Pediatrics

Pediatrics (also spelt paediatrics) is the branch of medicine that deals with the medical care of infants, children, and adolescents. The upper age limit ranges from age 14 to 21, depending on the country.

A medical practitioner who specializes in this area is thus known as a pediatrician (also spelt paediatrician).

The word pediatrics and its cognates mean healer of children; they derive from two Greek words: παῖς (pais = child) and ιατρός (iatros = doctor or healer).

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Differences between adult and pediatric medicine

Pediatrics differs from adult medicine in many respects. 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 a host of other issues are of greater concern to pediatricians than they often are to adult physicians.

Some diseases, such as sickle cell anemia and cystic fibrosis are more often treated by pediatricians because only recently did the majority of these patients survive into adulthood. Issues revolving around infectious diseases and immunizations are also dealt with primarily by pediatricians. Put simply, treating a child is not like treating a miniature adult.

Childhood is the period of greatest growth, development and maturation of the various organ systems in the body. Years of training and experience (above and beyond basic medical training) goes into recognizing the difference between normal variants and what is actually pathological.

Another major difference between pediatrics 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 pediatric procedure. In a sense, pediatricians 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, though this is in legal flux and varies by region.

History of pediatrics

In the 10th century, the famous Persian physician Rhazes (Muhammad ibn Zakarīya Rāzi) wrote The Diseases of Children, the first book to deal with pediatrics as an independant field of medicine. For this reason, some medical historians consider him the father of pediatrics.^[1] His teacher Ali ibn Sahl Rabban al-Tabari was also a pioneer in the field of child development, which he earlier discussed in his Firdous al-Hikmah.^[2] The first work on pediatrics in the Western world was the Book of Children, written circa 1530 by Thomas Phaer, who was inspired by the works of Rhazes and Avicenna.^[3]

Pediatrics as a separate area of medical practice in the Western world largely began in the nineteenth century. The Hospital for Sick Children, Great Ormond Street (London) was founded in 1852, and is probably the oldest such children's hospital in the English-speaking world. Great Ormond Street is adjacent to Coram's Fields, the site of the much earlier Foundling Hospital. The emigrant German physician, Abraham Jacobi, worked in the same period and is often considered the father of American pediatrics.

Pediatrician versus Paediatrician

There is a slight semantic difference associated with the difference in spelling. In the USA, a pediatrician (US spelling) is a primary care physician, or general practitioner, who specializes in children. A similar situation exists in Germany: a kinderarzt is a primary care pediatrician.

In the Commonwealth and in much of the rest of the world , a paediatrician (British spelling) is normally a specialist physician not in primary general practice: he or she sees patients who are either urgently admitted to a hospital or who are referred by general practitioners. A paediatrician in this sense could fairly be described as an internist who has subspecialized in infants & children, and usually had longer post-graduate training in child health than a primary care pediatrician.

Further training in all sub-specialties is available for pediatricians. Hence, pediatric cardiologists deal with the heart conditions of children, particularly congenital heart defects, and pediatric oncologists most often treat types of cancer (certain leukemias, lymphomas and sarcomas) rarely seen in adults. Practising a subspecialty in pediatrics is often similar to practising an adult subspeciality, though typically the diseases commonly seen in children are rarely seen in adults (eg bronchiolitis) and those seen in adults are rare in children (eg coronary artery disease). Every subspecialty of adult medicine exists in pediatrics (with the exception of geriatrics), but some are unique to pediatrics, such as adolescent medicine, and neonatology.

Pediatric organizations

Most pediatricians are members of a national body. Examples are the American Academy of Pediatrics, the Canadian Paediatric Society, the Royal College Of Paediatrics and Child Health, Norsk barnelegeforening (The Norwegian society of pediatricians) or the Indian Academy of Pediatrics. In Australia and New Zealand, paediatricians are fellows of the Royal Australasian College of Physicians, which covers both nations and which has adult & paediatric sections. This was the situation in the UK until the late 1990s, where specialist paediatricians were Members or Fellows of either the Royal College of Physicians or of the fraternal colleges in Scotland. In 1996, British paediatricians were granted a royal charter to form their own college, the Royal College of Paediatrics and Child Health.The U.S. Bureau of Labor Statistics estimates that general pediatricians earned an average of $141,440 in 2006.

See also

• Children's hospital
• Medical specialty
• Pediatric ophthalmology

References

Further reading

• Contemporary Pediatrics - a monthly magazine
• Clinical Pediatrics - a peer-reviewed journal