Understanding Paediatric Infectious Diseases: Insights from Dr. Linny Kimly Phuong

In this episode of PAEDS Small Talk, we delve into the world of paediatric infectious diseases with Dr. Linny, aaediatric infectious diseases physician and researcher. We discuss the current landscape of infectious diseases, vaccination hesitancy, and the importance of completing antibiotic courses. Dr. Linny also explains the impact of social determinants of health on infection risks in children and shares insights about The Water Well Project, a health promotion charity. 

Additionally, the conversation touches on the new RSV vaccine and the resurgence of measles, offering vital information for parents on recognising signs of serious infections in their children.

In this episode we discuss Dr. Linny's charity The Water Well Project

https://www.thewaterwellproject.org

Other helpful links 

RSV vaccine 

Measles

visit our website at www.paedseducation.com.au

Transcript

Hey, Sarah, how's your week been so far? Oh, grace. We are nearing the end of the term. Uh, and I hate to always say the word busy, but it is, it is really busy. We've had a lot of training, uh, in the last few weeks, which is fantastic. So many people learning CPR learning first Aid. Learning complex care. Uh, but yeah, busy.

It's busy and the kids are done. The kids are ready for a break. Um, I'm not sure if there's any parents listening who have got kids at school for the first time this year, but this time of year kids are tired. They just get worn down. Um, we're heading into the winter season, so there's sort of some little sniffles and coughs and colds going around, but um, yeah, we're all a bit tired.

I'm ready for some holiday sunshine. Yeah. Well, you'll be looking forward to your annual leave that you've got coming up. I am very much looking forward to it. How are you? Yeah. You know, um, I saw this analogy just the other day about, you know, we talk about the juggle where you're juggling balls. And I often joke that I'm dropping them quite frequently, and I saw this analogy about like how all the balls.

Uh, actually different, like some of them are crystal balls and some of them are rubber balls. So obviously you can let some of those [00:02:00] balls drop if they're gonna bounce and some you can't let drop. And then every now and then someone throws a bowling ball at you. I sort of feel like last week someone threw a bowling ball at me, but important thing is I didn't let any of the crystal balls drop, which to me is my family.

So yeah, just I was. So that's, uh, the crystal ones, obviously not the balling balls. Um, but uh, that's probably enough to talk about balls for today. Um, that's your ball quota. Uh, let's, uh, have a chat about, um, this week's topic. So, uh, what do you know about infectious diseases? What do I know about infectious diseases?

There's a lot of them. Gray. Yeah. Broad. There's a broad, uh, look. The word of infectious diseases, I think we're in the midst of it right now. I actually just had tracheitis recently. Um, and it was just. So horrendous. I, I thought I had hooping cough, and I went to the GP and [00:03:00] said, I need a full respiratory panel.

I need to know what bug I've got because I'm around people all the time. You know, I'm a pediatric nurse. And they said to me, oh, surely you wouldn't have hooping, cough. And I said, look, I, I'm a pediatric nurse. I work the intensive care and straight away anything's possible. Yeah. Uh, look, we are just, it's just constant, isn't it?

In the ICU we do not have a season anymore of, of viruses, and I feel like we're getting more and more. Really intense sort of periods of viruses. Um, and I don't know why that is, but it used to be that we had a bronchiolitis season, that we had a influenza season, but now it's all year round. We just have kids all the time who have really severe, um.

Episodes of influenza or, or bronchiolitis or, or whatever, whatever virus it might be. But look, there's so many diseases and there's viruses, there's bacteria. We have fungi, we have so many diseases that, um, we are exposed to all the time. But certainly at the moment, like we're hearing a lot about [00:04:00] RSV.

There's a lot of that going around, which we know is one of the leading causes of bronchiolitis as well as pneumonia in kids. Um, and we had a lot about hooping cough last year. We had, uh, it was over 50,000 cases or something. Um, huge numbers. Um, so there's still a lot of talk around pooping cough. Uh, and then we're also hearing a lot about measles, um, at the moment as well, particularly overseas.

So. Yeah, look, I know a little bit about infectious diseases, but I love Dr. Lenny who we, you've talked to in this episode, and I know that this is gonna be an amazing episode and I can't wait to listen. Great. Let's have a listen then. 

 We have a very special guest joining today we have Dr. Lenny. I'd love you to introduce yourself and tell everyone who you are. 

Yeah, thank you so much, grace, for having me. So I'm [00:05:00] Linnie. I'm a pediatric infectious diseases physician.

I'm also a researcher and founder of a charity called The Water Well Project. I guess we'll find out a bit more about me in this. 

Yeah, you've got a few different, strings to your bow there, but all of them are really quite focused on improving public health, aren't they? So you are working quite a lot in the community and look infectious diseases.

That's always been something that's been really interesting to me, and particularly pediatric infectious diseases. What got you into that line of work? 

That's a really good question. I went through, medicine as a postgraduate, so I was actually a pharmacist to begin with and, went into medicine thinking I was gonna do pediatrics.

'cause obviously love working with children and love kind of that communication aspect with parents, during my pediatric training, I was exposed to lots, lo lots and lots of different subspecialties, hemon, gastro neuro rheumatology neonatology.

I did a stint through infectious diseases. I [00:06:00] found with the ID cases that I was reading in my spare time I got, quite intrigued and found myself very interested in those cases more so than some of the other specialties.

I also was exposed to some really great senior clinicians as well, and, you learn who you would like to be like in the future and, I think those particular role models for me, encouraged me, but also kind of made. The spec specialty a lot more interesting and perhaps a bit more accessible as well.

So I, followed that line. I love Id, I think it, you know, I think of it like detective work, get to solve puzzles, you know, what's causing the fever. You get to work with all body systems which I find really interesting, and it means that you get to work with a diverse range of patients and subspecialists it's the surgeons and the physicians I love it.

It's just super interesting work. 

Yeah, I can imagine it would be really interesting. And it's so diverse as well. We think about, health as nursing and medicine. We can have our specialties and subspecialties. Even within infectious diseases, there's so many different [00:07:00] areas you can look at.

There's the epidemiology side the laboratory side and the patient and community side. So yeah, it must be, yeah, forever an environment that you're learning within and challenge within. So I can see why you might have gravitated to it. Since I've got you here, I've got a few questions that I would love to ask you.

Both from like my prep. Perspective as a health professional, but also as someone who teaches in the community. We get some really common themed questions being able to pick your brain about that would be awesome. And so I'm gonna throw a curly one at you from the start and get that out of the way.

That is, around the discussions, regarding vaccine hesitancy this has been a topic, for as long as I've worked as a pediatric nurse, it's getting louder and louder thing that, you know, you see more in the news, like we're talking more in healthcare.

And I'm just curious to know, what are some of the most common concerns that you hear from parents, round vaccine hesitancy, and how do you approach those conversations if you are [00:08:00]involved? 

Absolutely. I think it's very topical at the moment with the amount of misinformation circulating and the amount of attention that some of the anti-vaccine views are getting in the media.

Some of the common concerns we hear about are things around safety, around, you know, side effects. The fact that vaccines are unnatural, that, perhaps vaccines might overwhelm, you know, someone's immune system. We get a lot of those questions to address those, what I do and what a lot of my colleagues do is that, you know, every sort of healthcare encounter that we come across, we are listening to parents and carers in a very non-judgmental way.

We know that parents and carers usually want the best for their child. It's really important that we explore concerns, figure out, what information they have, what do they know, what, what are they worried about in particular, and then tailor the information we give back to them, based on those concerns.

It's really hard to have a conversation with someone if they're, if trust isn't there. [00:09:00] So, you know, it's really around kind of getting. Like, yeah, really meeting someone where they are building that trust and rapport, and then having that information flow. Vaccination not only protects the individual, it also protects the community around them.

So thinking about newborns. Grandparents that might be around or, you know, other individuals that they might be encountering in their day-to-day lives who cannot be vaccinated. That's often a good angle as well. In terms of those questions, there's so many things that I feel like we talk about over and over, you know, the benefits of vaccines outweigh the risks of infection, you know, that sort of stuff.

So, yeah. Are there, are there any specific questions, grace, that you. Feel you're coming across more often than not at the moment. 

Yeah, I think probably one of the ones that really worried people was the COVID. Vaccine. That was something that worried people more than, any of the other childhood immunization schedules.

When you talk about coming to that [00:10:00] conversation with open-mindedness and trying to understand and be trusting, I think, you know what I was hearing. Was just around the fact that it had come out and worked through the process very quickly.

That's where a lot of people's hesitancy was coming from. Would you ever hear conversations around that, or is that common for you to hear as well? 

I think that was the challenge with COVID. It was a new variant of a virus that we had seen before.

We didn't know what the consequences would be. Those initial rumblings from the WHO became a worldwide pandemic that we had never seen before. And so we had asked as ID physicians trying to figure out what the consequences would be and, you know, seeing many deaths occurring overseas, particularly, you know, out of the us, out of Europe, for example.

This vaccine being fast tracked in terms of approval processes. One of the platforms that we use is an mRNA vaccine platform, and that is not a new thing at all.

There had been mRNA trials for other agents that had been, in the works anyway, so it was about [00:11:00] making sure that, there was. Sequencing of the virus. Then they were able to tailor that mRNA vaccine platform to be rolled out for COVID. It all seemed quick, but there were rigorous tests, post-marketing surveillance still happens for the COVID vaccine.

There were changes to the schedule depending on what we were seeing overseas. That message was continually changing. It's an unprecedented thing. Unlike some of the other vaccines that have been around for many decades I think it was a unique situation.

It's obviously made a mark in terms of history and affected people's, psyche around vaccines and how they view vaccines. Unfortunately for us it's really about undoing it and making sure that people get back to that understanding of why vaccines are protective. 

Yeah, that makes a lot of sense and thanks for explaining that.

I imagine with your pharmacy background you would have a good understanding of both sides I know we've got a new vaccine that's come out recently as well, which is the RSV vaccine, and this is [00:12:00] now, I think it's on the schedule everywhere in Australia, isn't it?

Where we can access it for our kids. Can you explain a little about that vaccine and how it can be helpful with RSV 

yeah. So the thing with RSV that's been game changing is there's two new products. One is the RSV maternal vaccine, given to pregnant women.

Then there is a product called umab, essentially a monoclonal antibody. So not a vaccine, but a pre-formed antibody that we're injecting into babies to allow them protection. So what a lot of people don't know we've been using a monoclonal antibody in babies for decades now.

We've been using a product called Palivizumab, a short acting monoclonal antibody. It lasted only a month, so we were giving five monthly injections over the RSV season. This new product, that has been rolled out, Australia wide, is. Now being given to all newborn babies.

And then there is a catch up program for anyone up to anywhere between six to eight months of age, depending on your state and territory. And it's also been given to children who have high risk conditions [00:13:00] for RSV in their second year of life. So I think, in terms of what it does, it's really giving you the antibodies so that you are able to fight RSV and not end up with severe inflammation in your chest and, end up in hospital with bronchiolitis, which is huge because in winter, you and I see so many of these kids in hospital.

So yeah, it's definitely a game changer. 

RSV is a quite common virus isn't it? It's one of those seasonal ones a lot of our ICU beds would be occupied during winter with little ones who had severe cases of RSV and it would be quite touch and go with some of them for a while.

Yeah. Actually just sort of thinking about RSV and like all of those winter type viruses, influenza, or even COVID now, is it, has it been a change in pattern in those viruses after the pandemic? Well, I mean, we are in Victoria obviously. We [00:14:00] had a very lockdown. Pandemic experience and you know, a lot of people felt like viruses were rampant when we went back to school and childcare 

is that true? Have we got some evidence to back that up now 

Yeah, definitely. So it's a really good question. Coming out of the pandemic in the first couple of years, we did see that things were completely outta season. You know, infections like RSV, which we typically saw from April to September, we saw in January even.

So it was completely out of whack to begin with, but now we've found things are starting to settle back into their usual seasonal patterns. I think the other example there is pertussis or hooping cough. So what we saw last year was we had a very high number of cases. There were 57,000 cases, which was 23 times the number we saw the year before in 2023.

That is probably a result of some of the public health restrictions we know with pertussis we usually get three to four yearly, outbreaks. Because of the COVID public health [00:15:00] restrictions, we saw that put a halt to it and perhaps delayed it a little bit.

Hooping cough is something we have been watching quite closely. It can cause life-threatening, apnea, where babies stop breathing. It's definitely another significant, infection we are watching closely. 

And there is a vaccination for hooping cough.

But it wears off, doesn't it, you have to get boosters. Yes, exactly. Fairly regularly. 

Yeah. That's right. And I think the thing that, pregnant women, often forget about is that you need to get the pertussis or whooping cough vaccine with every pregnancy. So what we find is that we're boosting mom's, antibody response that's being passed to baby so that they are protected from birth.

And then because it kind of depletes mom's antibody supply, you essentially wanna boost them again for every pregnancy to allow each baby to be protected. But yeah, you're right. We give the pertussis vaccine in our childhood schedule and then boosters, as they get older to maintain that protection.

And it's often given with diptheria and tetanus. 

So I [00:16:00] suppose if you're not sure where you're at, you can visit your GP and they can help you figure out whether you're due one or not. Exactly. 

Definitely. Good answer. 

So the other one that we are hearing a lot about at the moment is measles.

There's a big resurgence, and this might circle back to these other topics that we've been talking about, with the vaccine hesitancy, post COVID with, the different ways that things are behaving, post the lockdown period. How much of a threat is this for us in Australia at the moment?

How worried should parents be? 

Yeah, I think that's a really good question. So there's been a lot in the media around measles and particularly the us, because a lot of misinformation, if you look at the World Health Organization data, the top 10 countries with measles outbreaks at the moment are actually not the us.

It's places like Yemen Pakistan India and Afghanistan. In Australia we do have a relatively high percentage of people who are vaccinated against measles. There are pockets in Australia where there isn't, as high, and we need 95% herd [00:17:00] immunity.

Protection in the community to be able to prevent an outbreak. So far in Australia, we've seen 77 cases nationally. There was 57 last year. And I think just in terms of, how worried people should be, certainly, the reason why parents should be worried is that if their child is under 12 months of age, they haven't received the measles vaccine in Australia yet.

Our childhood schedule is that children receive the measles vaccine as MMR or MMRV, which is with the chicken pox vaccine at 12 months and at 18 months of age. When children are traveling overseas to a high risk country. We can go as low as six months of age, safely with the measles vaccine.

So I guess that question around, should parents be worried? If moms have been protected in their lifetime, then their babies up until six months of age are likely to be protected with maternal antibodies. The six to 12 month window is where a child would be most at risk. We will [00:18:00]recommend in high risk situations to have the measles vaccine early.

We would still recommend the 12 and the 18 month doses to ensure lifelong immunity, there's a cohort of adults who have missed out. Anyone born between 1966 to 1992 has probably only had one dose of measles vaccine.

And might need a booster as well. 

Yeah, well I can be a walking testament to how one dose doesn't help because I went on a bit of a measles dive a while ago I've had measles, mumps and Ella as a child. Don't recommend any of those. So yeah, not fun.

Mumps was definitely not fun either. I got that at Christmas time and everyone was eating ice cream and I couldn't, so, that's a core memory for me. But anyway, to get back to my point, I'm one of those people that would've only had one dose 'cause I fit into that cohort. I had a bit look back at New Zealand, which was where I was born, and I realized, oh, well, I would've actually only had the one dose.

And so obviously what we know now is that you need. Both of those doses to increase that immunity level [00:19:00] lifelong. I'm a walking testament to why both doses are important. 

I think the only other thing, just speaking to kind of measles and why people should be concerned, we. Know, measles is one of the most infectious viruses known to man. We know that if there are 10 people in the room, who are unvaccinated, nine out of 10 of those will get measles infection.

We also know that the measles virus can last for up to two hours in a room after someone who's infected walks away, airborne, like aerosolized, measles virus. And then there's high rates of hospitalization. One in five hospitalized, one in 20 will get pneumonia or inflammation or infection of the lungs.

And then one in a thousand can unfortunately get brain swelling or inflammation. Risky. In terms of the virus, the other thing that people talk about is something called SSPE, which is subacute sclerosing panencephalitis. A type of inflammation of the brain. 

Getting the vaccine is less of a risk than having the disease itself because [00:20:00] over many years after having measles infection, there is a one in 10,000 to one in a hundred thousand risk of having SSPE, which is essentially damaging to your brain and can have long-term consequences.

I was listening to the podcast called, this podcast Will Kill You, and they were covering measles and speaking about how when you, you know, get measles, it actually wipes out urin innate, immunity.

Yeah. So your memory, your new memory. So that's essentially what's preventing you from getting other things that you've already been exposed to. That really blew my mind when I heard them say that. Maybe that's why after I had measles, I then had mumps and rebels.

Oh, then you had everything else. Yeah. 

Nothing. Yeah, that's right. Yeah. Essentially measles virus because immune amnesia, which is is fascinating but awful at the same time. Anything that you've been vaccinated against in the past. You can actually suddenly lose that memory.

Your immune system loses its memory to it and can't fight it in the exact same way. That can [00:21:00] last up to, two years after a measles infection so you are certainly at greater risk of other infections in that time. 

Yeah, it's amazing going into how all of these different viruses work.

I can definitely see how you end up in this specialty For sure. It's more interesting. Alright, just to change, direction for a moment. So we've sort of been speaking specifically around like vaccines and viruses and infectious diseases. But often, you know, for parents in particular, we don't expect them to necessarily be diagnosing at home what exactly their child has.

Like, what I'll often teach is just being aware of those signs and knowing when to seek help is really your job as a parent. And then we can sort of figure it out with further testing and investigations. What do you think the most important signs a parent should be aware of in terms of, recognizing that their child is unwell from an infection?

Absolutely. I think that's a really good question. I [00:22:00] think the first thing, first thing I wanna say is that. As parents and carers, like, you know your child best. If you think there is something wrong with your child and you are seeking help, it is the responsibility of the healthcare provider to listen to your concerns.

That's absolute number one. In terms of infections and signs and symptoms to look out for. I would be worried if your child was unusually quiet and, you know, had behavior changes compared to normal if they're unusually drowsy, you know, and difficult to wake up for whatever reason.

If they had, photophobia. So sensitivity to light. If they weren't drinking, normally, particularly for babies that, you know, I think of the example of RSV there, where, if they are breathing so hard and working so hard that they can't actually, have their, milk feeds.

If someone's breathing fast, that's often a sign as well. The fevers can be a sign. Fevers in itself are not harmful, but fevers without a clear cause is always something that we worry about. Rashes that are non [00:23:00] blanching.

When you do that glass test and the rash doesn't go away, that's another sign. I don't expect parents to diagnose their child. But I think parents are the biggest, biggest, you know, assesses for if there's something wrong with their child 

if you think that something's not right, please seek attention and, get an opinion. 

Absolutely, reinforce that as well. Whenever we've looked back at kids that have been really unwell, there's always been parental concern present. It's one of our biggest red flags and should always be 

I know that for a lot of people, when we have our children unwell, they're not presenting to hospital unwell, but they're unwell enough for us to maybe book an appointment and see the gp. What I'm trying to ask is around antibiotics, 

we might feel that antibiotics will fix that and it might fix the problem. But with moving further and further away from administering an antibiotics for every coffin cold, and again, I, I can talk about my [00:24:00] childhood. In the eighties, I felt like every winter I was on antibiotics. But there's an issue with that, isn't it?

It might make someone better, but it's not a silver bullet it's not. Always the best thing. I was just curious to know, are you able to expand on that, like, explain why antibiotics are not always the correct answer when your child is unwell.

Absolutely. With antibiotics, it seems like, the magic bullet and cure for all, but it, is also associated with its own side effects. As clinicians we're always weighing up whether it's the right time to start, especially when the symptoms aren't clearly a bacterial infection.

So I think the next point is really around, you know, is it a bacterial infection or a viral infection? Viruses do not respond to antibiotics. That's a clear but difficult message to get across because when your kid is unwell, then of course you wanna try everything and, and you know, I'm a mom as well.

I would love to be able to just know when to start antibiotics in my child. If we keep using antibiotics [00:25:00] and they're not warranted. Then in the person you're giving them to, they're gonna get unwarranted side effects.

They might have diarrhea, they might get a rash, they might get sensitized. But then the other issue is antibiotic, stewardship and resistance. The more we give certain bacteria exposure to antibiotics when they don't need 'em, the more likely we are to train these bacteria to become resistant 

and there are only a finite number of antibiotics that are available worldwide. And so what we worry about is that we're gonna get to the point where there are infections that we just cannot treat because the antibiotics aren't gonna work anymore. And so that's why that antibiotic stewardship and our, usage has perhaps decreased over the last, few decades 

yeah. And do we actually have any antibiotics at the moment that don't have something resistant to it? 'cause I feel like pretty much everything we've got at the moment has something that has learned how to evade it. Is there anything that we've got?

Yeah, there are some [00:26:00] magic antibiotics that we use. They're, often quite last line. We will sometimes have to use antibiotics in combination. By then, kids are really unwell, often in ICU, for example. We're literally throwing everything at the child to make sure that they're better.

Antibiotics also, in terms of those life-threatening infections aren't the only thing that we do, in hospitals, we are supporting care in terms of fluids. Often we've got surgeons involved as well trying to actually remove the source of infections. In the community it can be a little bit more of a challenge 

there are lots of cough and colds, most of them are viruses and then there are the, you know, the small percentage that God gps have the really difficult job of having to pick out which ones have become infected with the bacteria as well. So not an easy thing to do. But yeah, I think, you know, when families know when their child is getting worse or when to seek help, I think that's probably the most useful, piece of advice 

yeah, for sure. And I suppose the other thing around that, you know, you're talking about [00:27:00]antimicrobial stewardship, which is making sure that we are keeping these antibiotics so our children and our children's children can benefit from those. Another part of that is if you do get given antibiotics, it's really important that you take the whole course, isn't it?

'cause often what can happen is you feel a bit better maybe within a few days starting them. And I had someone say to me just the other day, I never finish my course of antibiotics. I start taking it as soon as I feel better. And I was like, that's not very good. So, I'd love to hear in your words, why it's so important to finish the whole course if you do get started on an antibiotics.

Yeah. So a lot of people won't realize that when we start a course of antibiotics, there's often some evidence behind how long we need to treat infections for certain infections. What we wanna do when we use an antibiotic is we're trying to wipe out the bacteria causing that particular infection.

And so we know after, let's just say five days, that that is enough to treat, a [00:28:00] urinary tract infection, for example. We know that in a more complex case we might need to treat for 14 days, and so there is some evidence around that duration. And so when you stop early, sometimes you are giving that bacteria.

The opportunity to regrow and or sort of have low levels of bacteria around. And that's where that issue of resistance can become a problem. I think there are some conditions now that we use shorter courses because we know that shorter courses work and then there are some that we would say, treat for longer.

The message should be. Do what was prescribed and, continue the course as long as, as your doctor is prescribed. And also, please don't share your antibiotics with other people because we see quite a bit of that as well. 

Oh, okay. All right. Here, I've got some amoxicillin.

Would you like to try that sort of thing? Yeah. You've got a 

cough. 

Yeah. 

Have some of this. My doctor gave it me six months ago. Yeah. [00:29:00]

Yeah, because if you are prescribed an antibiotic, it's being very carefully selected. Correct. As the most likely antibiotic that's going to treat the most likely bacteria that you have.

That's just really careful consideration around the use of them so that, yeah, because otherwise. It can add into the growth of these superbus and the resistance and all these things that we wanna avoid happening. Exactly.

And also just unnecessary side effects. Like who wants to take something and get loose poopoo 

exactly 

right. 

Would you usually, how good is it to take a probiotic after you take antibiotics? Is that something you would usually recommend people to do? 

Yeah. In terms of the evidence, it's not strong evidence, but I'm definitely a proponent for recommending probiotics after antibiotics.

Definitely not whilst you're on antibiotics, because you are gonna wipe out the probiotic bacteria too. After a course, I guess there's no harm in it. It can be a little bit expensive though, so sometimes, it is a little bit out of reach for families.

But it is a good thing to do. It's not the same as giving someone, [00:30:00] yogurt, because you need quite a high concentration of specific good bacteria to be able to repopulate your gut after you've had antibiotics. Yogurt, although they're okay.

They're not the same and they've got a lot of sugar, so sometimes they can be not the right thing to do. 

Great. Okay. So, here is another topic change, but still within the same way. Go for it. So Australia, we are a different type of geography, I suppose.

We've got different areas and different population groups. So, you know, we talk about these social determinants of health. And I know this is something that you're quite passionate about, because of the water Well project. How much do these things influence infection risks in children?

Yeah, I think it's a really good question. Obviously the things I think about when thinking about the social determinants of health are, where you live, what your environment is, you know, how much you know pollution are you being exposed to, you know, so much of we live [00:31:00] influences.

Your outcome in terms of your health and life expectancy. There are studies to show higher rates of chronic disease in disadvantaged areas. Unfortunately, people have shorter life expectancy and. Often there are less, avenues for preventative care as well, whether it's vaccinations or, GPS around.

I think in terms of the health of children, what's really important to maintain, a healthy immune system is to have outdoor play, be exposed to vitamin D. Have access to good nutrition as opposed to, fast food, which is, becoming increasingly available.

Sleep well and, not be exposed to, some of the traumas we're seeing overseas at the moment all of those factors can affect stress levels, therefore affect immune system levels and.

Impact health.

Great. Would you like to tell, everyone a little bit about what you do with the Water Well Project 

the Water Well Project is my side project. It is 14 years old now and [00:32:00] essentially a health promotion charity. We deliver health education to communities from refugee asylum seeker backgrounds.

It's about making sure we are all on the same page in terms of understanding health and healthcare resources. For example, we might go into a women's group, who are, you know, nearly arrived. And talk to them about what antenatal care looks like in Australia. All of our sessions are practical and culturally sensitive.

So we will often have an interpreter present. We'll have lots of visual aids and models and, props so breast models to feel for lumps. We'll have a pelvic model to show what the reproductive system does. And it's really about empowering them so they understand.

When signs, and symptoms are not quite right, when to seek help and where to go to get that help. 

Yeah, that's fantastic. And that's very close to my heart as well. With social determinants of health, we have to look at co-design targeted for the communities, because it's not a one size fits all, which is [00:33:00] pediatrics in general.

Health everyone's different and needs a different approach for sure. I completely agree. We might, pop a link to the World Whale Project into the show nights notes. So if anyone who's listening does think that that could be beneficial for their community, they can reach out and, have a discussion with you around.

How you operate. 

Absolutely. 

So to wrap things up, just to ask one final question. If you could improve one aspect of the health system to better manage infectious diseases in children what would that be? Imagine, what would you do if you could cast a spell in a moment to 

I think, that's such a challenging question. Similar to you, grace, I think a lot of. Resources need to be in improving education for families. I think that, obviously, we in Australia have such an amazing healthcare system, the system works in terms of, treating children at their sickest.

It's really about that prevention piece around, vaccination understanding signs and [00:34:00]symptoms and when to seek help. But also when parents are in hospital, with their children, understanding how the system works and why their child is having the test that they're having, why they're having the antibiotics or not having the antibiotics.

And then what they need to do afterwards when their child goes home and make sure that, they do eventually get better. I think, education is definitely a big thing. 

Yeah, I a hundred percent agree with you. I think, if we can prevent things from happening in the first place, then great.

Maybe one day we'll be out of a job. 

Yeah, that too. 

That too. 

I think health education is so important and, education leads to empowerment and therefore better decision making. And hopefully the preventative behaviors that stop you from ending up in hospital in the first place.

Yeah, a hundred percent. It has been so interesting to chat to you. I really have enjoyed talking about all things infectious diseases and immunizations a lot of the kids that, we do education for at peds have [00:35:00] complex medical needs. And so that puts 'em in a really high risk group.

And so when we're talking about, herd immunity and trying to prevent these, diseases in the community. Those are some of the cohorts of kids that we're protecting it's really great to get this information out in the open.

Dispel some myths, some misconceptions. And you know, I think you've sort of put it out really nicely, Lenny, that if people are having concerns or you've got queries, then just go and have a chat to your healthcare provider, gp or pediatrician so that you can understand.

Better about how they work and make informed decisions. 

Don't believe everything that you read on the internet, and if you've got any questions, ask your healthcare provider. 

Yeah, absolutely. Thank you so much. you. Thanks for having me.

Well, everyone, that's it for today. Thank you so much for tuning in to another episode of Pete's Small Talk. If you love this episode, we'd be so grateful if you left a review, subscribe to our podcast, and follow us on social media, where you are guaranteed to find life saving tips and tricks for [00:36:00]keeping your little ones safe.

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