2015-11-18
Department of Pediatrics and Developmental Disorders Medical University of Bialystok Head of the Dept.: Assoc. Prof. Jerzy Konstantynowicz, MD, PhD
Introduction to Pediatrics
General issues in child health & care
Assoc. Prof. Jerzy Konstantynowicz, MD, PhD
Pediatrics
Developmental medicine Pediatrics & school medicine
Pediatrics & adolescent medicine
Neonatology (newborn: 0 – 28 days of life)
Auxology (?)
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Pediatrics slightly differs from ‘adult’ medicine
Age range: 0 – 18 years
Parental assistance during each visit, check-up or hospital stay
The goal of modern pediatrcs is mainly preventive medicine, not just repair or intervention
Diseases in infancy & childhood (symptoms, clinical manifestations, aetiology) depend on age / developmental stage
Auxology = science of growth
is a meta-term covering the study of all aspects of human physical growth (Paul Godin 1903)
is a highly multi-disciplinary science involving health sciences / medicine, (pediatrics, general practice, endocrinology , neuroendocrinology, physiology, epidemiology) and, to a lesser extent: nutrition, genetics, anthropometry, ergonomics, socioeconomics, sociology, public health and psychology among others.
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KNOWLEDGE OF NORMAL GROWTH AND DEVELOPMENT employed in
Prevention Diagnostics Prognostics Rehabilitation
Health maintenance, developmental surveillance and prophylactic activities… Preventive strategies in pediatrics
Health status in adulthood
INTERNAL MED. PEDIATRICS CARDIOLOGY ENDOCRINOLOGY GENETICS RHEUMATOLOGY DIABETES CARE ORTHOPEDICS REHABILITATION GYNAECOLOGY GASTROENTEROLOGY GERIATRICS
F A M I L Y M E D I C I N E
18 years Age
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Comparison of health care proportions, services, reasearch and published studies between developmental medicine (pediatric care) and adult medicine
Pediatrics Adult medicine
16 – 20 yrs Adolescent medicine
18 years Age
C o n t i n u u m
18 yrs is only Age a formal cut-off point
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All chronic diseases (inborn or acquired) in childhood are transferred to adulthood
or
… (at least) may be associated with late consequences in distant future i.e. in later life
GENERAL CATEGORIES essential to pediatric care
Growth increase of the size of the body (quantitative) strongly associated with the genetic potential
Differentation morphological / structural changes of tisues, organs and systems shaping typical age-related body proportions
Maturation functional perfection of organs and systems, inter-organ integration of the whole body
Anthropometric measurements (weight, length / standing height, BMI, head & chest circumferences) are essential for pediatric care and monitoring growth.
This is mandatory procedure!
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standard reference ranges, however…
Individual variations exist ! Individual trajectory
First issue is child’s age:
Chronological (calendar) age
years & months (be precise!)
First issue is child’s age:
If there is a discrepancy between calendar age and somatic features…
Check biological characteristics: - Bone age (X-ray of the hand / wrist) - Sexual maturation (Tanner stage) - Dental age - Morphological age
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Main causes of mortality in children
1 – 4 y 5 – 9 y
Injury / Accident Injury / Accident Congenital defects Cancer Cancer / Tumors / Congenital defects ALL Homicide / Suicide Cardiac defects Cardiac defects
Main causes of mortality in children
10 – 14 y 15 – 24 y
Injury / Accident Injury / Accident Cancer / Tumors Suicide Suicide Homicide Homicide Cancer Congenital defects Cardiac defects
What does receive a well-being child ?
What is mangement of a healthy person during growth ?
Provide care, security and positive emotions Good environment & external temperature Hygiene & sanitary needs Nutrition (optimal: breast feeding until 6 mo) Complete immunization scheduled for infancy Vitamin K (if breastfed) Vitamin D (rickets prevention)
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Medical record / History
Information obtained Skills & experience from patient of the staff
Initial diagnosis
Diagnostics Prognostic value
Observation / Monitoring
Therapy
90% of spot on Dx are possible due to 70% of accurate Pathology an appropriate diagnoses are based history and only on the history physical Physical examination examination
History
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