Overview of Pediatrics

Pediatrics branch of medicine concerned with the health of infants, children and adolescents; their growth and development; and their opportunity to achieve full potential as adults Global perspective of the field of pediatrics a reality and necessity, since uneven advances within and across countries are brought forth by: Advanced transportation and communication Categorization of countries into: Developed or industrialized and Developing or low income Globalization of economy Modern means of warfare Pediatricians: Must be concerned not only with the particular organ systems and biological processes, likewise with environmental and social influences, having a major impact on the physical, emotional, and mental health of children and their families Should serve as advocates for all children irrespective of gender, race, ethnicity, culture, religion or of local, state or national boundaries, for children cannot advocate for themselves Should recognize that: The young are often the most vulnerable or disadvantaged in society, thus, special attention is required for them Children have many biologic and physiologic characteristics, disease peculiarities and health problems that are different from adults The child is continuously growing and developing, requiring specific nutrients in adequate amounts, and activities and anabolic requirements are greater than those of an adult Stresses and adverse factors often affect children in unexpected and at times in exaggerated proportions Their response and reaction to environmental factors, drugs, or even to medical procedures differ from those of adults Age groups Perinatal period 20th week of gestation to first 6 days after birth Neonatal period first 28 days after birth Infancy 0-1 years old Toddler 1-2 years old Preschool 2-6 years old School age 6-12 years old Adolescence 10-20 years old

History of Pediatrics and Vital Statistics More than a century ago dealt with care of sick children with the goal to prevent them from succumbing to serious diseases 1947 start of Philippine pediatrics with birth of Philippine Pediatric Society 1959 UN issued the Declaration of the Rights of the Child, stating the universal presumption of the fundamental needs and rights of children everywhere Factors that influence health problems of children between and within populations worldwide: 1. Economic disparities 2. Educational, social, cultural considerations 3. Prevalence and ecology of infectious diseases and their hosts 4. Climate and geography 5. Agricultural resources and practices nutritional resources 6. Stage of industrialization and urbanization 7. Gene frequencies for some disorders 8. Health and social welfare infrastructure available Widespread recognition of interrelation of health issues across the globe: SARS and AIDS epidemics Pandemics of cholera and West Nile virus War and bioterrorism Tsunami of 2004 Child health priorities must reflect local politics, resources, and needs State of health must be defined by incidence of illness, changes in data that occur with time, response to programs of prevention, case finding therapy, and surveillance Accordingly, with time, the relative importance of the various causes of childhood morbidity and mortality may undergo major changes Resources vary greatly by nation Health care expenditures vary Strong correlation but not absolute relationships per capita income and child health outcomes (and between child health outcomes and expenditure for health) Children higher proportion of population worldwide History of infant and child health Infant health - USA late 19th century: IMR = 200/1000 - Causes of death: dysentery, pneumonia, diphtheria, whooping cough - majority of deaths in infants less than 1 year old in first 28 days, most in first 7 days, majority on first day -decline in IMR since 1970: decrease in birthweight-specific infant mortality rate related to neonatal intensice care and not to the prevention of low birthweight births

Infant mortality rate useful indicator of countrys level of health and development - component of physical quality of life index 3 leading causes of death among infants (USA, 2002): 1. Congenital anomalies 2. Disorders related to gestation and low birth weight 3. Sudden infant death syndrome Developing countries: 1. Infectious disease - 24% severe infections - 7% tetanus 2. Birth asphyxia 3. Complications of prematurity Philippines (1995): 1. Pneumonias 2. Respiratory conditions of fetus and newborn 3. Congenital anomalies Maternal risk characteristic predicting infant mortality: 1. Poor level of education most robust predictor 2. Unmarried 3. Alcoholism 4. High parity Health among post infancy children (1-5 years old): - reasons for improved child health in the 20th century: 1. Antibacterial disinfectants 2. Antibiotics 3. Vacccines Early 20th century in industrialized nations: - control of infectious diseases + better understanding of nutrition = reduced morbidity and mortality 1970 smallpox eradication program - global eradication of smallpox in 1977 - Expanded Program on Immunization universal vaccination against 6 diseases by WHO and UNICEF = decrease of 2M deaths/year globally - ORS for diarrhea Later in 20th century attention shifted to broad spectrum of conditions that are potentially lethal and temporarily or permanently handicapped: Leukemia Cystic fibrosis Diseases of the newborn Congenital heart disease Mental retardation Genetic defects Rheumatic diseases Renal disorders Metabolic and endocrine disorders Last 2 decades in the 20th century accelerated understanding of new approaches to the many disorders resulting from advances in molecular biology, genetics, and immunology

Other child health concerns: Behavioral and social aspects Factors leading to reduced cognition, child labor, undernutrition, war, poor schooling Local famines and disasters AIDS, SARS, avian flu Obesity Motor vehicle crashes Causes of under 5 mortality (2002) -in developing countries: 66%of all deaths infectious and parasitic diseases -in 42 countries with 90% deaths 22% diarrheal disease 21% pneumonia 9% malaria 3% AIDS 1% measles 33% neonatal cause -in developed countries (USA) 33% unintentional injuries 11% congenital anomalies 8% malignant neoplasm 7% homicide 2% pneumonia (and influenza) Under 5 Clinic (Philippines) - designed to meet the demands for child health in urban and rural areas in the country, providing low cost comprehensive child care 1. To treat common childhood illnesses Acute respiratory infection Diarrhea Malnutrition Micronutrient deficiency 2. Primary prevention through: Growth surveillance Proper nutrition Immunization Promotion of breastfeeding, ORT, FP Environmental sanitation Counseling on health matters, safety, protection of childs psychosocial environment 3. Identification of at risk children and prompt management of recognized problems or diseases and possible complications 4. Promotion of parent-child relations Under-5 Mortality / Child Mortality Rate indicator of change in level of child well-being Under-5 Sector: Measures the outcome of the childs development Gives the results of essential health care

 Sensitive indicator of child survival and individual progress Significant early child health programs (Philippines): 1. EPI launched by DOH in 1976 2. ORS for diarrheas 3. Breastfeeding promotion and Mother-Baby Friendly Hospital Initiative 4. Control of Acute Respiratory Infection 5. Micronutrients iron, vitamin A, zinc, folate Morbidities among children: Obesity Asthma ADHD Mental retardation Post-traumatic stress disorder Special Risk Populations 1. Children in poverty more likely to: Experience maternal deprivation and poor health Die during childhood Score lower on standardized tests Be retained in a grade or drop out of school Have out-of-wedlock births Experience violent crime 2. Children of immigrants and racial minority groups Discrimination, oppression Low-wage labor Different health problems and cultural backgrounds 3. Children of migrant workers Increased frequency of infections Trauma Poor nutrition Poor dental care Low immunization rate 4. Homeless children 5. Run-away and thrown-away children Run-away Children less than 18 years old, gone for at least 1 night from home without parental permission Thrown-away Told directly to leave home Away from home and not allowed to return Abandoned and deserted Runaway but whose caretakers make no effort to recover them or do not appear to care if they return Same constellation of causes common to other special risk groups: Environmental problems family dysfunction, abuse, poverty Personal problems of the young poor impulse control, substance abuse, school failure