training Centre in Mugalur, Karnataka (since 2006)- once in a month. Health workers from the community trained in community-based rehabilitation regularly follow up the children with disabilities to track the progress.
● The Unit of Hope liaises with ACCORD, Adivasi Hospital, The Nilgiris, Gudalur, Tamil Nadu (since 2008) and conducts multidisciplinary team camps for the residential tribal children with disabilities.
● The department conducts General Pediatrics Outpatient services once in a week basis at St. Johns center at Brigade meadows, kanakpura.

Community Programs:
Awareness activities by Unit of Hope
● Down Syndrome celebration day
● A focused group discussion on Adolescents with Disabilities
● Celebrated World Disability Day with a Skit

Others :
● Positive living for HIV infected adolescent and parents (session for 50 patients, training of counsellors, material for patient education)
● World Diabetes Day celebration – for creating awareness among parents and children.
● National Girl Child Day celebration annually.
● World Obesity Day for creating awareness related to obesity and its complications
● Thalassemia Day celebration annually.