Introduction Of Pediatrics

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  • This is the first class of Pediatrics. During this two-hour class, I will just give you an overview of pedatrics.
  • Introduction Of Pediatrics

    1. 1. 儿科学 Pediatrics (Introduction) Rongxiu Zheng, MD Pediatric Dpt. General Hospital of Tianjin Medical University
    2. 2. 儿科学Pediatrics Key Points <ul><li>Scope and tasks of pediatrics </li></ul><ul><li>Characteristics of pediatrics </li></ul><ul><li>Stage of children by age </li></ul>
    3. 3. <ul><li>Scope and tasks of pediatrics </li></ul>
    4. 4. <ul><li>Pediatrics is concerned with the health of infants, children and adolescents, their growth and development, and their opportunity to achieve full potential as adults. </li></ul><ul><li>(Richard E.Behrman in Nelson's Textbook of Pediatrics) </li></ul>儿科学Pediatrics
    5. 5. Pediatrics <ul><li>Objects: infants, childeren and adolescents(0~17y) </li></ul><ul><li>Content: * regular rules of growth and development </li></ul><ul><li>*physical and mental health care </li></ul><ul><li>*diseases </li></ul><ul><li>Specialties: *d evelopemental pediatrics </li></ul><ul><li>*p reventive pediatrics </li></ul><ul><li>*c linical pediatrics </li></ul>
    6. 6. <ul><li>Pediatricians are medical doctors who have specialized training in evaluating, diagnosing and treating children. </li></ul><ul><li>Responsibility: To improve children’s physical, mental, behavioral, psychological and social health; reduce their morbidity & mortality. </li></ul>
    7. 7. 1. infective disease 2. psycho-behavior problem 3. accidental injury 4. congenital anomalies 5. prevention of adult disease in childhood 儿科学Pediatrics Tasks in 21’ century
    8. 8. <ul><li>Characteristics of pediatrics </li></ul>
    9. 9. <ul><li>Basic Medicine </li></ul><ul><li>Clinical Medicine </li></ul>A child’s growing up deals with physical growth, organs’ functional maturation, and cognitive, motor and emotional development, which results in differences between children and adults and even among children at different age.
    10. 10. <ul><li>Anatomy </li></ul><ul><li>Physiology and Biochemistry </li></ul><ul><li>Nutrition and Metabalism </li></ul><ul><li>Immunology </li></ul><ul><li>Pathology </li></ul>Characteristics of Pediatrics
    11. 11. <ul><li>Changing in the appearance: weight, height, circumferences of head, chest, and arm, and body proportions </li></ul><ul><li>Skeletal development: Anterior fontanel closes, ossification center occurs, primary and permanent teeth </li></ul><ul><li>Size, position of viscera, skin, muscle, nerve and lymph system vary in different age. </li></ul><ul><li>Narrow respiratory tract tends to be obstructive. </li></ul>Pediatric Characteristics in Basic Medicine
    12. 12. Changes in body proportions from the 2nd fetal mo to adulthood. (From Robbins WJ, Brody S, Hogan AG, et al: Growth. New Haven, Yale University Press, 1928.)
    13. 13. Images from http://www.yoursurgery.com/ProcedureDetails.cfm?BR=4&Proc=19 Pediatric Anatomy NOT TO SCALE
    14. 14. Pediatric Anatomy Images from http://faculty.clintoncc.suny.edu/faculty/Michael.Gregory/files/ Bio%20102/Bio%20102%20lectures/Motor%20Systems/infant_skull.jpg and http://www.uoftbookstore.com/online/prodimg/49090.jpg NOT TO SCALE
    15. 15. Pediatric Airway Considerations
    16. 16. <ul><li>During the organs’ developmental progress, children face more risk factors. For instance: limited kidney's ability leads to electrolyte and Acid-Base disorders in children. </li></ul><ul><li>Data generated from observation, history, and physical examination are greatly influenced by a child's developmental stage: like heart rate, blood pressure, routine blood test result and composition of body fluids. </li></ul>Pediatric Characteristics in Basic Medicine
    17. 17.   Pediatric Respiratory Rates   Age   Rate (breaths per minute)   Infant (birth–1 year) 30–60   Toddler (1–3 years)   24–40   Preschooler (3–6 years)   22–34   School-age (6–12 years)   18–30   Adolescent (12–18 years)   12–16
    18. 19. Pediatric Pulse Rates   Age   Low   High   Infant (birth–1 year)   100   160   Toddler (1–3 years)   90   150 Preschooler (3–6 years)   80   140   School-age (6–12 years) 70 120   Adolescent (12–18 years)   60   100
    19. 20.   Low-Normal Pediatric Systolic Blood Pressure     Age *   Low Normal   Infant (birth–1 year)   greater than 60*   Toddler (1–3 years)   greater than 70*   Preschooler (3–6 years)   greater than 75   School-age (6–12 years)   greater than 80   Adolescent (12–18 years)   greater than 90
    20. 23. <ul><li>The dramatic growth of children during the beginning period of life demands unique nutrients. Unfortunately, provision of these special nutritional needs is complicated by the immature digestive and metabolic processes. </li></ul><ul><li>Inborn errors of metabolism causing clinical manifestations are almost found in the children stage. </li></ul>Nutrition and Metablism Pediatric Characteristics in Basic Medicine
    21. 24. <ul><li>3-5 months after birth, the diminished concentration of immunoglobulin and other immunologic factors and the decreased function of neutrophils and other cells involved in the response to infection put infants at ongoing high risk for infection . </li></ul><ul><li>Other immunologic factors include complement, T cell, monocyte-macrophage system, cytokines and inflammatory mediators. </li></ul>Pediatric Characteristics in Basic Medicine
    22. 25. 儿科学Pediatrics disparity in immunology
    23. 26. Pediatric Characteristics in Basic Medicine Children differ greatly from adults in pathological changes osteomalacia Rickets Vitamin D deficiency bone marrow hematopoiesis hematopoiesis occurs in the yolk sac and liver Stress Lobar pneumonia bronchopneu-monia Streptococcus pneumoniae Adolescents or Adults Infants
    24. 27. <ul><li>Types of Diseases </li></ul><ul><li>Clinical Manifestations </li></ul><ul><li>Diagnosis </li></ul><ul><li>Treatment </li></ul><ul><li>Prognosis </li></ul><ul><li>Prevention </li></ul>Characteristics of Pediatrics
    25. 28. <ul><li>Congenital, hereditary and infectious diseases are much more commonly found among child patients. </li></ul><ul><li>*Phenylketonuria (PKU), 21-trisomy syndrome, Congenital hypothyroidism, Congenital heart diseases </li></ul><ul><li>Malignancy: Acute leukemia and Medulloblastoma </li></ul>Pediatric Characteristics in Clinical Medicine
    26. 29. <ul><li>Changeable, recurrent, variable, atypical </li></ul><ul><li>Neonate with severe infection is always weak in response, apathy, rejects feeding, but has neither fever, nor increase in WBC counting or other obvious clinical manifestations. </li></ul>Pediatric Characteristics in Clinical Medicine
    27. 30. <ul><li>Varies with age. </li></ul><ul><li>Convulsion in children: Neonatal Period--obstetric injuries, asphyxia, congenital diseases, intracranial hemorrhage; <6 mo. Old--intracranial infection, tetany of Vit D deficiency; 6 mo. ~ 3 yr. old: high fever, intracranial infection; > 3 yr. old: epilepsy, intracranial tumor or infection. </li></ul><ul><li>Parents and children as participants in the clinical evaluation. </li></ul>Pediatric Characteristics in Clinical Medicine
    28. 31. <ul><li>Prescribe treatment: </li></ul><ul><li>1.disease </li></ul><ul><li>2.complications and other co-existing diseases </li></ul><ul><li>Nursing and supporting treatment is essential. </li></ul><ul><li>Understand the mechanism, indications, adverse effect of a certain drug; the dosage varies with body weight or surface area. </li></ul>Pediatric Characteristics in Clinical Medicine
    29. 32. <ul><li>POSITIVE: </li></ul><ul><li>Children are more likely to recover after proper treatment from bone fracture and acute infection with less sequela occurrence </li></ul><ul><li>NEGATIVE: </li></ul><ul><li>Infants are vulnerable to certain acute severe diseases; sudden death may happen. Such diseases include acute sepsis, pneumonia, congenital malformation, foreign body in trachea, endocardial fibroelastosis and severe myocarditis. </li></ul>Pediatric Characteristics in Clinical Medicine
    30. 33. <ul><li>Prevention in the health care of infants, children, and adolescents is at the core of the field of pediatrics. </li></ul><ul><li>Planned immunization (vaccination) and supervision of infectious diseases. </li></ul><ul><li>Health care of perinatal period and other stages of children. </li></ul><ul><li>Neonatal screening tests can identify congenital hypothyroidism and PKU, for which only early treatment works. </li></ul><ul><li>Treat urinary tract infection, acute nephritis to avoid the chronic progress and renal dysfunction. </li></ul><ul><li>The goal of treating rheumatic diseases in childhood is to prevent or reduce organ damage </li></ul>Pediatric Characteristics in Clinical Medicine
    31. 34. <ul><li>Stage of Children by Age & Principles of Health Care by Age Stages </li></ul>
    32. 35. <ul><li>Fetal period </li></ul><ul><li>Neonatal period </li></ul><ul><li>Infant period </li></ul><ul><li>Toddler age </li></ul><ul><li>Preschool age </li></ul><ul><li>School age </li></ul><ul><li>Adolescence </li></ul>儿科学Pediatrics Stage of Children by Age
    33. 36. 儿科学Pediatrics ⑴ Function of various organ system; (2) Degree of immunity to disease; (3) Response to the effects of disease; (4) Drug dosages and tolerance to drugs; (5) Mental and motor ability, and (6) Pattern of emotional response. There are differences for these various age levels in
    34. 37. <ul><li>From fertilized ovum formed until to delivery (about 40 weeks) </li></ul><ul><li>Feature:  easy abortion or malformation formed by any risk factors </li></ul><ul><li>Health care:  pregnant woman and fetus </li></ul>Stage of Children by Age
    35. 38. <ul><li>Intrauterine life: embryonic and fetal period </li></ul><ul><li>first trimester first 12 wk </li></ul><ul><li>second trimester 13 ~ 28wk </li></ul><ul><li>third trimester 29 ~ 40wk </li></ul>Stage of Children by Age
    36. 39. Schematic illustration of the sensitive or critical periods in prenatal development. Dark boxes denote highly sensitive periods; light boxes indicate states that are less sensitive to teratogens. (From Moore KL: Before We Are Born: Basic Embryology and Birth Defects, 2nd ed. Philadelphia, WB Saunders, 1977.)
    37. 40. <ul><li>From umbilical ligation to 28th day after birth </li></ul><ul><li>Features:  beginning independent living </li></ul><ul><li>The physiological regulation ability and adaptation to circumstances are very poor. </li></ul><ul><li>The morbidity and mortality are very high </li></ul><ul><li>Health care:   enough nutrition </li></ul><ul><li>proper nursing care </li></ul><ul><li>prevention of diseases </li></ul>Stage of Children by Age
    38. 41. <ul><li>From 28 weeks of gestational age (wt>1000g) until to 7th day after birth (3th trimester pregancy, delivery, and early neonatal period) </li></ul><ul><li>Perinatal mortality is influenced by prenatal, maternal, and fetal conditions and by circumstances surrounding delivery. </li></ul><ul><li>Diseases associated with preterm birth, low birth weight (LBW), and intrauterine growth restriction (IUGR), such as placental insufficiency, predispose the fetus to asphyxia, severe congenital malformations, overwhelming early-onset neonatal infections . </li></ul>Stage of Children by Age
    39. 42. <ul><li>The Physician’s Role: promoting optimal medical practices before, during, and after delivery. (perinatal period) </li></ul><ul><li>Routine Delivery Room Care: </li></ul><ul><ul><li>Clear mouth and pharynx of fluid </li></ul></ul><ul><ul><li>Give the Apgar score </li></ul></ul><ul><ul><li>Antiseptic Skin and Cord Care </li></ul></ul><ul><ul><li>Maintenance of Body Heat </li></ul></ul><ul><ul><li>Breast- or bottle-feeds </li></ul></ul>Stage of Children by Age
    40. 43. <ul><li>After delivery until 1 year-old </li></ul><ul><li>Features:  Rapid growth period </li></ul><ul><li>         Fastest brain growth </li></ul><ul><li>        Nutrition and energy requirement are more. </li></ul><ul><li>         Digestion and absorption functions are poor </li></ul><ul><li>        Passive immunity gradually drops </li></ul><ul><li>Health care:  Enough nutrition </li></ul><ul><li>Prevention of diseases </li></ul><ul><li>Basic immunity </li></ul>Stage of Children by Age
    41. 44. <ul><li>From 1 to 3 year-old </li></ul><ul><li>Features:  growth becomes slower </li></ul><ul><li>         more vigorous, contact more objects. </li></ul><ul><li>      intelligence develops faster </li></ul><ul><li>       poor ability of identifying damage. </li></ul><ul><li>Health care:  enough nutrition </li></ul><ul><li>Prevention of diseases </li></ul><ul><li>Prevention of accident </li></ul>Stage of Children by Age
    42. 45. <ul><li>3 years old until 6-7 years old </li></ul><ul><li>Features:  growth becomes slower, </li></ul><ul><li>more mature intelligence. </li></ul><ul><li>         strong desire for knowledge </li></ul><ul><li>imitating adult’s behavior </li></ul><ul><li>         poor ability to identify damage </li></ul><ul><li>     character forming. </li></ul><ul><li>Health care:   enough nutrition </li></ul><ul><li>             prevention of diseases </li></ul><ul><li>              prevention of accident </li></ul><ul><li>             a good habit training </li></ul>Stage of Children by Age
    43. 46. <ul><li>From 6-7 years old until adolescence </li></ul><ul><li>Features:   growth becomes relatively steady </li></ul><ul><li>          more mature intelligence developed </li></ul><ul><li>         increasing desire for knowledge </li></ul><ul><li>           decreasing incidence of diseases </li></ul><ul><li>Health care: enough nutrition </li></ul><ul><li>prevention of myopia and dental caries </li></ul><ul><li>prevention of problems in psychology, </li></ul><ul><li>emotion and behavior </li></ul>Stage of Children by Age
    44. 47. <ul><li>From 2nd sexual character appearing until sexual mature and growth stopped </li></ul><ul><li>--Girl: from 11-12 yrs to 17-18 yrs </li></ul><ul><li>--boy: from 13-14 yrs to 18-20 yrs </li></ul><ul><li>Features:   the second fastest period of growth and development  </li></ul><ul><li>neuroendocrine regulation unsteady </li></ul><ul><li>having problems in psychology, emotion, behavior </li></ul><ul><li>Health care: enough nutrition </li></ul><ul><li>health care of adolescence </li></ul><ul><li>education </li></ul>Stage of Children by Age
    45. 48. Which age stages do the children of 5 days, 5 months and 15 year-old belong to  respectively?  What are their features?  What should their health care be? 【 Question 】
    46. 49. Thanks for Attention!

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