Introduction to Pediatrics Rashmi Kumar Prof Head Pediatrics

Introduction to Pediatrics Rashmi Kumar Prof & Head, Pediatrics CSMMU

Pediatrics • Earlier treated as small adults, but unique problems, definitive approach • Treating children 0 -21 yrs/ 18 yrs/14 yrs/ 12 yrs • Human child vs animals • Population pyramid • Population of India? • 42% of population is below 18 yrs

What’s different? • Treating children (birth to 21 yrs); – Growing / developing individuals • Need to remember doses/ intakes by weight/size • Diseases of children affect G&D disorders of G&D as a symptom • Primary disorders of G&D – Child’s metabolism is different (faster) • • Drug doses are higher Fluid/ calorie intake higher Parameters (HR, RR higher, BP lower in younger) Higher proportion of body water

What’s different? • Spectrum of disease in children is different – Congenital/inherited – Infectious – Nutritional – Less of degenerative – atherosclerosis/ CAD/ HT – Less psychiatric – Still, overlap with adult medicine is there

What’s different? • Child’s response to disease and treatment is different: – Deteriorate very quickly – need careful watching – Improve also very quickly – gratifying – Hold more true for younger kids

Pediatric History • Taken 2 nd hand, from caregiver • Some symptoms maybe nonspecific – eg crying, vomiting, diarrhea • Sequence • 4 extra histories – Feeding – Antenatal, neonatal – Developmental – Immunization

Pediatric examination • Rapport important • Do not follow set sequence, leave unpleasant parts to the end • Some signs are different in children – eg palpable liver, brisk tendon reflexes, extensor plantar • Sometimes, just not possible – eg neurological, percussion, auscultation, JVP, AF • Abdominal palpation easier • ENT examn • Nonspecific signs in younger kids

Approach • Lower threshold for investigation • Lower threshold for treatment • Remember, uncommon presentation of a common ailment is more likely than a rare disease • Make a list of possibilities, with points for and against Procedures • Generally easier, except in the very tiny • Drips difficult • Sedation, analgesia

Examination • Major subject in Part II MBBS • Separate subject since 1997, need to pass separately • Internal assessment • One theory paper • Practical – long case, short case, newborn, viva, OSCE

Some definitions • Embryogenesis: 1 st eight weeks after fertilization • Fetal period: the stage between the third and ninth months of in utero human development, during which there is growth of preformed structures • Perinatal period: 22 completed weeks (154 days) of gestation (the time when birthweight is normally 500 grams) and ends seven completed days after birth'. • • • Newborn 0 -1 month Infant birth to 1 year Toddler 1 -3 years Child - primary school, middle and high Adolescent 10 -21 yrs

Stats LBW 28% Underweight 43% Stunted 48% One third of all malnourished children live in India – malnutrition capital • Contributory cause for child mortality • •

Stats • IMR 47. 5/1000 • Under 5 mortality 62. 7/1000 • Neonatal mortality rate 32/1000 – accounts for 2/3 rd of IMR and ½ of under 5 mortality • 90% of all deaths are easily preventable – Neonatal causes – sepsis/pneumonia, LBW, birth asphyxia – ARI – Diarrhea

Child Survival Strategies • • • Early breast feeds Exclusive breast feeds Appropriate weaning Vaccination Antenatal, intrapartum and neonatal care Case management of pneumonia and diarrhea

Careers in Pediatrics • Very vast, varied • Tough • Satisfying – incorporates the Art and Science of medical practice • Ambulatory, indoor, emergency, intensive care • Subspecialties – neonatology, neurology, PHO • Research • Community/ public health

• Even a lifetime is not enough to master even one specialty • If the quest continues, you will enjoy the journey • Remember, you always learn something new from each patient, however mundane you think his problem is