L1 Introduction To Pediatrics PY

Introduction to pediatrics
Mazin Faisal Al-Jadiry

Pediatric department
Baghdad College of Medicine
September 25, 2017
Objectives
• Understand medical terminology in pediatrics
• Identify the differences between adults and pediatric patients
• Understand the content differences in obtaining a medical history and
approach to the physical examination in a pediatric patient compared
to an adult.
• Comprehend the principles of child’s right
• Define the principles of medical Ethics
• Appreciate the use of Evidence Based Pediatrics
What does a pediatrician do?
• A paediatrician is a child's physician who provides not only medical care
for children who are acutely or chronically ill but also preventive health
services for healthy children.
• A paediatrician manages physical, mental, and emotional well-being of the
children under their care at every stage of development, in both sickness
and health.
• Pediatrics is a collaborative specialty -- pediatricians work with other
medical specialists and healthcare professionals to provide the health and
emotional needs of children
• Pediatricians often have to treat the parents and the family, rather than
just the child.
Any differences?
Adults Pediatrics
What’s different?
• Growing / developing individuals
• Need to remember doses/ intakes by weight/size
• Diseases of children affect Growth and development
• Primary disorders of Growth & Development
• 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
Terminology
Terminology Age period
Neonate (newborn) <28 days
<1 year
Infant 1-12 months
Toddler 1-3 years 2-5
years
Pre-schooler 3-5 years
School age 5-12 years
> 5years
Adolescent >13 years
Pediatrics is a specialty governed by age
What’s different?
• Spectrum of disease in children is different
• Congenital/inherited
• Infectious
• Nutritional
• Less of degenerative – atherosclerosis/ Coronary artery disease/ Hypertension
• Less psychiatric
• Still, overlap with adult medicine is there
Child’s environment
• In order to be a truly effective clinician, the
doctor must be able to place the child’s clinical
problems within the context of the family and
of the society in which they live.
• Children’s health is profoundly influenced by
their social, cultural and physical environment.
This can be considered in terms of:
The child,
The family and immediate social environment,
The local social fabric and
The national and international environment.
The child’s world
• The child’s world will be affected by gender, genes, physical health, temperament
and development. The impact of the social environment varies markedly with
age:
Infant or toddler: life is mainly determined by the home environment
Young child: by school and friends
Teenager: also aware of and influenced by events nationally but also
internationally, e.g. in music, sport, fashion or politics.
Right of the child
• Children’s rights are laid down in the United
Nations Convention on the Rights of the Child.
• Unfortunately, the rights of many children are not
met. Implications of the convention include the
involvement of children in clinical decision-
making and in issues of consent.
Right of the child
1. Survival rights
The child’s right to life and to the most basic
needs– food, shelter and access to healthcare.
2. Developmental rights
To achieve their full potential – education, play,
freedom of thought, conscience and religion.
Those with disabilities to receive special
services.
3. Protection rights
Against all forms of abuse, neglect, exploitation
and discrimination.
4. Participation rights
To take an active role in their communities and
nations.
History:
• The history and examination
should be goal-oriented,
based on the presenting
complaint.
• Comprehensive history-
taking is best reserved for
training or for complex,
multi-system disorders
• This is not an excuse for a
short, slipshod history, but
instead allows one to focus
on the areas where a
thorough, detailed history is
required
Care of sick
children
• The majority of acute
illnesses in children are
mild and transient (e.g.
upper respiratory tract
infection, gastroenteritis)
or readily treatable (e.g.
urinary tract infection).
Clinical iceberg’ of the provision of care for sick children

Frequency of clinical problems
• Although serious
conditions are
uncommon, they must
be identified promptly
Number of years a general practitioner needs to work before encountering a child newly
presenting with these conditions
Definitions of the principles of medical ethics
• Non-maleficence – do no harm (psychological and/ or physical)
• Beneficence – positive obligation to do good
(these two principles have been part of medical ethics since the Hippocratic Oath)
• Justice – fairness for all, equity and equality of care
• Respect for autonomy – respect for individuals’ rights to make informed and thought-out
decisions for themselves in accordance with their capabilities
• Truth-telling and confidentiality – important aspects of autonomy that support trust, essential in
the doctor–patient relationship
• Duty – the moral obligation to act irrespective of the consequences in accordance with moral
laws which are universal, apply equally to all and which respect persons as autonomous beings
• Utility – the obligation to do the greatest good for the greatest number
• Rights – justifiable moral claims, e.g. the right to life, respect, education, which impose moral
obligations upon others.
Truth-telling
• It is more difficult with children than adults to be sure that they
understand what is happening to them. For example, it is easy to
reassure children falsely that procedures will not hurt; when they find
this is untrue, trust will be lost for future occasions.
Evidence-based paediatrics
• Provides a systematic approach to enable
clinicians to efficiently use the best
available evidence, usually from research,
to help them solve their clinical problems.
• The difference between this approach and
old-style clinical practice is that clinicians
need to know how to turn their clinical
problems into questions that can be
answered by the research literature, to
search the literature efficiently, and to
analyse the evidence, using
epidemiological and biostatistical rules
History and Examination in
Paediatrics
Differences of a Pediatric History Compared to
an Adult History
I. Content Differences
1. Prenatal and birth history
2. Developmental history
3. Feeding history
4. Immunization history
Differences of a Pediatric History Compared to
an Adult History
II. Parent as Historian
• Parent’s interpretation of signs, symptoms
o Children above the age of 5 may be able to provide some of their own history
o Reliability of parents’ observations varies
• Observation of parent-child interactions
• Parental behaviors/emotions are important
• Quality of relationship
Listen to the patient, he is
telling you the diagnosis
“Sir William Osler 1904”
A smart mother makes
often a better diagnosis
than a poor doctor.
August Bier (1861–1949)
A German surgeon and a pioneer of spinal anesthesia
Listening to Mothers
• Mothers are excellent observers of their offspring and do know
when they are sick.
Let The Children Speak
Don’t forget the child!!
The child should be included
in the discussion as much as
possible
History – General, Personal
• Date
• Patient's name
• Birth date……..Age
• Gender, be careful to use the correct gender
• Residence
• Person giving the history (relationship to patient and perceived
reliability)
• Whenever you consider a pediatric problem, whether medical,
developmental or behavioral, first ask,
'What is the child's age?‘
The course and prognosis of an illness can change
completely in a 1 year old vs. a 5 year old. Can the
same be said if the patient were 51 years old vs. 55
years old?
Your assessment should be rapid
Why?
• Child’s response to disease and treatment is different:
• Deteriorate very quickly – need careful watching
• Improve also very quickly – gratifying
A Sample History
About 70 – 80 %
of pediatric diagnoses are based
mainly on history
Examination
“Don't touch the patient…state first what you see; cultivate

your powers of observation…”
Sir William Osler
Be flexible
References:
• Illustrated Textbook of Paediatrics Fourth Edition, 2012.
A journey of a thousand miles begins
with a single step
Lao-tzu, The Way of Lao-tzu, Chinese philosopher (604 BC - 531 BC)
36
When you smile or
make funny faces
at a baby, the baby
gives them right
back to you
Laboratory tests and X-rays seldom beat a good history and physical
examination— investigations are rarely needed

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Introduction to pediatrics

Mazin Faisal Al-Jadiry

Clinical iceberg’ of the provision of care for sick children

“Don't touch the patient…state first what you see; cultivate

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