Working on the children's ward at Salisbury District Hospital - taking care of 2,000 children a year

Cared for by a specialist team, they arrive in the children’s ward having been admitted from the day assessment unit, the emergency department or the burns unit.

Carl Taylor, the lead consultant paediatrician at the hospital, says care is completely different from the adult world.

“It is entirely focused around the child and their family. We never wear white coats. Doctors generally stopped wearing them ten years ago because of infection control but paediatricians have never worn white coats because it’s more child friendly.

“The approach to children is very different to that of adults. It is important the children’s voice is heard.

"A lower-level approach is needed to ensure children’s views and wishes are included in their care.

"We have to adjust our approach – the interaction would be very different taking care of a sick baby that has just been born to looking after a 16-year-old who has mental health issues.”

The Sarum Ward has 16 beds with each one containing an area for parents so they can sleep near their child.

Ten of the beds are in their own cubicles allowing for isolation if children have infectious diseases.

The children’s unit incorporates inpatient (Sarum Ward), a day assessment unit (DAU) and the outpatient department.

The DAU, known as Woodlands, is open 9am to 9pm and over winter has also been running at weekends to cope with the seasonal rise in flu cases and bronchiolitis, a respiratory illness affecting infants.

The outpatients department has a sea theme with a large fish tank and it is here medical staff care for children suffering lifelong conditions, such as diabetes or cystic fibrosis, to more acute problems such as constipation.

“Children with Type 1 diabetes have to either inject themselves with insulin four times a day and monitor their blood sugar levels or use an insulin pump,” Dr Taylor says.

“Forty per cent of children are on insulin pumps and all of that care needs constant adjustment as they grow and as their lifestyle changes.

“It is not just doctors involved but diabetes specialist nurses, dieticians and psychologists.

“We run clinics every week and patients are seen every three months to monitor all aspects of the management of their diabetes - we work with the patient to get the best treatment of their diabetes which helps to reduce long term complications.

“A chronic condition increases the risk of depression, anxiety and feeling different from their friends, so we have a psychologist who supports patients, taking the time to talk to them and seeing if certain strategies will help them cope or manage it better.”

The team treats children aged from birth up to 16-years-old, and sometimes even up to 19, if they are already known to the hospital. The unit also supports children at Exeter House School, a school for children with learning difficulties.

Child protection and safeguarding has become more and more important in recent times with medical teams working in a multi-disciplinary team including paediatricians, social workers, police officers, primary care and school teachers.

“Something that all consultant paediatricians struggle with is the fact that parents and others can cause harm to their children,” Dr Taylor says.

“As doctors we are always taught that we should have total trust in patients and believe what they are saying but with child protection, we have to think that maybe the child has come to harm from their parents, carers or others.

“If we find any evidence that’s suspicious we involve the larger team and hold a strategy meeting looking at how we move forward.”

Dr Taylor became a consultant paediatrician after doing a five-year medical degree, an extra year in physiology and ten years training as a junior doctor, which included a year in a Toronto children’s hospital. He joined SDH as a consultant in 2002.

“One of the aspects of doing a medical degree is it travels – you can go anywhere in the world and work.

"The best part of paediatrics is its brilliant when things go well and you have good outcomes and we they do very frequently.

"However, when patients don’t get well, it’s extremely upsetting and you have to cope with the fact that sometimes children don’t survive.

"Thankfully that is becoming rarer and rarer, child mortality is decreasing.”