Pediatrics

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This article is about the branch of medicine. Pediatrics_sentence_0

For the journal, see Pediatrics (journal). Pediatrics_sentence_1

For the branch of dentistry, see Pedodontics. Pediatrics_sentence_2

Pediatrics_table_infobox_0

PediatricsPediatrics_table_caption_0
FocusPediatrics_header_cell_0_0_0 Children, adolescents, and Young adultsPediatrics_cell_0_0_1
SubdivisionsPediatrics_header_cell_0_1_0 Pediatric cardiology, neonatology, critical care, pediatric oncology, hospital medicine, primary care, others (see below)Pediatrics_cell_0_1_1
Significant diseasesPediatrics_header_cell_0_2_0 Congenital diseases, Infectious diseases, Childhood cancer, Mental disordersPediatrics_cell_0_2_1
Significant testsPediatrics_header_cell_0_3_0 World Health OrganizationPediatrics_cell_0_3_1
SpecialistPediatrics_header_cell_0_4_0 PediatricianPediatrics_cell_0_4_1
GlossaryPediatrics_header_cell_0_5_0 Glossary of medicinePediatrics_cell_0_5_1

Pediatrics (also spelled paediatrics or pædiatrics) is the branch of medicine that involves the medical care of infants, children, and adolescents. Pediatrics_sentence_3

The American Academy of Pediatrics recommends people be under pediatric care through the age of 21 (though usually only minors are required to be under pediatric care). Pediatrics_sentence_4

In the United Kingdom, pediatrics covers patients until age 18. Pediatrics_sentence_5

Worldwide age limits of pediatrics have been trending up year over year. Pediatrics_sentence_6

A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. Pediatrics_sentence_7

The word pediatrics and its cognates mean "healer of children"; they derive from two Greek words: (pais "child") and (iatros "doctor, healer"). Pediatrics_sentence_8

Pediatricians work in hospitals and children's hospitals particularly those working in its subspecialties (e.g. neonatology), and as outpatient primary care physicians. Pediatrics_sentence_9

History Pediatrics_section_0

Already Hippocrates, Aristotle, Celsus, Soranus, and Galen understood the differences in growing and maturing organisms that necessitated different treatment: Ex toto non sic pueri ut viri curari debent ("In general, boys should not be treated in the same way as men"). Pediatrics_sentence_10

Some of the oldest traces of pediatrics can be discovered in Ancient India where children's doctors were called kumara bhrtya. Pediatrics_sentence_11

Sushruta Samhita an ayurvedic text, composed during the sixth century BC contains the text about pediatrics. Pediatrics_sentence_12

Another ayurvedic text from this period is Kashyapa Samhita. Pediatrics_sentence_13

A second century AD manuscript by the Greek physician and gynecologist Soranus of Ephesus dealt with neonatal pediatrics. Pediatrics_sentence_14

Byzantine physicians Oribasius, Aëtius of Amida, Alexander Trallianus, and Paulus Aegineta contributed to the field. Pediatrics_sentence_15

The Byzantines also built brephotrophia (crêches). Pediatrics_sentence_16

Islamic writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own, especially Haly Abbas, Serapion, Avicenna, and Averroes. Pediatrics_sentence_17

The Persian philosopher and physician al-Razi (865–925) published a monograph on pediatrics titled Diseases in Children as well as the first definite description of smallpox as a clinical entity. Pediatrics_sentence_18

Also among the first books about pediatrics was Libellus [Opusculum] de aegritudinibus et remediis infantium 1472 ("Little Book on Children Diseases and Treatment"), by the Italian pediatrician Paolo Bagellardo. Pediatrics_sentence_19

In sequence came Bartholomäus Metlinger's Ein Regiment der Jungerkinder 1473, Cornelius Roelans (1450–1525) no title Buchlein, or Latin compendium, 1483, and Heinrich von Louffenburg (1391–1460) Versehung des Leibs written in 1429 (published 1491), together form the Pediatric Incunabula, four great medical treatises on children's physiology and pathology. Pediatrics_sentence_20

The Swedish physician Nils Rosén von Rosenstein (1706–1773) is considered to be the founder of modern pediatrics as a medical specialty, while his work The diseases of children, and their remedies (1764) is considered to be "the first modern textbook on the subject". Pediatrics_sentence_21

Pediatrics as a specialized field of medicine continued to develop in the mid-19th century; German physician Abraham Jacobi (1830–1919) is known as the father of American pediatrics because of his many contributions to the field. Pediatrics_sentence_22

He received his medical training in Germany and later practiced in New York City. Pediatrics_sentence_23

The first generally accepted pediatric hospital is the Hôpital des Enfants Malades (French: Hospital for Sick Children), which opened in Paris in June 1802 on the site of a previous orphanage. Pediatrics_sentence_24

From its beginning, this famous hospital accepted patients up to the age of fifteen years, and it continues to this day as the pediatric division of the Necker-Enfants Malades Hospital, created in 1920 by merging with the physically contiguous Necker Hospital, founded in 1778. Pediatrics_sentence_25

In other European countries, the Charité (a hospital founded in 1710) in Berlin established a separate Pediatric Pavilion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (now Wrocław), both in 1837. Pediatrics_sentence_26

In 1852 Britain's first pediatric hospital, the Hospital for Sick Children, Great Ormond Street was founded by Charles West. Pediatrics_sentence_27

The first Children's hospital in Scotland opened in 1860 in Edinburgh. Pediatrics_sentence_28

In the US, the first similar institutions were the Children's Hospital of Philadelphia, which opened in 1855, and then Boston Children's Hospital (1869). Pediatrics_sentence_29

Subspecialties in pediatrics were created at the Harriet Lane Home at Johns Hopkins by Edwards A. Pediatrics_sentence_30 Park. Pediatrics_sentence_31

Differences between adult and pediatric medicine Pediatrics_section_1

The body size differences are paralleled by maturation changes. Pediatrics_sentence_32

The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Pediatrics_sentence_33

Congenital defects, genetic variance, and developmental issues are of greater concern to pediatricians than they often are to adult physicians. Pediatrics_sentence_34

A common adage is that children are not simply "little adults". Pediatrics_sentence_35

The clinician must take into account the immature physiology of the infant or child when considering symptoms, prescribing medications, and diagnosing illnesses. Pediatrics_sentence_36

Pediatric physiology directly impacts the pharmacokinetic properties of drugs that enter the body. Pediatrics_sentence_37

The absorption, distribution, metabolism, and elimination of medications differ between developing children and grown adults. Pediatrics_sentence_38

Despite completed studies and reviews, continual research is needed to better understand how these factors should affect the decisions of healthcare providers when prescribing and administering medications to the pediatric population. Pediatrics_sentence_39

Absorption Pediatrics_section_2

Many drug absorption differences between pediatric and adult populations revolve around the stomach. Pediatrics_sentence_40

Neonates and young infants have increased stomach pH due to decreased acid secretion, thereby creating a more basic environment for drugs that are taken by mouth. Pediatrics_sentence_41

Acid is essential to degrading certain oral drugs before systemic absorption. Pediatrics_sentence_42

Therefore, the absorption of these drugs in children is greater than in adults due to decreased breakdown and increased preservation in a less acidic gastric space. Pediatrics_sentence_43

Children also have an extended rate of gastric emptying, which slows the rate of drug absorption. Pediatrics_sentence_44

Drug absorption also depends on specific enzymes that come in contact with the oral drug as it travels through the body. Pediatrics_sentence_45

Supply of these enzymes increase as children continue to develop their gastrointestinal tract. Pediatrics_sentence_46

Pediatric patients have underdeveloped proteins, which leads to decreased metabolism and increased serum concentrations of specific drugs. Pediatrics_sentence_47

However, prodrugs experience the opposite effect because enzymes are necessary in allowing their active form to enter systemic circulation. Pediatrics_sentence_48

Distribution Pediatrics_section_3

Percentage of total body water and extracellular fluid volume both decrease as children grow and develop with time. Pediatrics_sentence_49

Pediatric patients thus have a larger volume of distribution than adults, which directly affects the dosing of hydrophilic drugs such as beta-lactam antibiotics like ampicillin. Pediatrics_sentence_50

Thus, these drugs are administered at greater weight-based doses or with adjusted dosing intervals in children to account for this key difference in body composition. Pediatrics_sentence_51

Infants and neonates also have less plasma proteins. Pediatrics_sentence_52

Thus, highly protein-bound drugs have fewer opportunities for protein binding, leading to increased distribution. Pediatrics_sentence_53

Metabolism Pediatrics_section_4

Drug metabolism primarily occurs via enzymes in the liver and can vary according to which specific enzymes are affected in a specific stage of development. Pediatrics_sentence_54

Phase I and Phase II enzymes have different rates of maturation and development, depending on their specific mechanism of action (i.e. oxidation, hydrolysis, acetylation, methylation, etc.). Pediatrics_sentence_55

Enzyme capacity, clearance, and half-life are all factors that contribute to metabolism differences between children and adults. Pediatrics_sentence_56

Drug metabolism can even differ within the pediatric population, separating neonates and infants from young children. Pediatrics_sentence_57

Elimination Pediatrics_section_5

Drug elimination is primarily facilitated via the liver and kidneys. Pediatrics_sentence_58

In infants and young children, the larger relative size of their kidneys leads to increased renal clearance of medications that are eliminated through urine. Pediatrics_sentence_59

In preterm neonates and infants, their kidneys are slower to mature and thus are unable to clear as much drug as fully developed kidneys. Pediatrics_sentence_60

This can cause unwanted drug build-up, which is why it is important to consider lower doses and greater dosing intervals for this population. Pediatrics_sentence_61

Diseases that negatively affect kidney function can also have the same effect and thus warrant similar considerations. Pediatrics_sentence_62

Pediatric autonomy in healthcare Pediatrics_section_6

A major difference between the practice of pediatric and adult medicine is that children, in most jurisdictions and with certain exceptions, cannot make decisions for themselves. Pediatrics_sentence_63

The issues of guardianship, privacy, legal responsibility and informed consent must always be considered in every pediatric procedure. Pediatrics_sentence_64

Pediatricians often have to treat the parents and sometimes, the family, rather than just the child. Pediatrics_sentence_65

Adolescents are in their own legal class, having rights to their own health care decisions in certain circumstances. Pediatrics_sentence_66

The concept of legal consent combined with the non-legal consent (assent) of the child when considering treatment options, especially in the face of conditions with poor prognosis or complicated and painful procedures/surgeries, means the pediatrician must take into account the desires of many people, in addition to those of the patient. Pediatrics_sentence_67

Education requirements Pediatrics_section_7

Aspiring medical students will need 4 years of undergraduate courses at a college or university, which will get them a BS, BA or other bachelor's degree. Pediatrics_sentence_68

After completing college future pediatricians will need to attend 4 years of medical school (MD/MBBS) and later do 3 more years of residency training, the first year of which is called "internship." Pediatrics_sentence_69

After completing the 3 years of residency, physicians are eligible to become certified in pediatrics by passing a rigorous test that deals with medical conditions related to young children. Pediatrics_sentence_70

In high school, future pediatricians are required to take basic science classes such as biology, chemistry, physics, algebra, geometry, and calculus. Pediatrics_sentence_71

It is also advisable to learn a foreign language (preferably Spanish in the United States) and be involved in high school organizations and extracurricular activities. Pediatrics_sentence_72

After high school, college students simply need to fulfill the basic science course requirements that most medical schools recommend and will need to prepare to take the MCAT (Medical College Admission Test) in their junior or early senior year in college. Pediatrics_sentence_73

Once attending medical school, student courses will focus on basic medical sciences like human anatomy, physiology, chemistry, etc., for the first three years, the second year of which is when medical students start to get hands-on experience with actual patients. Pediatrics_sentence_74

Training of pediatricians Pediatrics_section_8

Pediatrics_table_infobox_1

PediatricsPediatrics_table_caption_1
OccupationPediatrics_header_cell_1_0_0
NamesPediatrics_header_cell_1_1_0 Pediatrics_cell_1_1_1
Occupation typePediatrics_header_cell_1_2_0 SpecialtyPediatrics_cell_1_2_1
Activity sectorsPediatrics_header_cell_1_3_0 MedicinePediatrics_cell_1_3_1
DescriptionPediatrics_header_cell_1_4_0
Education requiredPediatrics_header_cell_1_5_0 Pediatrics_cell_1_5_1
Fields of

employmentPediatrics_header_cell_1_6_0

Hospitals, ClinicsPediatrics_cell_1_6_1

The training of pediatricians varies considerably across the world. Pediatrics_sentence_75

Depending on jurisdiction and university, a medical degree course may be either undergraduate-entry or graduate-entry. Pediatrics_sentence_76

The former commonly takes five or six years, and has been usual in the Commonwealth. Pediatrics_sentence_77

Entrants to graduate-entry courses (as in the US), usually lasting four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Pediatrics_sentence_78

Medical graduates hold a degree specific to the country and university in and from which they graduated. Pediatrics_sentence_79

This degree qualifies that medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for "internship" or "conditional registration". Pediatrics_sentence_80

Pediatricians must undertake further training in their chosen field. Pediatrics_sentence_81

This may take from four to eleven or more years depending on jurisdiction and the degree of specialization. Pediatrics_sentence_82

In the United States, a medical school graduate wishing to specialize in pediatrics must undergo a three-year residency composed of outpatient, inpatient, and critical care rotations. Pediatrics_sentence_83

Subspecialties within pediatrics require further training in the form of 3-year fellowships. Pediatrics_sentence_84

Subspecialties include critical care, gastroenterology, neurology, infectious disease, hematology/oncology, rheumatology, pulmonology, child abuse, emergency medicine, endocrinology, neonatology, and others. Pediatrics_sentence_85

In most jurisdictions, entry-level degrees are common to all branches of the medical profession, but in some jurisdictions, specialization in pediatrics may begin before completion of this degree. Pediatrics_sentence_86

In some jurisdictions, pediatric training is begun immediately following completion of entry-level training. Pediatrics_sentence_87

In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing pediatric (or any other) specialization. Pediatrics_sentence_88

Specialist training is often largely under the control of pediatric organizations (see below) rather than universities, and depend on jurisdiction. Pediatrics_sentence_89

Subspecialties Pediatrics_section_9

Subspecialties of pediatrics include: Pediatrics_sentence_90

(not an exhaustive list) Pediatrics_sentence_91

Pediatrics_unordered_list_0

Other specialties that care for children Pediatrics_section_10

(not an exhaustive list) Pediatrics_sentence_92

Pediatrics_unordered_list_1

See also Pediatrics_section_11

Pediatrics_unordered_list_2


Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Pediatrics.