Pediatrics

Pediatrics (also spelled paediatrics or pædiatrics) is the branch of medicine that deals with the medical care of infants, children, and adolescents, and the age limit usually ranges from birth up to 18 (in some places until completion of secondary education, and until age 21 in the United States). A medical practitioner who specializes in this area is known as a pediatrician, or paediatrician. The word paediatrics and its cognates mean healer of children; they derive from two Greek words: παῖς (pais = child) and ἰατρός (iatros = doctor or healer).

In the United States, a pediatrician is often a primary care physician who specializes in children, whilst in the Commonwealth a paediatrician in paediatrics but generally not as a primary general practitioner.

History


Pediatrics is a relatively new medical specialty. Hippocrates, Aristotle, Celsus, Soranus, and Galen, understood the differences in growing and maturing organisms that necessitated different treatment "Ex toto non sic pueri ut viri curari debent." A 2nd century AD manuscript by the Greek physician and gynecologist Soranus of Ephesus dealt with neonatal pediatrics. Byzantine physicians; Oribasius, Aëtius of Amida, Alexander Trallianus, and Paulus Aegineta stand out for their contributions to child care. The Byzintines also built brephotrophia, "baby shelters,"or "children's hospitals." Islamic writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own especially Haly Abbas, Serapion, Rhazes, Avicenna, and Averroes, The Persian scholar and doctor al-Razi (865–925) published a short treatise on diseases among children. The first printed book on pediatrics was in Italian (1472) – Bagallarder's Little Book on Disease in Children. Paulus Bagellardus a Flumine (d.1492) De Infantium Aegritudinibus et Remediis 1472, Bartolomaeus Metlinger (d.1491) Ein Regiment der Jungerkinder 1473, Cornelius Roelans (1450-1525) no title Buchlein, or Latin compendium, 1483, and Heinrich von Louffenburg (1391-1460) Versehung des Leibs written in 1429 (published 1491), together form the Pediatric Incunabula, four great medical treatises on children's physiology and pathology. Pediatrics as a specialized field of medicine developed in the mid-19th century; Abraham Jacobi (1830–1919) is known as the father of pediatrics because of his many contributions to the field. He was born in Germany, where he received his medical training, but later practiced in New York City.

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

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

Differences between adult and pediatric medicine
The 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 pediatricians than they often are to adult physicians.

A 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. In basic terms, pediatricians take care of all of the children's needs from emotional support to medical support.

Training of pediatricians
The training of pediatricians varies considerably across the world. 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". Pediatricians must undertake further training in their chosen field. This may take from four to eleven or more years, (depending on jurisdiction and the degree of specialization). The post-graduate training for a primary care physician, including primary care pediatricians, 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 pediatrics may begin before completion of this degree. In some jurisdictions, pediatric 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 pediatric (or any other) specialization. Specialist training is often largely under the control of pediatric organizations (see below) rather than universities,and depending on jurisdiction.

Subspecialties
Subspecialties of pediatrics include:
 * Adolescent Medicine
 * Child Abuse Pediatrician
 * Neonatology
 * Pediatric allergy and immunology
 * Pediatric cardiology
 * Pediatric critical care
 * Pediatric dermatology
 * Pediatric emergency medicine
 * Pediatric endocrinology
 * Pediatric gastroenterology
 * Pediatric hematology
 * Pediatric infectious disease
 * Pediatric nephrology
 * Pediatric neuropsychology
 * Pediatric oncology
 * Pediatric ophthalmology
 * Pediatric psychiatry
 * Pediatric pulmonology
 * Pediatric rheumatology