Healthy Kindy Kids, Thriving Kids, and the village of supports that already exist

Speaker 1 — speech pathologist, Child Development Service

Leading the Gold Coast rollout of Healthy Kindy Kids. Opens with an Acknowledgement of Country to the Yugambeh people (Otter: Ugabe) of South East Queensland. Then Thriving Kids: “what we know and what we don’t.” Otter never gives her name.

Dr Angela Owens

Developmental paediatrician, Child Development Service. Built the CDS website. Talks DevPed Connect (Otter: Debbie Connect, DeafBy Connect). Same clinician as the 12 June morning session at child-development.drkotha.com — this is a different lecture: evening Healthy Kids / Thriving Kids / clinic topics, not the morning ADHD/DevPed session.

Lisa

Nurse navigator, Child Development Service. More than 20 years in community child health. Angela’s “official pusher” who visits GP practices. Otter’s Speaker 3 in this recording, jumping in on school nurses, waiting-room posters, the Indigenous arm of child health, and PHN IAR training.

Floor

Christy (named) on the new Medicare speech-sound / dyspraxia item. Others on Benevolent Society, Kalwun (Otter: Cowan / Callan), Wesley Mission, Family and Child Connect versus intensive family support. Angela names Natasha Russell as another CDS paediatrician who will talk later.

Otter “Speaker 16” — unnamed paediatrician

Works across community child health, paediatric medicine, and CDS (Otter: “DCH medicine, peace medicine, and CDS”). Interest in nephrology. Clinic teaching on gaming, iron, nocturnal enuresis, and unilateral renal agenesis. Otter never labels this speaker by name; this write-up does not assume they are Natasha Russell.

Healthy Kindy Kids: $37.5 million, kinder-year checks, not yet on the Gold Coast

Speaker 1, a Child Development Service speech pathologist leading the Gold Coast rollout, opened with an Acknowledgement of Country to the Yugambeh people (Otter: “Ugabe people from East Queensland”) and elders. Then the program Otter kept hearing as Healthy Indie Kids, Health Kibbe Kits, Healthy Sydney Kids, Healthy Beauty Kids, and “public in the kids.” The real name, from the rest of her script, is Healthy Kindy Kids.

It was born from the 2024 Disability Royal Commission (Otter: “2024 Disability Government”). The vision: every Queensland child has access to vision, hearing, and speech development checks in their kindergarten year, before school. Funding commitment: $37.5 million. Targeted support to identify health and developmental concerns in that kinder year.

Checks happen in children’s kindergartens and childcare centres that run a Queensland government–approved kindergarten program. Some children with concerns will already be known to families, educators, and GPs. Others will not. A kindy-based screen is a near-universal chance to notice them.

How a child gets in

1. The kindergarten-approved provider opts in and signs a participation agreement with Queensland Health.
2. Families receive information and give consent for their child to be screened.
3. Parents and caregivers complete a Healthy Kindy Kids questionnaire. With parental consent, so does the early childhood educator — because how a child functions in kindy can be quite different from home.
4. The Healthy Kindy Kids team screens in the centre. Families get the outcome. If further support is needed, advice and referrals go to the appropriate health or community services.
5. If the family has consented, results can be shared with the kindy and their nominated GP.

Questionnaires and tools: Spot, Sound Scouts, Language Screen, ICS

Healthy Kindy Kids uses questionnaires plus screening tools. Parent/caregiver and educator questionnaires include background developmental information and draw on Learn the Signs. Act Early. They include the Intelligibility in Context Scale (Otter: “Intelligibility and Context Scale”) for speech-sound production.

Delivery is in the kindy, by Allied Health Assistants, with clinical oversight from allied health. Health and education have to collaborate. That is the hard bit, and it is why Gold Coast legal agreements are still being worked through.

Universal, universal-plus, enhanced — and the GP’s job

The pathway is described across universal, universal-plus, and enhanced levels.

• No identified concerns: usual monitoring through GPs and regular child health checks.
• Some concerns: advice, monitoring, further checks, or referral. That can mean general practice, child and family health, community hearing, optometry, non-government organisations, or kindy inclusion supports — depending on the concern and local availability.
• Significant concerns: more targeted referral and support. Ongoing GP review, Child Development Service, Early Childhood Development Programs through Education Queensland, NDIS pathways where appropriate, and other services depending on need.

Local Gold Coast implementation details will keep being refined. The right referral for each child depends on the screening result, the child’s broader developmental and medical context, family priorities, and local service availability.

For GPs, the practical role is helping families make sense of results, reviewing the broader health and developmental history, considering hearing or vision follow-up where indicated, supporting referral pathways, and ongoing surveillance. Some children identified through Healthy Kindy Kids will never have had concerns raised in general practice. Others will be very well known. Either way, GPs remain key partners in the longitudinal journey.

Thriving Kids: what we know, and the very few things we do

Speaker 1 then put on her “normal job” hat — speech pathologist at CDS — and talked about Thriving Kids (Otter: driving kids, Friday kids). She titled the slide “what we know and what we don’t,” then said it should possibly be called the reverse. She is not an expert in Thriving Kids. She is known as “a little bit of a critical observer of the NDIA,” which, she said, may be why she was talking about it.

Current NDIS reform has emerged in response to increased demand for early childhood supports, long wait times for assessment and intervention, and a sense that families need a diagnosis before they can access any meaningful supports. Significant variation between jurisdictions. Pressure on health, general practice, education, and disability systems.

The government’s policy response is foundational supports. Thriving Kids is the first major implementation phase, focused on young children. Nationally it has been described as a foundational-supports initiative for children aged eight years and under with developmental delay and/or autism who have low to moderate support needs. Exactly how that is defined is yet to be determined. The intention is to support the child and also families and carers.

Published information suggests supports may include more focus on information and advice, parent coaching, navigation between services, group programs, some allied-health interventions, and community-based developmental supports. These concepts are not new. They align with contemporary early childhood intervention: family-centred practice, participation, capacity building, support in natural environments. What remains less clear is how they will be delivered, who will be eligible, what intensity will be available, and how families with low health literacy, lower parenting capacity, First Nations families, or families who speak a home language other than English will be supported to access them.

National statements continue to indicate that children with permanent and significant disability and children with higher support needs are expected to remain eligible for the NDIS, and existing NDIS participants are expected to be protected through transition arrangements.

Eligibility, Queensland, 1 October 2026 — still unanswered

“Arguably this is the most important slide.” Many of the questions health professionals are asking still remain unanswered:

• Exact eligibility criteria.
• What the Queensland pathway will look like.
• Whether GP referral will be required.
• Whether there will be a three-year-old assessment / screening assessment.
• What assessments or documentation might be required, and how children will enter the system locally.
• How Thriving Kids will interface with Child Development Service, community child health, Education Queensland, private allied-health providers, or general practice.

These are not small operational details. They are how families will access support. A common question: is Queensland ahead, behind, or in the middle? From a public-facing perspective, New South Wales appears to have progressed further — visible commissioning activity, increasing information about intended NGO involvement (not necessarily private practice) in service delivery. Queensland has released very limited implementation information publicly. That does not mean work is not occurring. Visibility is limited.

Angela, taking the floor: they have not got extra money yet to redesign CDS services, and she is not sure how they are going to do “the whole October,” but they will try. In lieu of that, a briefing on what is available now.

What exists now: school nurses, the CDS website, DevPed Connect

Lisa: over 20 years in community child health, nurse navigator within CDS for the last six years, Angela’s official pusher who goes out to GP practices (Otter: “coat cooking practices”) once a week — or you can get her to come out. She knows the support-service map. If Lisa does not know, she will get you the information. She does not only talk developmental paediatrics; she can talk community child health and the interfaces. Angela’s philosophy: it takes a village. Spread the love. The children you are most afraid of, the most complex families — get more people involved. There is so much you can do with an 18-month wait. You may not need CDS at all.

School-based youth health nurses

Everyone forgets school-based youth health nurses. They visit. If you do not have time to do a HEEADSSS assessment on an adolescent and nut out drug use or whatever else is going on — you just have the parent in front of you — you can refer through Smart Referrals. You can refer to the school-based youth health nurse (Otter: “school AC partners” / “school best”). They will go and chat to the kid and get the juicy details. Lisa: if they are really confident, young people can self-refer. It is in every state high school on the Gold Coast. Not the privates. They are about to roll out more mental health screens. They can pull school collateral in high school, which is otherwise hard because the student is in so many different classes.

Angela’s CDS website

She is biased because she made it. Landing page, left side: while you wait for your appointment. First, a checklist, then grouped under six and over six — largely because when she was making it, NDIS used that cut-off; it is a little more flexible now.

The main checklist is what she wants to know before even DevPed Connect (Otter: DeafBy Connect): that they hear, that they see, then collateral. Dropdown lists all the free hearing services on the Gold Coast, plus some private ones and rough costs. Vision: the Children’s Health Queensland–aligned list of optometrists. They do not want behavioural optometry. They want a standard visual acuity. If you can subtly improve the vision, you will not fix everything, but you will help the inattentive kid who cannot see the board.

Under six and over six are grouped by concern — a starting platform of things they want you to do, then links to resource pages: emergency phone numbers, parent lines, teenager mental health, university clinics (each provides different things; one of the lowest-cost therapy options), reputable websites for finding a private therapist. She has gone through topics that come up constantly: tech safety, sleep, ADHD, transition to prep. They tend to chop links into an email to families, or you can send the parent to the website. There is also a programs page — UnitingCare (Otter: United Care) and other NGOs running get-ready-for-prep, and some police services for difficult kids looking like they are going into crime. They try to keep it current. They cannot keep up with everything.

If it is really developmental, or you want support navigating: contact them. DevPed Connect is not just Angela. She can rope Lisa in, she can rope social workers in. “I do touch first, but then if not, just go help.”

Community child health — not only babies

If you think there is a developmental concern, particularly less speech, refer to child health nurses first. They have a full set of developmental screens. They can help link with NDIS early childhood. That is a lot of legwork GPs do not have time for. They screen who actually needs a developmental assessment. Lisa: posters in the foyer about ages and stages — put them up in your waiting room; normalise what is normal. Angela: everyone thinks community child health nurse means babies and breastfeeding. Do not forget them in the older kids. CDS is trying to make them a pathway before CDS, to screen out and support. Lisa: they have the Indigenous arm as well.

ECA under nine, care plans, and the new speech-sound item

Early Childhood Approach and NDIS: under nine as it stands currently, you do not need a diagnosis to get onto the early childhood part of NDIS. You need a developmental concern. Ideally the threshold sits at two developmental areas — language plus social skills, or language plus play. If your early screeners identify two areas, send them ECA. Even if they do not get a full package, they have short bursts of therapy they can access, as well as your care plans. Do not forget care plans. There is still an out-of-pocket for private providers, but it is better than nothing — and sometimes in anxious families it is enough reassurance, or it gets you the assessment that language is awful and you really do need it, which is the evidence for a proper NDIS package.

The website has contact numbers for ECA (under nine) and local area coordinators (over nine). If someone has put in an NDIS application and heard nothing, it does not hurt to email extra information. They may have based a decision on information sent six months ago; you now have more assessments.

New Medicare item: speech-sound disorders / dyspraxia — not language-only

Floor (later named Christy in the room): on the Medicare care-plan page, the new addition of speech-sound disorders. Otter captured “stuttering 20 assessments, so 20 is…” Angela: 20 sessions. Therapy interventions until 2025 (Otter: “until the 25”). It is not just language disorders, and it is not just speech-sound disorders: a formal diagnosis of dyspraxia. The first ordinary care plan is useful to get that diagnosis in writing, then you can enact the extra item (Otter: “the one 3000 sessions for assessment” — garbled; do not treat that as an item number).

Christy: does the child have to have an overarching developmental disorder, or can speech sounds be the only concern? Angela: language is the content of what they are talking about; the sounds are the bit in dyspraxia — how understandable they are. Floor: it is speech sounds; it does not include language disorders as the only concern. It is on the eligible disabilities list. The rest of that list is things GPs have had access to “for donkeys.” This is a new addition to that complex list.

Later, someone clicked through: items one through nine as an eligible-disabilities care plan (Otter: “139 so far”). The recording is messy here. Use the current MBS eligible-disabilities list, not Otter’s digits.

Speaker 4 / PHN voice: the PHN will pay for GPs’ time to do the IAR session. Another voice: “definitely.”

Family and Child Connect is a call centre; intensive family support is home visits

For tricky kids, please link them with family support. The commonest name GPs know is Family and Child Connect. These are the children you are worried about who are not quite child-safety (Otter: DOCS) criteria. You do not want to do a report, but you have a concern the family is not coping. Funded under the same area as child safety.

Misconception, including inside CDS: “they’ll solve everything.” They are good navigators of services, but they literally do it via phone. If the family pick up and say they are right, that is the end of the service. Or: you need NDIS, here is the website, goodbye. For a family who have their life together a little bit, that can be okay. Often the families you want family support for do not have the headspace to make the phone calls and jump through referral hoops.

That is intensive family support, on the same website. One form, you tell the concerns, and at the end there are three tick boxes: Family and Child Connect, intensive family support, or an Indigenous version of intensive family support. For the ones you are worried about, pick intensive family support. They hold the family for six months, usually weekly or fortnightly home visits, and step them through the process — NDIS paperwork especially, multicultural families especially. Family and Child Connect is pretty much a call centre. You may as well give the family the links from the CDS website. If you think they will not click through, do not use FaCC as your only move. Angela did not want to “diss” them. It is short-term support.

Technical threshold for intensive family support: you need to be worried that if they do not get this support, they will end up in the child-safety system. For some families you cannot hand-on-heart say that — they have not got their stuff together, but you are not saying they will hurt the child or the child will be grossly neglected. For those ones in the middle: Wesley Mission. More hand-holding, without the child-at-risk threshold.

Wesley Mission, Benevolent Society, Kalwun, multicultural, Act for Kids

Floor: also add Ben Sock. Angela: Benevolent Society is very similar to Wesley Mission. Floor (Speaker 10): schools and GPs have started to refer to Benevolent Society directly; they get the NDIS paperwork done, then may refer on to paeds. If parents come in with a diagnosis of learning difficulties or dyslexia, Benevolent Society can help complete the application. They only see kids under the age of eight. If you are seeing a family with older kids but one child is under eight, refer that under-eight even if they are not your primary concern, and they will support the whole family if you can show that younger child also has sufficient difficulties. Becoming a more common pathway, especially northern Gold Coast.

Kalwun (Otter: Cowan, Callan). More than GP services: psychologists, nurse navigators, data around support for First Nations people. They also have a paediatrician. Do not refer to CDS and to Kalwun. They can handle that for those families. Later Angela: Waijungbah Jarjums (Otter: “wide junky gardens,” which she can never say properly) for under-fives — developmental assessment, parent–child interaction. Kalwun focusing more on five and up, whole family unit, culturally appropriate. Both have paediatricians within their services.

Lisa: multicultural communities — they work amazingly both ways. Angela: specific communities on the website. One down at the (Otter: “ring”) that specialises in New Zealanders; other multicultural organisations for non-English-speaking families. Have a look on the website. She could not cover everything.

Act for Kids (Otter: Act Two Kids) own the intensive family support service. They also have other arms, including Pathways for Early Learning and Development — preschool-age, not just family tensions but attachment and relationship. The families where the kid is really hard, but it is more about parent–child interaction.

There is also a Griffith program, Parent–Child Interaction Therapy (PCIT), up till eight (she thinks), 17 weeks of weekly intervention. Little earpiece in the parent’s ear, child and parent in the room, scenarios designed to provoke the relationship, live feedback. Theory is not enough until you are in the moment. Otter also captured “17 years, it’s good pelt” — likely 17 weeks, PCIT.

The more complex the family, the more she wants you to pick one from every arm. If you cannot navigate: DevPed Connect advice, or book a case conference and she will get the right people in the virtual room. Lisa: when you refer, ask what the outcome was. Overarching organisations have doors that do not talk to each other; you may need to copy-paste the referral the other way. If a file does not make threshold, ask what would. Angela: they did not realise for a long time that having a paediatrician was an exclusion to CYMHS (Otter: Kim’s). They had been keeping files open “just in case CYMHS needs you back,” and were actually blocking access.

Medicare Mental Health, IAR-DST, Headspace, trauma

They get so many referrals that are actually mental health, or coexist. New program: Medicare Mental Health — a website that aims to do the navigation. Give the family the phone number; they ring, do a screening based on the IAR-DST tool (Initial Assessment and Referral Decision Support Tool; Otter: IAR DST / IR / IARS). Severity, complexity, functional impact, where they should go, cost. Lisa: PHN runs this training online; she has done it; it scores at the end.

You can do the tool yourself. Technically you should complete the training. Problem she sees: kids who are obviously CYMHS patients; parent rings; they get screened; they did not tell them all the stuff. Or: as soon as there is a developmental diagnosis, intake says CDS will sort it out. She cannot sort declining mental health in a once-a-year review. Autism does not mean they do not have declining mental health.

Fill it yourself. Pick developmental age at the top, work through sections. The bit that matters for them is the impact of coexisting conditions — autism mild, mental health high. Eight little sections; recommended level of care at the end. Level four or five, moderate to severe, is CYMHS cut-off in her framing. She often emails a referral and attaches this report so they cannot really not do a proper assessment of the actual child, above a phone intake. Also useful when it comes out mild to moderate: Head to Health Kids or private psychology. There is a guide of services at different levels. If you do not have time, parents ring the mental health number and they will screen.

Do not forget Headspace for 12 to 25s — free-ish therapy; they do get a mental health care plan sign-off to cover costs. Trauma: Act for Kids run Flourish, a trauma-focused intervention, no cost, limited capacity. Sexual abuse: Bravehearts (Otter: Braveheart); another counselling service that child safety only can access.

A side note on toddler autism screens

They were not really discussing autism today, but someone had asked about the best screening questionnaire for parents of toddlers with suspected ASD. Angela was told there is an ASD Detect app (no double D) that GPs can access. Her message under five: if they are really concerned it is autism, there is probably no great screening, because there are too many possibilities. Go through child health first and let them nut out how much is normal, parent anxiety, or a problem. Do actual developmental screening tests to narrow which areas to focus on. Legislation still is that paediatricians or registered psychologists need to be involved to make an ASD diagnosis; even when a registered psychologist makes it, NDIS sometimes get funny about funding. Those kids are coming to CDS in the end. She would really appreciate child health as assessment support rather than GPs wasting time on a screen that will probably come up positive and still not tell you which supports to start.

Floor on Novopsych (Otter: Novosyke): they have an autism screening tool; people send it with referrals. A psychologist in the room: for kids under six they have a comprehensive interview screener, Otter captured as “ADAR.” Angela: GPs do not have the time. If you are seriously worried — child in the corner, stimming, not interacting — get a psychologist involved. Screeners are not good enough for the borderline kids. She wants a whole look at the child.

Closing this block: most of those services you do not need a diagnosis for, and you do not need a letter from her. You can access most of what she can access. Do not wait and think a paediatrician is the answer. There is only so much she can do in an hour.

Gaming and internet gaming disorder

From about 46 minutes, Otter’s Speaker 16 — a paediatrician who works across community child health, paediatric medicine, and CDS, with a nephrology interest — taught clinic topics GPs see first: too much Mario, iron, nocturnal enuresis, and a single kidney.

Gaming is common and not going anywhere. The industry is worth almost as much as the entire movie industry and traditional TV combined. In Australia alone, about $608 million gross turnover. 90% of children identify as having played video games; 40% identify as gamers — essentially playing every day. In practice, almost all kids have played some sort of video game. Games are not inherently bad. Some evidence around cognitive skills and hand–eye coordination. For a lot of kids, relaxation after holding it together at school. In the neurodivergent cohort, a way to connect without face-to-face social cues. Local chronic pain service uses VR headsets; the hospital uses VR as distraction for anxious kids and procedures.

Esports is legitimately a thing. A lot of schools run programs. An avenue of connection for kids who might otherwise be isolated. Pre-COVID participation about 4%; the speaker reckons post-COVID a bit higher. The 2026 Esports World Cup — which they also did not know existed — in Paris, a trail of 24 titles, total prize pool $75 million. Ironically, one of the titles is chess.

The other side. Half of kids who play games interact with people they do not know online — potential for manipulation. Three kids in the last 18 months had a knock on the door from the Australian Federal Police after sending pictures of themselves in compromising positions that were picked up or distributed. 17% of kids have experienced bullying online. The one safe haven becomes littered with abuse.

Roblox is not one game. People can make their own. There is supposed to be oversight. The speaker described user-made games with violent and sexualised content that parents do not expect, and cited a Guardian article that called the platform a “pedophile hellscape.” A lot of parents just hear “the kids play Roblox” and do not understand how far it can go.

Gambling-adjacent: loot boxes, real-world money for character skins, pay-to-win. Two weeks before the talk, a child in clinic had stolen $10,000 from his grandmother to buy Fortnite skins. Credit card out of the wallet, kept buying, until her electricity bills were being knocked back.

DSM-5 internet gaming disorder — and three hours

DSM-5 has internet gaming disorder. The speaker does not think it is named the best, because some of these games are not necessarily online. Like any addiction: it crowds out day-to-day lives and activities you want to be doing. Prevalence in Australia estimated about 3% pre-COVID. Not a lot of studies post-COVID; one suggests around 1–4%. In practice probably a bit higher, under-reported.

Three hours a day seems to be a bit of a magic number. A study looked at symptoms across gamers who played less than three hours versus more than three. Correlation, not causation — not saying four hours of video games will give you ADHD or oppositional defiant disorder — but higher rates of those diagnoses in the kids who played more.

Parent worried about gaming. First: what are the parents’ expectations? Child playing two or three hours a day, still going to school, still good grades, still has external friendships — where is the disorder? Have they sat down and played the game with the kid? They rarely ever have, if they are actually seriously concerned. The ones who play with the kids are often gamers themselves; the speaker is less worried about that relationship.

Then: why is the kid playing? Self-determination theory: autonomy, relatedness, competency. Autonomy: finally in control — Zelda character, something done well when everything else is a struggle. Relatedness: Rocket League online with friends in different states. Competency: feeling capable and effective. These games are designed to be addictive, particularly mobile games; psychologists optimise lights, noises, colours. Some almost look like poker machines. Unregulated.

Key: escapism. If there is a problem with the gaming, what is the kid trying to escape from, and how can we help them find that in real life?

Help: DevPed Connect if you have questions. Game Aware, based in Victoria — monthly online meetings, families join for Q&A; an online parent program that can be funded through NDIS if the child has NDIS from a disability perspective. They are looking into research with them. Otter also captured “Gang criticism and Dr. Marshall” as other resources — unclear names; do not invent. Main evidence, like other addiction programs: CBT, family therapy, a mentor who models healthy gaming (a proper gamer, a guidance officer, the person who runs esports). An activity matrix using self-determination theory ranks what the kid likes based on the games they play, then suggests real-life activities that fill the same buckets. An “IRL skill tree”: read a book, 15 points — external reward until internal motivation builds. If this interests you, email the speaker; talks with Game Aware about clinician education on attitudes, knowledge, and practice.

Iron: ferritin, reticulocyte haemoglobin, supplements

Special thanks to Dr Olivia Starwitz (Otter’s spelling), a paediatrician at the hospital with a haematology interest, who put the slides together.

Main point: normal ferritin range in kids is a little different from what the lab suggests. In kids, a ferritin in the 20s is completely normal. It can be a little lower — sort of 15 as the lower range of normal. Ferritin is an acute-phase reactant. Lots of things influence it. Not long ago, a girl referred for persistent anaemia was felt not to be iron-deficient because of a “normal” ferritin. She actually had CKD, which falsely elevated ferritin, and when they did a reticulocyte haemoglobin it was more related to the CKD than iron as a function of her anaemia.

Upcoming: the hospital runs reticulocyte haemoglobin — looking at the haemoglobin concentration of the reticulocytes coming out. Not affected by acute-phase inflammation. More reliable marker of iron storage when you cannot use ferritin. The speaker has not found other labs doing that. If you ask for it at Sullivan Nicolaides or QML (Otter: Sally Nicolaies), they just want a reticulocyte count — not what is wanted. They do it at the hospital. If you wrote it on a request form and the child had it done at Robina or Gold Coast, it would be able to do it. Griffith are about to do research into urinary hepcidin (Otter: “urinary person”) — a non-invasive way to measure iron in neurodivergent kids with food sensitivities, where bloods are tricky. Watch this space.

Iron replacement: lots of preparations; some better tolerated. The iron liquid tastes “pretty feral”; some kids refuse it. The speaker quite likes “the FIFO, the span chills” — Otter, almost certainly ferro spansules or similar capsules you can open into yoghurt, as long as the child does not chew them; better absorbed, less overbearing taste. This write-up does not invent a brand Otter did not clearly name. Nice information on RCH Melbourne and the National Blood Authority.

Angela, jumping in: thinks less constipating. Under 12 you need a PBS authority (Otter: “fee authority”). New registrars happy to help with that. Under 12, pharmacists want AMH (Otter: “AMH from Malaysia or something… not an Australian AMH”). They feel more comfortable over 12. For kids you cannot get iron into.

Lots of official “tasteless, flavourless, textureless” supplements coming out. The speaker does not know the efficacy of all of them. Lots of families have started using them. Lots of multivitamins have iron built in — look at how much is actually in there. Otter captured some of them with “like 0.03 micrograms of iron,” versus a teaspoon with more; non-haem as well as haem. Quote Otter; do not treat 0.03 micrograms as a dosing fact.

Strategies: alternate-day administration has been shown to be a bit better, fewer side effects. Taking tablets or liquid at night can be a bit more effective. Vitamin C is beneficial.

Olivia asked the speaker to flag a new combined paediatric and adolescent gynaecology clinic for adolescents with heavy menstrual bleeding — haematology side as well. Open almost 12 months, happens monthly, referrals through the gynaecology referral pathway. Age range: any adolescent who is having periods; they did not land a hard cut-off in the room.

Nocturnal enuresis: alarm, desmopressin, constipation

Super common. This talk is monosymptomatic nocturnal enuresis. Daytime symptoms as well need a different approach. Natural history: daytime control by about four years, night-time control somewhere between five and seven. Still heaps of older kids. The speaker often sees 12-, 13-, 14-year-olds; incidence still 2 to 3%. “How many kids are in your year? 150? Three or four having the same problem as you, but no one talks about it.” There is a whole lot of benefit in active treatment before about six to seven years old. A big part of clinic is setting expectations. Families want a quick solution now. That is not always going to happen.

Why it happens

• Delayed maturation of the bladder-control system. Studies put EEGs on kids overnight; changes around the maturation centre — the child is not waking properly.
• Small bladder capacity, including constipation: a massive stool sitting there, bladder cannot fill; as soon as it hits, they go. Chronic constipation kids also lose sensation and control.
• Disordered sleep — sleep apnoea, sleep-disordered breathing, some kids who are super deep sleepers. That tends to run in families, in the speaker’s experience.
• Hormone — delayed or lesser response to antidiuretic hormone / vasopressin.
• Something in the urine pulling fluid — often protein or glucose.
• Weird things: in the last 18 months, three children whose only symptom of coeliac disease was nocturnal enuresis, maybe a little grumbling belly pain. Bloods, gluten out, enuresis cleared.
• Neurological: spina bifida — keep an eye, but you tend to get daytime symptoms with that as well.

Exam: always worth checking growth, blood pressure, ENT, spine, a little bit of reflexes, press the belly.

Investigations the speaker actually finds useful

First up: an early morning urine. MCS, exclude pyuria or lots of red cells. Labs (Sullivan Nicolaides, QML) often dipstick for protein or glucose and give you a concentration. If you can concentrate urine to over 600 milliosmoles (Otter: millisemales), the body is concentrating overnight, ADH / vasopressin is working, as long as they are not drinking overnight. Effectively excludes things like diabetes insipidus (Otter: “diabetes and syphilis”).

Ultrasound, if there are questions after about seven, eight, ten — or a little younger if lots of anxiety. Kidneys, bladder, does it empty fully? Incomplete emptying overnight means you start already not empty. Always ask for a transabdominal rectal diameter. Nobody ever believes there is constipation. Objective number. Otter: “Johnny’s transit normal recculometers, four centimetres, that tells me some rectum has been distended for a long time.” Treat 4 cm as the figure the speaker used for a rectum that has been distended — not as a “normal” value, and not as a protocol.

Treatment

• Bell / pad alarms. Probably the best evidence in really highly motivated families. The speaker is seeing a selected cohort where this has failed or they have not wanted to do it. Adherence, in that group, is really poor. Fewer relapses. Similar success rates to desmopressin.
• Desmopressin (Otter: Desmond Preston). Useful if there is a short-term goal — camp, sleepovers — a bit of confidence they might not have an accident. Similar response rate to alarms, higher relapse when you withdraw it.
• Anticholinergics. Maybe a little bit of evidence they are better; a study coming on the slides. In the speaker’s experience they cause more constipation, which is often at the base of the enuresis in the first place. Reserve unless there are daytime symptoms of urgency and dribbling / overactive bladder.
• Mirabegron (Otter: Mirabegon), a beta-3 agonist, meant to increase bladder capacity. Not going to do much if the pelvis is already full of stool. Urologists at Queensland Children’s Hospital “love this and reckon it works really well.” Not on the PBS. No dose was given in the recording.
• Combination desmopressin plus anticholinergics: a little bit of evidence; some agents not available in Australia yet.

Floor: child on both treatments (Otter garbled the product names) still highly unable. Speaker 16: sometimes say it is not working, stop everything, do more organic investigation that had not been done. Lower the pressure on the kid. Families really sick of it, want a quick solution. Often: stop everything for three months.

Unilateral renal agenesis / the single-kidney pack

Unilateral renal agenesis: more common in males; usually the left kidney is the one that is missing. Also relevant: multicystic dysplastic kidney — non-functional tissue, tends to shrivel up and die by the time kids are usually five or six, leaving one functional kidney.

That kidney does all the work. Compensatory high pressure; it gets a lot bigger. A single kidney is at higher risk of CKD later in life. Education: hydration; avoiding nephrotoxic agents, like really high-dose regular NSAIDs. Every now and then is fine — kid rolls an ankle, no worries. Frequent days and days, lots of sport, dehydrated: you can end up with renal insult. The other nephrotoxic medicine the speaker always tells families about is gentamicin, which hopefully they are not having too much of.

Sport is great. Families ask: do I need to stop contact sports? No. Absolutely play contact sports. The speaker does not suggest MMA — “I don’t suggest doing MMA to anyone anyway.” Kidney guards: they do not use any actual evidence, but if it gives the kid and family a bit of confidence, grown-ups.

Monitoring. Good information packs — Western Australia, South Australia, RCH; the speaker tried to pull them together into one that covers everything, and is happy to send it out. Recommendations from an Italian study a couple of years ago: pretty frequent ultrasounds for the first 12 months of life, then it really backs off. Yearly urine protein:creatinine ratio and blood pressure — not leaking a lot of protein (marker of renal stress), not getting hypertensive.

Normal blood pressure in kids: the speaker loves a free app, BP Sentinels. Plug in the child’s gender and height. Otter then said it “gives you the 58% plus 12 millimetres.” That is garbled. Use the app; do not copy Otter’s percentile as a number.

Girls with unilateral renal agenesis, at about age 10, should have an ultrasound of the uterus and ovaries. Kidneys and bladder develop with the Müllerian duct (Otter: malaria duck). Can be associated with a bicornuate uterus. Before they hit puberty, understand the architecture. Puberty is a high-risk time if they do have some sneaky CKD — it becomes more apparent.

Take-home messages for clinic

1. Healthy Kindy Kids is $37.5 million from the 2024 Disability Royal Commission: vision, hearing, and speech checks in the kinder year, in approved kindergarten programs. Provider opt-in, Queensland Health participation agreement, parental consent. Parent and educator questionnaires (Learn the Signs. Act Early; Intelligibility in Context Scale). Spot (same as prep), Sound Scouts iPad, UK Language Screen iPad. Allied Health Assistants with allied-health oversight. Not diagnostic. Results to the family; with consent to kindy and the nominated GP.
2. Gold Coast has not started yet (legal agreements). Hoping some kindies from July. Statewide by the end of 2027. GP role: sense-making, history, hearing/vision follow-up, referral, longitudinal care. Universal / universal-plus / enhanced.
3. Thriving Kids is foundational supports for children 8 and under with developmental delay and/or autism and low–moderate needs: information, coaching, navigation, groups. National Agreement up to $4 billion over five years. Otter said “$2 million from the Commonwealth” to be matched by states — probably billion. State-delivered services from 1 October 2026; full implementation 1 January 2028.
4. Most of Thriving Kids is still unknown in Queensland: eligibility, pathway, whether you refer, three-year-old screen, interface with CDS / child health / Education / private allied health / GP. NSW is more visible. Keep using existing pathways. NDIS eligibility legislation has not changed. Do not delay assessment or intervention waiting for Thriving Kids. Do not predict NDIS’s future to families. Speaker 1’s pessimistic take on plan cuts before 1 October is her opinion as a critical observer of the NDIA.
5. School-based youth health nurses in every Gold Coast state high school, not privates. Smart Referrals; young people can self-refer. More mental health screens coming.
6. Angela’s CDS website: while-you-wait checklist, under 6 / over 6, free hearing list, CHQ-aligned optometrists (not behavioural optometry), uni clinics, tech safety, sleep, ADHD, prep transition. DevPed Connect plus Lisa plus social work for navigation. Community child health nurses for older kids too, including an Indigenous arm.
7. ECA NDIS under nine does not need a diagnosis — a developmental concern, ideally two areas. Use care plans. New Medicare extra sessions for speech-sound disorders / dyspraxia sit on the eligible disabilities list; not language-only. PHN funds GP time for IAR sessions.
8. Family and Child Connect is phone navigation. Intensive family support is six months of home visits (and an Indigenous IFS box). Wesley Mission and Benevolent Society for families not at child-safety threshold. Benevolent Society under 8; a younger sibling can open support for the whole family. Kalwun for First Nations (psych, nurse navigators, paediatrician) — do not double-refer CDS and Kalwun. Act for Kids / PCIT / multicultural orgs on the website.
9. Do the IAR-DST yourself when phone intake will undersell coexisting mental health, especially if a developmental diagnosis is being used to bounce them from CYMHS. Headspace 12–25. Flourish for trauma. Child health first for toddler “is this autism?” rather than an app.
10. Gaming: not inherently bad; DSM-5 internet gaming disorder when life is crowded out. About 3% (maybe 1–4% post-COVID). Three hours is a research cut, correlation not causation. Sit down and play the game. Autonomy / relatedness / competency / escapism. Game Aware. Roblox is a platform. Loot boxes are gambling-adjacent.
11. Iron: paediatric ferritin in the 20s can be normal; ~15 may still be in range. Acute-phase liar. Reticulocyte haemoglobin at Robina / Gold Coast University Hospital, not the private labs. Alternate-day, night-time, vitamin C. Under 12 may need PBS authority. Do not copy Otter’s 0.03 micrograms.
12. Monosymptomatic nocturnal enuresis: early morning urine (concentration >600 mOsm, protein, glucose, MCS), ultrasound plus transabdominal rectal diameter, treat constipation, alarm in motivated families, desmopressin for camp with higher relapse, anticholinergics constipate, mirabegron not PBS. Coeliac can present as bedwetting. If nothing is working, stop for three months and look again.
13. Single kidney: hydration, not chronic NSAIDs, gentamicin, contact sport is fine, yearly BP and urine protein:creatinine, frequent ultrasounds in the first year then back off, girls ~10 get uterus/ovaries ultrasound. Ask the speaker for the consolidated pack. BP Sentinels app; ignore Otter’s “58% plus 12 millimetres.”

Dr Kotha · Gold Coast · healthy-kids.drkotha.com