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 2 nd 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: 1 st 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 Perinatal period: 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 2/3 rd 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