Clinical Paediatrics
We seek to further the diagnosis, investigation and treatment of children with common childhood illnesses who present to hospital.
Our research aims to further the clinical diagnosis, investigation and treatment of children with common childhood infections and other illnesses who present to hospital, including management at home.
Our group includes members of the Departments of General Medicine including Infectious Diseases, Palliative Care, and Ambulatory Services, focusing on clinical and health services research.
Our strength lies in its wide range of research interests and the capacity to engage and collaborate with many clinicians on campus to translate findings into practice for the benefit of patients.
Research streams
Clinical Infections
The two major research questions that underlie the work we do are:
- How to optimise antibiotic use for childhood infections in children, both common (e.g. cellulitis, UTI) and specialised (e.g. infections in cancer)?
- How to get sick kids out of hospital and back home?
We know that by optimising antibiotic prescribing we can help get children home quicker, increase their quality of life, decrease costs for parents and the hospital and help reduce antimicrobial resistance, which is a current global crisis.
General Paediatrics
General Medicine has the largest number of Advanced Trainees rotating through any department. A focus of researchers is the supervision and mentoring of trainees through their Royal Australasian College of Physicians (RACP) projects.
We aim to provide research governance and support to clinicians with ideas for smaller projects related to general paediatric patients to ensure high-quality research and outcomes that are translatable.

Our projects
Vive La Resistance (VLR) Antimicrobial Resistance in Children
Antibiotics are usually very effective in treating infections. However, sometimes bacteria become resistant to antibiotics and much more difficult to treat - they become ‘Superbugs’. We want to find out what kinds of resistant bacteria are common among children living in Greater Melbourne and what factors make these bacteria either more or less likely to pop up.
CHOICE UTI (Care at Home Or Inpatient in Children from Emergency with UTI)
Urinary tract infections (UTIs) are very common in children, with 3% having at least one in their childhood. Most cases are straightforward and can be managed with oral antibiotics, however, some children will experience complications. For these children, there are no clinical guidelines on antibiotic use which can lead to overprescribing, hospital stays and antimicrobial resistance. CHOICE UTI is a multicentre clinical trial aiming to define a clinical guideline for antibiotic use in children with UTI. Through this we hope to achieve our primary aims; get kids home quicker, optimise antibiotic use and reduce antimicrobial resistance.
Optimising antibiotic use in Hospital-in-the-Home
We know home is the best place for children. Our research shows that recovery and quality of life are better at home. Therefore, one of our key drivers is how to get kids home more quickly or avoid hospital altogether. Some of our research questions to tackle this are:
- Can we safely send children home on antibiotics after complicated appendix surgery?
- Can we find ways to give antibiotics once daily rather than 2 or 3 times per day, making them easier to remember and more effective?
- Can we modify the way antibiotics are managed during their administration and therefore increase flexibility with prescribing?
- Can we give a constant 24-hour antibiotic infusion for children with cystic fibrosis over a shorter period to give kids a few hours off and help their quality of life?
HOMER: improving routing and scheduling to care for children at home
The Royal Children’s Hospital has the largest paediatric Hospital in the home (HITH)program (Wallaby Ward) in Australia. Since its onset, HITH has continued to grow and COVID has accelerated this growth. A major challenge for the HITH team is coordinating patient services with appropriate team members. We are working with Curve Tomorrow to build an automated route and scheduling platform that will revolutionise this process and allow HITH to continue to deliver first-class health care to even more children.
ELSA-FN
The Early versus Late Stopping of Antibiotics in high-risk Febrile Neutropenia (ELSA-FN) is a joint project with the Centre for Health Analytics. It is a first of its kind to develop new ways doctors can use patient Electronic Medical Records to improve antibiotic prescribing and outcomes for oncology patients. We hope not only to achieve our primary research goals but also to facilitate the use of the Electronic Medical Record for future research and help streamline the clinical practice.
Project Collaborations
Vive La Resistance
Antimicrobial resistance (AMR) is a global health crisis, but there are sizeable gaps in our understanding of which children carry resistant bacteria, how it develops, how it is spread among family members and the impacts on childhood infections and long-term health. To help us answer all these questions, so we can combat AMR, we are enrolling children who attend the emergency department and collecting swabs and risk information from them. This will allow us to map childhood resistance across Melbourne, investigate factors that influence its development, and investigate any impacts this may have on antibiotic usage. This research is in collaboration with the Doherty Institute, the University of Melbourne Department of General Practice, and the South Australian Health and Medical Research Institute, with funding support from the RCH Foundation.
Pre-surgical Changes to Operative Prophylaxis (Pre-ChOP)
Our previous research showed that the highest rate of inappropriate antibiotic prescribing was in surgical prophylaxis. Our aim is to improve the use of prophylactic antibiotics has been assessed in a broad range of high-frequency representative surgeries at the Royal Children's Hospital. A guideline is being developed in collaboration with clinical teams, to be implemented through the Electronic Medical Record. The goal is to standardize operative prophylaxis to decrease inappropriate use in the fight against antibiotic resistance. This research is in collaboration with the Centre for Health Analytics, with funding support from the Royal Children's Hospital Foundation.
Funding
- Medical Research Future Fund (MRFF)
- National Health and Medical Research Council (NHMRC)
- Royal Children's Hospital Foundation
- Department of Health and Human Services Victoria
Collaborations
- Royal Children's Hospital Emergency Department
- Hospital-in-the-Home program
- Centre for Health Analytics
- Curve Tomorrow
Featured publications
- Efficacy and safety of intravenous ceftriaxone at home versus intravenous flucloxacillin in hospital for children with cellulitis (CHOICE): a single-centre, open-label, randomised, controlled, non-inferiority trial. 2019
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30729-1/fulltext - Inpatient versus outpatient parenteral antibiotic therapy at home for acute infections in children: a systematic review. 2018
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30345-6/fulltext) - The characteristics of SARS-CoV-2-positive children who presented to Australian hospitals during 2020: a PREDICT network study. 2021
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8447363/pdf/MJA2-215-217.pdf - Cost-effectiveness of home-based care of febrile neutropenia in children with cancer.2021
https://onlinelibrary.wiley.com/doi/epdf/10.1002/pbc.29469 - Changing Epidemiology of Respiratory Syncytial Virus in Australia-Delayed Re-Emergence in Victoria Compared to Western Australia/New South Wales (WA/NSW) After Prolonged Lock-Down for Coronavirus Disease 2019 (COVID-19). 2021
+ Show/hide all publications
- Cost-effectiveness of home-based care of febrile neutropenia in children with cancer.2021
- Examining health-related quality of life in pediatric cancer patients with febrile neutropenia: Factors predicting poor recovery in children and their parents 2021
- Infliximab for Paradoxical Reactions in Pediatric Central Nervous System Tuberculosis 2021
- Invasive fungal disease in children with acute myeloid leukaemia: An Australian multicentre 10-year review 2021
- Procalcitonin and Interleukin-10 May Assist in Early Prediction of Bacteraemia in Children With Cancer and Febrile Neutropenia 2021
- Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children 2021
- Latent infection screening and prevalence in cancer patients born outside of Australia: a universal versus risk-based approach? 2021
- Candidemia in Children: A 16-year Longitudinal Epidemiologic Study 2021
- CAR-T cell therapy and infection: a review 2021
- Electronic health record data for antimicrobial prescribing 2021
- Home-based care of low-risk febrile neutropenia in children-an implementation study in a tertiary paediatric hospital 2021
- Characteristics and outcomes of SARS-CoV-2 infection in Victorian children at a tertiary paediatric hospital 2021
- The role of Kingella kingae in pre-school aged children with bone and joint infections 2021
- Pediatric Staphylococcus aureus bacteremia: clinical spectrum and predictors of poor outcome 2021
- Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach 2021
- Impact of an antimicrobial stewardship intervention in neonatal intensive care: Recommendations and implementation 2021
- What is the risk of missing orbital cellulitis in children? 2021
- The characteristics of SARS-CoV-2-positive children who presented to Australian hospitals during 2020: a PREDICT network study 2021
- Changing Epidemiology of Respiratory Syncytial Virus in Australia - delayed re-emergence in Victoria compared to WA/NSW after prolonged lock-down for COVID-19. 2021
- COVID-19 in children. II: Pathogenesis, disease spectrum and management. 2021
- COVID-19 in children: I. Epidemiology, prevention and indirect impacts. 2021
2020 - 2019
- The potential of proportionate universal health services. 2020
- The potential of proportionate universal health services. 2020
- Development and Validation of a Cellulitis Risk Score: The Melbourne ASSET Score. 2019
- Efficacy and safety of intravenous ceftriaxone at home versus intravenous flucloxacillin in hospital for children with cellulitis (CHOICE): a single-centre, open-label, randomised, controlled, non-inferiority trial. 2019
- Gain-of-Function Mutations in KCNN3 Encoding the Small-Conductance Ca2+-Activated K+ Channel SK3 Cause Zimmermann-Laband Syndrome. 2019
- Pulmonary Mycobacterium abscessus complex in children with cystic fibrosis: A practical management guideline. 2019
- Selected Children With Complicated Acute Urinary Tract Infection May Be Treated With Outpatient Parenteral Antibiotic Therapy at Home Directly From the Emergency Department. 2019
- Development and Validation of a Cellulitis Risk Score: The Melbourne ASSET Score. 2019
- Sex and puberty-related differences in metabolomic profiles associated with adiposity measures in youth with obesity. 2019
- Unintended consequences of a cautious approach to e-cigarette laws. 2019
- Varicella vaccine effectiveness over 10 years in Australia; moderate protection from 1-dose program. 2019
- A Chinese herbal medicine preparation (PTQX) for children with moderate to severe atopic eczema: a pilot RCT. 2018
- Adequate or Inadequate? The Volume of Blood Submitted for Blood Culture at a Tertiary Children's Hospital. 2018
- Adverse effects of amphotericin B in children; a retrospective comparison of conventional and liposomal formulations. 2018
- Children who soil: A review of the assessment and management of faecal incontinence. 2018
- Inpatient versus outpatient parenteral antibiotic therapy at home for acute infections in children: a systematic review. 2018
- Interdisciplinary medication decision making by pharmacists in pediatric hospital settings: An ethnographic study. 2018
- Management of fever and neutropenia in children with cancer: A survey of Australian and New Zealand practice. 2018
- Medication error trends and effects of person-related, environment-related and communication-related factors on medication errors in a paediatric hospital. 2018
2017 - 2016
- A Comparison of Hospital Versus Outpatient Parenteral Antibiotic Therapy at Home for Pyelonephritis and Meningitis. 2017
- Does a brief, behavioural intervention, delivered by paediatricians or psychologists improve sleep problems for children with ADHD? Protocol for a cluster-randomised, translational trial.2017
- Evaluating an admission avoidance pathway for children in the emergency department: outpatient intravenous antibiotics for moderate/severe cellulitis.2017
- External Validation of Six Pediatric Fever and Neutropenia Clinical Decision Rules.2017
- Hospital-in-the-Home - essential to an integrated model of paediatric care.2017
- Medication communication between nurses and doctors for paediatric acute care: An ethnographic study.2017
- Preparing for genomic medicine: a real world demonstration of health system change.2017
- QUESTION 1: What is the risk of a repeat reaction to amoxicillin or a cephalosporin in children with a history of a non-immediate reaction to amoxicillin?2017
- Quick-Wee: a novel non-invasive urine collection method.2017
- Alternatives to ward admission from the emergency department.2016
- Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines.2016
- Blood Cultures in Cellulitis are not Cost Effective and Should Prompt Investigation for an Alternative Focus.2016
- Cellulitis: Home Or Inpatient in Children from the Emergency Department (CHOICE): protocol for a randomised controlled trial.2016
- Congenital Tuberculosis Complicated by Hemophagocytic Lymphohistiocytosis.2016
- Interesting microorganism.2016
- The QuickWee trial: protocol for a randomised controlled trial of gentle suprapubic cutaneous stimulation to hasten non-invasive urine collection from infants.2016
- The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy.2016
- Voriconazole dosing and therapeutic drug monitoring in children: experience from a paediatric tertiary care centre.2016
- Who Can Have Parenteral Antibiotics at Home?: A Prospective Observational Study in Children with Moderate/Severe Cellulitis.2016
2015
- Anti-infective use in children and pregnancy: current deficiencies and future challenges.2015
- Antimicrobial stewardship resources and activities for children in tertiary hospitals in Australasia: a comprehensive survey. 2015
- Australia-wide point prevalence survey of antimicrobial prescribing in neonatal units: how much and how good? 2015
- Chinese herbal medicine granules (PTQX) for children with moderate to severe atopic eczema: study protocol for a randomised controlled trial. 2015
- Posaconazole: promising but problematic in practice in pediatric patients.2015
- Where should we measure waist circumference in clinically overweight and obese youth? 2014
- A digital picture is worth a thousand words in a different dialect: improving adherence to antiretroviral medication.2013
- Antibiotic-resistant Gram-negative bacteremia in pediatric oncology patients--risk factors and outcomes. 2013
- Fifteen-minute consultation: the infant with frequent infections. 2013
- Formal Infectious Diseases Consultations at a Tertiary Pediatric Hospital: A 14 Year Review 2013
- Neonatal Vancomycin Continuous Infusions: Still a Confusion? 2013
- Sleep and infection: no snooze, you lose? 2013
- Susceptibility to acute rheumatic fever: differential expression of genes involved in cytotoxicity, chemotaxis and apoptosis 2013
- Clinical predictors of pathological gastro-oesophageal reflux in infants with persistent distress.2006
- Effect of antireflux medication, placebo and infant mental health intervention on persistent crying: a randomized clinical trial.2006