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Children's Health 2019

The challenges and opportunities for children’s healthcare in Ireland

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Dr Ellen Crushell

Dean of the Faculty of Paediatrics, Royal College of Physicians of Ireland

More must be done to keep our children healthy and ensure services are there to care for them when they are sick, says Dr Ellen Crushell, Dean of the Faculty of Paediatrics, Royal College of Physicians of Ireland.


It’s an exciting time for children’s healthcare in Ireland. First of all, there’s the development of a new, world class children’s hospital to respond to children’s complex care needs, giving us a wonderful opportunity to improve health for all children. There is an enthusiasm and energy associated with this, and other changes, within child healthcare in Ireland.

Improving working conditions for doctors

Yet challenges exist. We need to recruit many more paediatricians as, with just 200, we fall far below the OECD average. Croatia, for example, has 700 for a similar population.

Irish paediatricians are highly valued abroad and contributing significantly to child health in many other countries. The current situation with pay inequality needs to be urgently resolved to entice these paediatricians to return home to work alongside their colleagues.

We have serious inequities in access to child health services, in particular for child and adolescent mental health services. Children in need of mental health services are presenting in crisis in rising numbers to our emergency departments.

One in 10 children lives in consistent poverty and although it is 30 years since the UN Convention of the Rights of the Child, we have a housing crisis with thousands of our children living in inadequate housing.

New therapies now available for previously untreatable conditions

My own special interest is in inherited metabolic disorders, which occur when abnormal chemical reactions interfere with the body’s ability to break down proteins, fats and carbohydrates from food.

All newborns are screened via the ‘heel-prick test’ for six metabolic disorders (other countries screen for many more), along with hypothyroidism and cystic fibrosis. Ireland was the first country to introduce a national screening programme for phenylketonuria (PKU) over 50 years ago, a condition that, if untreated, results in severe brain damage. New therapies are now available for previously untreatable conditions and we need to consider further expansion of newborn screening to improve outcomes for children with some of these disorders.

There are more than 700 individual metabolic disorders, with more being added to the list all the time. Most of these conditions are very rare, although some are common in certain populations. Disorders such as PKU are eminently treatable and warrant newborn screening, but some other diseases are chronic, progressive, require complex management and, tragically, can be life-limiting.

Unfortunately, because symptoms are often non-specific and some diseases are so rare, it can occasionally be difficult to arrive at a diagnosis, although that’s improving, thanks to better screening and advances in genetic testing.

When it comes to treatment, enzyme replacement therapy (to replace a genetically absent enzyme) has been a great medical advance recently, and gene therapy is on the horizon. Yet these treatments are very expensive and need serious levels of investment, as do basic essential multidisciplinary care services, which should be available to all children with complex needs but, invariably, are not.

Prevention and better education for better child health

Thankfully, children are physically healthier now than ever before. Children thrive if they have the opportunity to live in safe communities and supportive environments that provide the right conditions and opportunities for them to attain their full potential. While there will always be a place for medical management of unwell children, as a society, we need to increasingly move towards keeping them healthy.

Prevention is the answer and was the theme of the recent Europaediatrics Congress in Dublin. Investment in early childhood has been shown to be highly cost effective. Childhood obesity remains a major issue, for example, and must be tackled at societal level with better lifestyle and education. We need to pay more attention to our adolescents, a vulnerable group who are high healthcare service users. More, too, must be done to highlight the vital role that vaccines play in saving lives and preventing disability, in order to counter the alarming rise in distrust of vaccination.

These are some of the messages you’ll read about in Children’s Health, which explores prevention of conditions, treatment options and the support available to families, while dispelling some common myths.

The health of our nation is dependent on the health of our children. All of us — the government, medical establishments, families and communities — have our part to play, because children cannot achieve optimal health alone.

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