pediatrics

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Pediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. The upper age limit of such patients ranges from age 12 to 21, depending on the country. A medical practitioner who specializes in this area is known as a pediatrician. The word pediatrics and its cognates mean healer of children; they derive from two Greek words: παῖς (pais = child) and ἰατρός (iatros = doctor or healer).

In Commonwealth countries, the respective spellings paediatrics and paediatrician are usually preferred. There may be a slight semantic difference: in the USA, a pediatrician (US spelling) is often a primary care physician who specializes in children, whereas in the Commonwealth a paediatrician (British spellling) generally is a medical specialist not in primary general practice. For further detail, see discussion on the broad and narrow meanings of physician.

Pediatric polysomnography patient
Children's Hospital (Saint Louis), 2006

History

In Europe in the seventeenth and eighteenth centuries, a number of foundling hospitals were founded for foundlings and other destitute (usually illegitimate) children; the word hospital in this context may be better translated as hospice. Examples of these are London's Foundling Hospital, founded in 1739 by the philanthropic sea captain Thomas Coram (which still survives as the Thomas Coram Foundation for Children), and the even older Hospice des Enfants-Trouvés (1674-1838) in Paris (French = Hospice for Found-Children, ie Foundlings). There was a gradual move to found separate institutions specifically for ill children, partly to avoid exposing them to adults in adult hospitals. ^[1][2]

In the Western world, the first generally accepted paediatric hospital is the Hôpital des Enfants Malades (French = Hospital for Sick Children), opened in Paris in June 1802, on the site of a previous orphanage.^[3] From its beginning, this famous hospital hospital accepted patients up to the age of fifteen years,^[1] and it continues to this day as the paediatric division of the Necker-Enfants Malades Hospital, created in 1920 by merger with the physically contiguous Necker Hospital, founded in 1778 for adults.

This example was only gradually followed in other European countries. The Charité (a hospital founded in 1710) in Berlin established a separate Paediatric Pavillion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (now Wroclaw), both in 1837. The English-speaking world waited until 1852 for its first paediatric hospital, the Hospital for Sick Children, Great Ormond Street, some fifty years after the founding of its namesake in Paris.^[3] In the USA, the first similar institutions were the Children's Hospital of Philadelphia, which opened in in 1855, and then Boston Children's Hospital (1869). ^[4]

Differences between adult and paediatric medicine

Paediatrics differs from adult medicine in many respects ^[5]. The obvious body size differences are paralleled by maturational changes. The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Congenital defects, genetic variance, and developmental issues are of greater concern to paediatricians than they often are to adult physicians.

Treating a child is not like treating a miniature adult. A major difference between paediatrics and adult medicine is that children are minors and, in most jurisdictions, cannot make decisions for themselves. The issues of guardianship, privacy, legal responsibility and informed consent must always be considered in every paediatric procedure. In a sense, paediatricians often have to treat the parents and sometimes, the family, rather than just the child. Adolescents are in their own legal class, having rights to their own health care decisions in certain circumstances only....

Training of paediatricians

The training of paediatricians varies considerably across the world.

Like other medical practitioners, paediatricians begin their training with an entry-level medical education: a tertiary-level course, undertaken at a medical school attached to a university. Such a course leads to a medical degree.

Depending on jurisdiction and university, a medical degree course may be either undergraduate-entry or graduate-entry. The former commonly takes five or six years, and has been usual in the Commonwealth. Entrants to graduate-entry courses (as in the USA), usually lasting four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Medical graduates hold a degree specific to the country and university in and from which they graduated. 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".

Within the United States, the term physician also describes holders of the Doctor of Osteopathic medicine (D.O.) degree. For further information on osteopathic medicine, see the entry on the comparison of MD and DO in the US.

Paediatricians must undertake further training in their chosen field. This may take from three to six or more years, (depending on jurisdiction and the degree of specialization). The post-graduate training for a primary care physician, including primary care paediatricians, is generally not as lengthy as for a hospital-based medical specialist.

In most jurisdictions, entry-level degrees are common to all branches of the medical profession, but in some jurisdictions, specialization in paediatrics may begin before completion of this degree. In some jurisdictions, paediatric training is begun immediately following completion of entry-level training. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing paediatric (or any other) specialization. Specialist training is often largely under the control of paediatric organizations (see below) rather than universities, with varying degrees of government input, depending on jurisdiction.

== Paediatric organizations ==.

Social role of paediatric specialists

Like other medical practitioners, paediatricians are traditionally considered to be members of a learned profession, because of the extensive training requirements, and also because of the occupation's special ethical and legal duties.

Paediatricians commonly enjoy high social status, often combined with expectations of a high and stable income and job security. However, medical practitioners in general often work long and inflexible hours, with shifts at unsociable times, and may earn less than other professionals whose education is of comparable length. Neonatologists or general paediatricians in hospital practice are often on call at unsociable times for perinatal problems in particular — such as for Cesarean section or other high risk births, and for the care of ill newborn infants.

See also

• Children's hospital
• Medical specialty
• Paediatric ophthalmology
• Paediatric endocrinology
• Child life specialist

References

Further reading

• Contemporary Pediatrics - a monthly magazine
• Clinical Pediatrics - a peer-reviewed journal
• Pediatric Image Quiz - a collection of interesting images in paediatrics

External links

Wikimedia Commons has media related to: Pediatrics

Wikibooks has a book on the topic of Pediatrics

Look up Pediatrics in Wiktionary, the free dictionary.

• American Academy of Paediatrics
• Baby Constipation? See our Help Baby Poo FAQ
• Canadian Paediatric Society
• Pediatric Collection by the BMJ - Collection of Pediatric papers published in the British Medical Journal.
• Carrollton Paediatrics Health News
• Dynamic Differential Diagnosis
• Paediatrics.info
• SearchingPediatrics.com - Searching pediatric peer-reviewed information
• GeneralPediatrics.com - The general pediatrician's view of the Internet
• Pediatric Commons - A community of pediatric learning, teaching, sharing and collaboration
• "Pediatrician Online" - Online pediatricians answer queries related to child health, and run a parent friendly service