Kiara's mum Briony said her daughter's graduation from the educational catch up program closed a three year chapter in which she overcame a disruptive and painful scalp condition, as well as marked the start of her high school journey.

"It gave her back all of the confidence she lost," Mrs Byrnes said.

"That was really nice to see. She did not have to worry about if people were looking at her, that's what boosted her confidence - she could just get in there and learn. She really loved going."

Mrs Byrnes said she first noticed a small dry spot on Kiara's scalp in mid 2017 and thought she may have dermatitis, like some of her four siblings.

A doctor and pharmacist said it was likely to be seborrhoeic dermatitis and recommended shampoos, but the condition worsened.

Kiara, now 11, presented to John Hunter Hospital's emergency department (ED) with a sore and inflamed head and received her diagnosis of tinea capitis and started oral medication.

Mrs Byrnes said it had limited effect, because Kiara was later found to also have a staph infection on her scalp.

"She had really long hair and apart from the very front of it, the rest of it had formed a skull cap so you could not touch it, it was like you had set her hair with 10 bottles of hair spray."

The family visited the hospital's dermatology clinic and her dosage of medication was increased, but her condition continued to worsen.

When they returned to the ED in October, she was admitted for two weeks, put on intravenous and oral antibiotics and had the first of five surgeries to clean her scalp.

She had a skin graft in June 2018 and still has a small bald patch.

Mrs Byrnes said it had been a rollercoaster for the family, which was pulled in different directions between visits to hospital and doctors and cleaning Kiara's scalp at home.

"She was in a lot of pain and it was time consuming and exhausting," she said.

"When it first started at the end of June or July until October she was not sleeping very well at all. Her head was hurting or she was having nightmares... it was a huge toll on her."

Mrs Byrnes said the smell of hospitals would trigger Kiara's anxiety and she was fearful about leaving home and returning to school, because she was worried about getting sick again and being judged for her appearance.

Kiara had attended school for part of term three in 2017 but missed all of term four.

She started learning by distance education in 2018, which was complemented by the 40 hour Ronald McDonald Learning Program, in which teacher Tim Lawrie gave Kiara one-on-one tutor support with her school work, helping her reach her potential.

The program has been operating in the Hunter since 2001 and is funded by community donations and the Greater Charitable Foundation.

Kiara had four hours of the program left at the start of 2020, but it was paused due to COVID-19 and she finished it in December.

Mrs Byrnes said when Kiara started the program she was virtually sitting on her lap, but Kiara was soon able to spend lessons on her own while Mrs Byrnes waited outside.

"It's been huge," she said. "She would go in, have her tutoring session and come out smiling and happy."

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