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Introduction to Pediatrics

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  1. Introduction to Pediatrics Rashmi Kumar Prof & Head, Pediatrics CSMMU

  2. 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

  3. 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

  4. 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

  5. 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

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

  7. 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

  8. 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

  9. 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

  10. Some definitions • Embryogenesis: 1st 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 • Perinatalperiod: 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

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

  12. Stats • IMR 47.5/1000 • Under 5 mortality 62.7/1000 • Neonatal mortality rate 32/1000 – accounts for 2/3rd of IMR and ½ of under 5 mortality • 90% of all deaths are easily preventable • Neonatal causes – sepsis/pneumonia, LBW, birth asphyxia • ARI • Diarrhea

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

  14. 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

  15. 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