Pediatrics (
also spelled ''paediatrics'' or ''pædiatrics'') is the branch of
medicine
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...
that involves the medical care of
infant
An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...
s,
child
A child ( : children) is a human being between the stages of birth and puberty, or between the developmental period of infancy and puberty. The legal definition of ''child'' generally refers to a minor, otherwise known as a person younger ...
ren,
adolescents
Adolescence () is a transitional stage of Developmental biology, physical and psychological Human development (biology), development that generally occurs during the period from puberty to adulthood (typically corresponding to the age of majo ...
, and young adults. In the
United Kingdom
The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and North ...
, paediatrics covers many of their youth until the age of 18. The
American Academy of Pediatrics
The American Academy of Pediatrics (AAP) is an American professional association of pediatricians, headquartered in Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C.
Background
The Academy was founded ...
recommends people seek pediatric care through the age of 21, but some pediatric subspecialists continue to care for adults up to 25. Worldwide age limits of pediatrics have been trending upward year after year. A
medical doctor
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
who specializes in this area is known as a pediatrician, or paediatrician. The word ''pediatrics'' and its
cognates
In historical linguistics, cognates or lexical cognates are sets of words in different languages that have been inherited in direct descent from an etymological ancestor in a common parent language. Because language change can have radical eff ...
mean "healer of children," derived from the two
Greek
Greek may refer to:
Greece
Anything of, from, or related to Greece, a country in Southern Europe:
*Greeks, an ethnic group.
*Greek language, a branch of the Indo-European language family.
**Proto-Greek language, the assumed last common ancestor ...
words: (''pais'' "child") and (''iatros'' "doctor, healer"). Pediatricians work in clinics, research centers, universities, general
hospital
A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
s and
children's hospital
A children's hospital is a hospital that offers its services exclusively to infants, children, adolescents, and young adults. In certain special cases, they may also treat adults. The number of children's hospitals proliferated in the 20th ...
s, including those who practice pediatric subspecialties (e.g.
neonatology
Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a hospital-based specialty, and is usually practised in neonatal intensive care units (NICUs). The ...
requires resources available in a
NICU
A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants. Neonatal refers to the first 28 days of life. Neonatal care, as kn ...
).
History
![Great Ormond Street Hospital](https://upload.wikimedia.org/wikipedia/commons/9/9d/Great_Ormond_Street_Hospital.jpg)
The earliest mentions of child-specific medical problems appear in the ''
Hippocratic Corpus
The Hippocratic Corpus (Latin: ''Corpus Hippocraticum''), or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings. The Hippocratic Corpus cove ...
'', published in the fifth century B.C., and the famous ''Sacred Disease''. These publications discussed topics such as childhood epilepsy and premature births. From the first to fourth centuries A.D., Greek philosophers and physicians
Celsus
Celsus (; grc-x-hellen, Κέλσος, ''Kélsos''; ) was a 2nd-century Greek philosopher and opponent of early Christianity. His literary work, ''The True Word'' (also ''Account'', ''Doctrine'' or ''Discourse''; Greek: grc-x-hellen, Λόγ ...
,
Soranus of Ephesus
Soranus of Ephesus ( grc-gre, Σωρανός ὁ Ἑφέσιος; 1st/2nd century AD) was a Greek physician. He was born in Ephesus but practiced in Alexandria and subsequently in Rome, and was one of the chief representatives of the Methodic s ...
,
Aretaeus
Aretaeus ( grc-gre, Ἀρεταῖος) is one of the most celebrated of the ancient Greek physicians. Little is known of his life. He presumably was a native or at least a citizen of Cappadocia, a Roman province in Asia Minor (modern day Turkey ...
,
Galen
Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
, and
Oribasius
Oribasius or Oreibasius ( el, Ὀρειβάσιος; c. 320 – 403) was a Greek medical writer and the personal physician of the Roman emperor Julian. He studied at Alexandria under physician Zeno of Cyprus before joining Julian's retinue. He ...
, also discussed specific illnesses affecting children in their works, such as rashes, epilepsy, and meningitis.
Already
Hippocrates
Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...
,
Aristotle
Aristotle (; grc-gre, Ἀριστοτέλης ''Aristotélēs'', ; 384–322 BC) was a Greek philosopher and polymath during the Classical period in Ancient Greece. Taught by Plato, he was the founder of the Peripatetic school of phil ...
,
Celsus
Celsus (; grc-x-hellen, Κέλσος, ''Kélsos''; ) was a 2nd-century Greek philosopher and opponent of early Christianity. His literary work, ''The True Word'' (also ''Account'', ''Doctrine'' or ''Discourse''; Greek: grc-x-hellen, Λόγ ...
,
Soranus, and
Galen
Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
understood the differences in growing and maturing organisms that necessitated different treatment: ' ("In general, boys should not be treated in the same way as men"). Some of the oldest traces of pediatrics can be discovered in
Ancient India
According to consensus in modern genetics, anatomically modern humans first arrived on the Indian subcontinent from Africa between 73,000 and 55,000 years ago. Quote: "Y-Chromosome and Mt-DNA data support the colonization of South Asia by m ...
where children's doctors were called ''kumara bhrtya''.
Even though some pediatric works existed during this time, they were scarce and rarely published due to a lack of knowledge in pediatric medicine. ''
Sushruta Samhita
The ''Sushruta Samhita'' (सुश्रुतसंहिता, IAST: ''Suśrutasaṃhitā'', literally "Suśruta's Compendium") is an ancient Sanskrit text on medicine and surgery, and one of the most important such treatises on this subj ...
'' an
ayurvedic
Ayurveda () is an alternative medicine system with historical roots in the Indian subcontinent. The theory and practice of Ayurveda is pseudoscientific. Ayurveda is heavily practiced in India and Nepal, where around 80% of the population rep ...
text, composed during the sixth century BC contains the text about pediatrics. Another ayurvedic text from this period is ''
Kashyapa Samhita Kashyap Samhitā (Devanagari , also ''Kashyapa, Kasyap, Kasyapa''), also known as Vriddha Jivakiya Tantra is a treatise on Ayurveda attributed to the sage Kashyap.
The text is often named as one of the earliest treatises on Indian medicine, alongs ...
''. A second century AD manuscript by the Greek physician and gynecologist
Soranus of Ephesus
Soranus of Ephesus ( grc-gre, Σωρανός ὁ Ἑφέσιος; 1st/2nd century AD) was a Greek physician. He was born in Ephesus but practiced in Alexandria and subsequently in Rome, and was one of the chief representatives of the Methodic s ...
dealt with neonatal pediatrics. Byzantine physicians
Oribasius
Oribasius or Oreibasius ( el, Ὀρειβάσιος; c. 320 – 403) was a Greek medical writer and the personal physician of the Roman emperor Julian. He studied at Alexandria under physician Zeno of Cyprus before joining Julian's retinue. He ...
,
Aëtius of Amida
Aëtius of Amida (; grc-gre, Ἀέτιος Ἀμιδηνός; Latin: ''Aëtius Amidenus''; fl. mid-5th century to mid-6th century) was a Byzantine Greek physician and medical writer, particularly distinguished by the extent of his erudition. His ...
,
Alexander Trallianus, and
Paulus Aegineta
Paul of Aegina or Paulus Aegineta ( el, Παῦλος Αἰγινήτης; Aegina, ) was a 7th-century Byzantine Greek physician best known for writing the medical encyclopedia '' Medical Compendium in Seven Books.'' He is considered the “Fathe ...
contributed to the field.
The Byzantines also built ''brephotrophia'' (
crêches).
Islamic Golden Age
The Islamic Golden Age was a period of cultural, economic, and scientific flourishing in the history of Islam, traditionally dated from the 8th century to the 14th century. This period is traditionally understood to have begun during the reign ...
writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own, especially
Haly Abbas
'Ali ibn al-'Abbas al-Majusi ( fa, علی بن عباس مجوسی; died between 982 and 994), also known as Masoudi, or Latinized as Haly Abbas, was a Persian physician and psychologist from the Islamic Golden Age, most famous for the ''Kitab ...
,
Yahya Serapion,
Abulcasis
Abū al-Qāsim Khalaf ibn al-'Abbās al-Zahrāwī al-Ansari ( ar, أبو القاسم خلف بن العباس الزهراوي; 936–1013), popularly known as al-Zahrawi (), Latinised as Albucasis (from Arabic ''Abū al-Qāsim''), was ...
,
Avicenna
Ibn Sina ( fa, ابن سینا; 980 – June 1037 CE), commonly known in the West as Avicenna (), was a Persian polymath who is regarded as one of the most significant physicians, astronomers, philosophers, and writers of the Islamic G ...
, and
Averroes
Ibn Rushd ( ar, ; full name in ; 14 April 112611 December 1198), often Latinized as Averroes ( ), was an
Andalusian polymath and jurist who wrote about many subjects, including philosophy, theology, medicine, astronomy, physics, psycholog ...
. The Persian philosopher and physician
al-Razi Razi ( fa, رازی) or al-Razi ( ar, الرازی) is a name that was historically used to indicate a person coming from Ray, Iran.
People
It most commonly refers to:
* Muhammad ibn Zakariya al-Razi (865–925), influential physician, alchemist ...
(865–925), sometimes called the father of pediatrics, published a monograph on pediatrics titled ''Diseases in Children''.
Also among the first books about pediatrics was ''Libellus
pusculumde aegritudinibus et remediis infantium'' 1472 ("Little Book on Children Diseases and Treatment"), by the Italian pediatrician Paolo Bagellardo.
In sequence came
Bartholomäus Metlinger
Bartholomäus Metlinger (born in Augsburg – died c. 1491) was a German physician of the Late Middle Ages.
Metlinger graduated in 1470 from the University of Bologna. He was city physician () in Nördlingen from 1476 to 1483, when he took the sa ...
's ''Ein Regiment der Jungerkinder'' 1473,
Cornelius Roelans (1450–1525) no title Buchlein, or Latin compendium, 1483, and
Heinrich von Louffenburg
Heinrich von Louffenburg (1391–1460) was a Swabian priest born at Louffenburg on the Rhein, Germany.
He is best known for his treatise, ''Versehung des Leibs'' (Care of the Body), written in 1429. It was published in 1491 as one of four gr ...
(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.
While more information about childhood diseases became available, there was little evidence that children received the same kind of medical care that adults did.
It was during the seventeenth and eighteenth centuries that medical experts started offering specialized care for children.
The Swedish physician
Nils Rosén von Rosenstein
Nils Rosén von Rosenstein (11 February 1706 – 16 July 1773) was a Swedish physician. He is considered the founder of modern pediatrics, while his work ''The diseases of children, and their remedies'' is considered to be "the first modern textb ...
(1706–1773) is considered to be the founder of modern pediatrics as a medical specialty,
while his work ''The diseases of children, and their remedies'' (1764) is considered to be "the first modern textbook on the subject". However, it was not until the nineteenth century that medical professionals acknowledged pediatrics as a separate field of medicine. The first pediatric-specific publications appeared between the 1790s and the 1920s.
The term pediatrics was first introduced in English in 1859 by
Dr. Abraham Jacobi. In 1860, he became "the first dedicated professor of pediatrics in the world."
Pediatrics as a specialized field of medicine continued to develop in the mid-19th century; German physician
Abraham Jacobi
Abraham Jacobi (6 May 1830 – 10 July 1919) was a German physician and pioneer of pediatrics. He was a key figure in the movement to improve child healthcare and welfare in the United States and opened the first children's clinic in the country. ...
(1830–1919) is known as the ''father of American pediatrics'' because of his many contributions to the field. He received his medical training in
Germany
Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...
and later practiced in
New York City
New York, often called New York City or NYC, is the List of United States cities by population, most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the L ...
.
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.
In other European countries, the
Charité
The Charité – Universitätsmedizin Berlin (Charité – Berlin University of Medicine) is one of Europe's largest university hospitals, affiliated with Humboldt University and Free University Berlin. With numerous Collaborative Research Cen ...
(a hospital founded in 1710) in
Berlin
Berlin ( , ) is the capital and largest city of Germany by both area and population. Its 3.7 million inhabitants make it the European Union's most populous city, according to population within city limits. One of Germany's sixteen constitue ...
established a separate Pediatric Pavilion in 1830, followed by similar institutions at
Saint Petersburg
Saint Petersburg ( rus, links=no, Санкт-Петербург, a=Ru-Sankt Peterburg Leningrad Petrograd Piter.ogg, r=Sankt-Peterburg, p=ˈsankt pʲɪtʲɪrˈburk), formerly known as Petrograd (1914–1924) and later Leningrad (1924–1991), i ...
in 1834, and at
Vienna
en, Viennese
, iso_code = AT-9
, registration_plate = W
, postal_code_type = Postal code
, postal_code =
, timezone = CET
, utc_offset = +1
, timezone_DST ...
and
Breslau (now
Wrocław
Wrocław (; german: Breslau, or . ; Silesian German: ''Brassel'') is a city in southwestern Poland and the largest city in the historical region of Silesia. It lies on the banks of the River Oder in the Silesian Lowlands of Central Europe, rou ...
), both in 1837. In 1852 Britain's first pediatric hospital,
the Hospital for Sick Children, Great Ormond Street was founded by
Charles West.
The first Children's hospital in Scotland opened in 1860 in
Edinburgh
Edinburgh ( ; gd, Dùn Èideann ) is the capital city of Scotland and one of its 32 Council areas of Scotland, council areas. Historically part of the county of Midlothian (interchangeably Edinburghshire before 1921), it is located in Lothian ...
. In the US, the first similar institutions were the
Children's Hospital of Philadelphia
The Children's Hospital of Philadelphia (CHOP) is a children's hospital in Philadelphia, Pennsylvania, with its primary campus located in the University City neighborhood of West Philadelphia in the campus of the University of Pennsylvania. The h ...
, which opened in 1855, and then
Boston Children's Hospital
Boston Children's Hospital formerly known as Children's Hospital Boston until 2012 is a nationally ranked, freestanding acute care children's hospital located in Boston, Massachusetts, adjacent both to its teaching affiliate, Harvard Medical Scho ...
(1869).
Subspecialties in pediatrics were created at the Harriet Lane Home at
Johns Hopkins
Johns Hopkins (May 19, 1795 – December 24, 1873) was an American merchant, investor, and philanthropist. Born on a plantation, he left his home to start a career at the age of 17, and settled in Baltimore, Maryland where he remained for most ...
by
Edwards A. Park.
Differences between adult and pediatric medicine
The body size differences are paralleled by maturation changes. The smaller body of an
infant
An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...
or
neonate
An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...
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 common adage is that children are not simply "little adults".
The clinician must take into account the immature physiology of the infant or child when considering symptoms, prescribing medications, and diagnosing illnesses.
Pediatric physiology directly impacts the
pharmacokinetic
Pharmacokinetics (from Ancient Greek ''pharmakon'' "drug" and ''kinetikos'' "moving, putting in motion"; see chemical kinetics), sometimes abbreviated as PK, is a branch of pharmacology dedicated to determining the fate of substances administered ...
properties of drugs that enter the body. The
absorption
Absorption may refer to:
Chemistry and biology
* Absorption (biology), digestion
**Absorption (small intestine)
*Absorption (chemistry), diffusion of particles of gas or liquid into liquid or solid materials
*Absorption (skin), a route by which ...
,
distribution Distribution may refer to:
Mathematics
*Distribution (mathematics), generalized functions used to formulate solutions of partial differential equations
* Probability distribution, the probability of a particular value or value range of a vari ...
,
metabolism
Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...
, and
elimination of medications differ between developing children and grown adults.
Despite completed studies and reviews, continual research is needed to better understand how these factors should affect the decisions of healthcare providers when prescribing and administering medications to the pediatric population.
Absorption
Many drug absorption differences between pediatric and adult populations revolve around the stomach. Neonates and young infants have increased stomach
pH due to decreased
acid
In computer science, ACID ( atomicity, consistency, isolation, durability) is a set of properties of database transactions intended to guarantee data validity despite errors, power failures, and other mishaps. In the context of databases, a sequ ...
secretion, thereby creating a more basic environment for drugs that are taken by mouth.
Acid is essential to degrading certain oral drugs before systemic absorption. Therefore, the absorption of these drugs in children is greater than in adults due to decreased breakdown and increased preservation in a less acidic
gastric
The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...
space.
Children also have an extended rate of gastric emptying, which slows the rate of drug absorption.
Drug absorption also depends on specific
enzyme
Enzymes () are proteins that act as biological catalysts by accelerating chemical reactions. The molecules upon which enzymes may act are called substrates, and the enzyme converts the substrates into different molecules known as products. A ...
s that come in contact with the oral drug as it travels through the body. Supply of these enzymes increase as children continue to develop their gastrointestinal tract.
Pediatric patients have underdeveloped
protein
Proteins are large biomolecules and macromolecules that comprise one or more long chains of amino acid residues. Proteins perform a vast array of functions within organisms, including catalysing metabolic reactions, DNA replication, respo ...
s, which leads to decreased metabolism and increased serum concentrations of specific drugs. However,
prodrug
A prodrug is a medication or compound that, after intake, is metabolized (i.e., converted within the body) into a pharmacologically active drug. Instead of administering a drug directly, a corresponding prodrug can be used to improve how the drug ...
s experience the opposite effect because enzymes are necessary for allowing their active form to enter systemic circulation.
Distribution
Percentage of
total body water
In physiology, body water is the water content of an animal body that is contained in the tissues, the blood, the bones and elsewhere. The percentages of body water contained in various fluid compartments add up to total body water (TBW). This wa ...
and
extracellular fluid volume both decrease as children grow and develop with time. Pediatric patients thus have a larger
volume of distribution
In pharmacology, the volume of distribution (VD, also known as apparent volume of distribution, literally, ''volume of dilution'') is the theoretical volume that would be necessary to contain the total amount of an administered drug at the same c ...
than adults, which directly affects the dosing of
hydrophilic
A hydrophile is a molecule or other molecular entity that is attracted to water molecules and tends to be dissolved by water.Liddell, H.G. & Scott, R. (1940). ''A Greek-English Lexicon'' Oxford: Clarendon Press.
In contrast, hydrophobes are no ...
drugs such as
beta-lactam antibiotics
β-lactam antibiotics (beta-lactam antibiotics) are antibiotics that contain a beta-lactam ring in their chemical
structure. This includes penicillin derivatives (penams), cephalosporins and cephamycins (cephems), monobactams, carbapenems and ...
like ampicillin.
Thus, these drugs are administered at greater weight-based doses or with adjusted dosing intervals in children to account for this key difference in body composition.
Infants and neonates also have fewer plasma proteins. Thus, highly protein-bound drugs have fewer opportunities for protein binding, leading to increased distribution.
Metabolism
Drug metabolism primarily occurs via enzymes in the liver and can vary according to which specific enzymes are affected in a specific stage of development.
Phase I and Phase II enzymes have different rates of maturation and development, depending on their specific mechanism of action (i.e.
oxidation
Redox (reduction–oxidation, , ) is a type of chemical reaction in which the oxidation states of substrate change. Oxidation is the loss of electrons or an increase in the oxidation state, while reduction is the gain of electrons or a d ...
,
hydrolysis
Hydrolysis (; ) is any chemical reaction in which a molecule of water breaks one or more chemical bonds. The term is used broadly for substitution reaction, substitution, elimination reaction, elimination, and solvation reactions in which water ...
,
acetylation
:
In organic chemistry, acetylation is an organic esterification reaction with acetic acid. It introduces an acetyl group into a chemical compound. Such compounds are termed ''acetate esters'' or simply '' acetates''. Deacetylation is the oppo ...
,
methylation
In the chemical sciences, methylation denotes the addition of a methyl group on a substrate, or the substitution of an atom (or group) by a methyl group. Methylation is a form of alkylation, with a methyl group replacing a hydrogen atom. These t ...
, etc.). Enzyme capacity,
clearance, and
half-life
Half-life (symbol ) is the time required for a quantity (of substance) to reduce to half of its initial value. The term is commonly used in nuclear physics to describe how quickly unstable atoms undergo radioactive decay or how long stable ato ...
are all factors that contribute to metabolism differences between children and adults.
Drug metabolism can even differ within the pediatric population, separating neonates and infants from young children.
Elimination
Drug elimination is primarily facilitated via the liver and kidneys.
In infants and young children, the larger relative size of their kidneys leads to increased
renal
The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blood ...
clearance of medications that are eliminated through urine.
In
preterm
Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between ...
neonates and infants, their kidneys are slower to mature and thus are unable to clear as much drug as fully developed kidneys. This can cause unwanted drug build-up, which is why it is important to consider lower doses and greater dosing intervals for this population.
Diseases that negatively affect kidney function can also have the same effect and thus warrant similar considerations.
Pediatric autonomy in healthcare
A major difference between the practice of pediatric and adult medicine is that children, in most
jurisdiction
Jurisdiction (from Latin 'law' + 'declaration') is the legal term for the legal authority granted to a legal entity to enact justice. In federations like the United States, areas of jurisdiction apply to local, state, and federal levels.
Jur ...
s and with certain exceptions, cannot make decisions for themselves. The issues of
guardianship, privacy, legal responsibility, and informed consent must always be considered in every pediatric procedure. 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. The concept of legal consent combined with the non-legal consent (assent) of the child when considering treatment options, especially in the face of conditions with poor prognosis or complicated and painful procedures/surgeries, means the pediatrician must take into account the desires of many people, in addition to those of the patient.
History of Pediatric Autonomy
The term autonomy is traceable to ethical theory and law, where it states that autonomous individuals can make decisions based on their own logic. Hippocrates was the first to use the term in a medical setting. He created a code of ethics for doctors called the ''
Hippocratic Oath
The Hippocratic Oath is an oath of ethics historically taken by physicians. It is one of the most widely known of Greek medical texts. In its original form, it requires a new physician to swear, by a number of healing gods, to uphold specific e ...
'' that highlighted the importance of putting patients' interests first, making autonomy for patients a top priority in health care.
In ancient times, society did not view pediatric medicine as essential or scientific.
Experts considered professional medicine unsuitable for treating children. Children also had no rights. Fathers regarded their children as property, so their children's health decisions were entrusted to them.
As a result, mothers, midwives, "wise women," and general practitioners treated the children instead of doctors.
Since mothers could not rely on professional medicine to take care of their children, they developed their own methods, such as using alkaline soda ash to remove the vernix at birth and treating teething pain with opium or wine. The absence of proper pediatric care, rights, and laws in health care to prioritize children's health led to many of their deaths. Ancient Greeks and Romans sometimes even killed healthy female babies and infants with deformities since they had no adequate medical treatment and no laws prohibiting infanticide.
In the twentieth century, medical experts began to put more emphasis on children's rights. In 1989, in the United Nations Rights of the Child Convention, medical experts developed the Best Interest Standard of Child to prioritize children's rights and best interests. This event marked the onset of pediatric autonomy. In 1995, the
American Academy of Pediatrics
The American Academy of Pediatrics (AAP) is an American professional association of pediatricians, headquartered in Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C.
Background
The Academy was founded ...
(AAP) finally acknowledged the Best Interest Standard of a Child as an ethical principle for pediatric decision-making, and it is still being used today.
Parental Authority and Current Medical Issues
The majority of the time, parents have the authority to decide what happens to their child. Philosopher John Locke argued that it is the responsibility of parents to raise their children and that God gave them this authority. In modern society, Jeffrey Blustein, modern philosopher and author of the book ''Parents and Children: The Ethics of Family'', argues that parental authority is granted because the child requires parents to satisfy their needs. He believes that parental autonomy is more about parents providing good care for their children and treating them with respect than parents having rights. The researcher Kyriakos Martakis, MD, MSc, explains that research shows parental influence negatively affects children's ability to form autonomy. However, involving children in the decision-making process allows children to develop their cognitive skills and create their own opinions and, thus, decisions about their health. Parental authority affects the degree of autonomy the child patient has. As a result, in Argentina, the new National Civil and Commercial Code has enacted various changes to the healthcare system to encourage children and adolescents to develop autonomy. It has become more crucial to let children take accountability for their own health decisions.
In most cases, the pediatrician, parent, and child work as a team to make the best possible medical decision. The pediatrician has the right to intervene for the child's welfare and seek advice from an ethics committee. However, in recent studies, authors have denied that complete autonomy is present in pediatric healthcare. The same moral standards should apply to children as they do to adults. In support of this idea is the concept of paternalism, which negates autonomy when it is in the patient's interests. This concept aims to keep the child's best interests in mind regarding autonomy. Pediatricians can interact with patients and help them make decisions that will benefit them, thus enhancing their autonomy. However, radical theories that question a child's moral worth continue to be debated today.
Authors often question whether the treatment and equality of a child and an adult should be the same. Author Tamar Schapiro notes that children need nurturing and cannot exercise the same level of authority as adults. Hence, continuing the discussion on whether children are capable of making important health decisions until this day.
Modern Advancements
According to the Subcommittee of Clinical Ethics of the Argentinean Pediatric Society (SAP), children can understand moral feelings at all ages and can make reasonable decisions based on those feelings. Therefore, children and teens are deemed capable of making their own health decisions when they reach the age of 13. Recently, studies made on the decision-making of children have challenged that age to be 12.
Technology has made several modern advancements that contribute to the future development of child autonomy, for example, unsolicited findings (U.F.s) of pediatric exome sequencing. They are findings based on pediatric exome sequencing that explain in greater detail the intellectual disability of a child and predict to what extent it will affect the child in the future. Genetic and intellectual disorders in children make them incapable of making moral decisions, so people look down upon this kind of testing because the child's future autonomy is at risk. It is still in question whether parents should request these types of testing for their children. Medical experts argue that it could endanger the autonomous rights the child will possess in the future. However, the parents contend that genetic testing would benefit the welfare of their children since it would allow them to make better health care decisions. Exome sequencing for children and the decision to grant parents the right to request them is a medically ethical issue that many still debate today.
Education requirements
Aspiring medical students will need 4 years of undergraduate courses at a college or university, which will get them a BS, BA or other bachelor's degree. After completing college, future pediatricians will need to attend 4 years of medical school (MD/DO/MBBS) and later do 3 more years of residency training, the first year of which is called "internship." After completing the 3 years of residency, physicians are eligible to become certified in pediatrics by passing a rigorous test that deals with medical conditions related to young children.
In high school, future pediatricians are required to take basic science classes such as biology, chemistry, physics, algebra, geometry, and calculus. It is also advisable to learn a foreign language (preferably Spanish in the United States) and be involved in high school organizations and extracurricular activities. After high school, college students simply need to fulfill the basic science course requirements that most medical schools recommend and will need to prepare to take the MCAT (Medical College Admission Test) in their junior or early senior year in college. Once attending medical school, student courses will focus on basic medical sciences like human anatomy, physiology, chemistry, etc., for the first three years, the second year of which is when medical students start to get hands-on experience with actual patients.
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
A commonwealth is a traditional English term for a political community founded for the common good. Historically, it has been synonymous with "republic". The noun "commonwealth", meaning "public welfare, general good or advantage", dates from the ...
. Entrants to graduate-entry courses (as in the US), 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
An internship is a period of work experience offered by an organization for a limited period of time. Once confined to medical graduates, internship is used practice for a wide range of placements in businesses, non-profit organizations and gover ...
" 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.
In the United States, a medical school graduate wishing to specialize in pediatrics must undergo a three-year residency composed of outpatient, inpatient, and critical care rotations. Subspecialties within pediatrics require further training in the form of 3-year fellowships. Subspecialties include critical care, gastroenterology, neurology, infectious disease, hematology/oncology, rheumatology, pulmonology, child abuse, emergency medicine, endocrinology, neonatology, and others.
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 the 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
Specialization or Specialized may refer to:
Academia
* Academic specialization, may be a course of study or major at an academic institution or may refer to the field in which a specialist practices
* Specialty (medicine), a branch of medical ...
. Specialist training is often largely under the control of pediatric organizations'' (see below) rather than universities and depends on the jurisdiction.
Subspecialties
Subspecialties of pediatrics include:
(''not an exhaustive list'')
*
Addiction medicine
Addiction medicine is a medical subspecialty that deals with the diagnosis, prevention, evaluation, treatment, and recovery of persons with addiction, of those with substance-related and addictive disorders, and of people who show unhealthy us ...
(multidisciplinary)
*
Adolescent medicine
Adolescent medicine also known as adolescent and young adult medicine is a medical subspecialty that focuses on care of patients who are in the adolescent period of development. This period begins at puberty and lasts until growth has stopped, a ...
*
Child abuse pediatrics
*
Clinical genetics
Medical genetics is the branch
tics in that human genetics is a field of scientific research that may or may not apply to medicine, while medical genetics refers to the application of genetics to medical care. For example, research on the caus ...
* Clinical informatics
* Developmental-behavioral pediatrics
*
Headache medicine
*
Hospital medicine
Hospital medicine is a medical specialty that exists in some countries as a branch of family medicine or internal medicine, dealing with the care of acutely ill hospitalized patients. Physicians whose primary professional focus is caring for hos ...
*
Medical toxicology
Medical toxicology is a subspecialty of medicine focusing on toxicology and providing the diagnosis, management, and prevention of poisoning and other adverse effects due to medications, occupational and environmental toxicants, and biological ...
*
Metabolic medicine
*
Neonatology
Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a hospital-based specialty, and is usually practised in neonatal intensive care units (NICUs). The ...
/Perinatology
*
Pain medicine
Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals pr ...
(multidisciplinary)
*
Palliative care
Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wit ...
(multidisciplinary)
*
Pediatric allergy and immunology
''Pediatric Allergy and Immunology'' is a peer-reviewed medical journal covering immunology and allergy as they relate to pediatrics. It was established in 1990 and is published eight times per year by John Wiley & Sons. It is the official journal ...
*
Pediatric cardiology
** Pediatric cardiac critical care
*
Pediatric critical care
** Neurocritical care
** Pediatric cardiac critical care
*
Pediatric emergency medicine
Pediatric emergency medicine (PEM) is a medical subspecialty of both pediatrics and emergency medicine. It involves the care of undifferentiated, unscheduled children with acute illnesses or injuries that require immediate medical attention. While ...
*
Pediatric endocrinology Pediatric endocrinology (British: Paediatric) is a medical subspecialty dealing with disorders of the endocrine glands, such as variations of physical growth and sexual development in childhood, diabetes and many more.
By age, pediatric endocrin ...
*
Pediatric gastroenterology Pediatric gastroenterology developed as a sub-specialty of pediatrics and gastroenterology. It is concerned with treating the gastrointestinal tract, liver and pancreas of children from infancy until age eighteen. The principal diseases it is conc ...
**
Transplant hepatology
*
Pediatric hematology
*
Pediatric infectious disease
*
Pediatric nephrology
*
Pediatric oncology
Childhood cancer is cancer in a child. About 80% of childhood cancer cases can be successfully treated thanks to modern medical treatments and optimal patient care. However, only about 10% of children diagnosed with cancer reside in high-income cou ...
** Pediatric neuro-oncology
*
Pediatric pulmonology
''Pediatric Pulmonology'' is a monthly peer-reviewed medical journal covering pediatric pulmonology. It was established in 1985; the editor-in-chief is Susanna McColley, MD. According to the ''Journal Citation Reports'', the journal has a 2020 i ...
*
Primary care
Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care t ...
*
Pediatric rheumatology
*
Sleep medicine
Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and sleep disorder, disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many ...
(multidisciplinary)
* Social pediatrics
*
Sports medicine
Sports medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Although most sports teams have employed team physicians for many years, it is only since the ...
Other specialties that care for children
(''not an exhaustive list'')
*
Child neurology
**
Addiction medicine
Addiction medicine is a medical subspecialty that deals with the diagnosis, prevention, evaluation, treatment, and recovery of persons with addiction, of those with substance-related and addictive disorders, and of people who show unhealthy us ...
(multidisciplinary)
** Brain injury medicine
** Clinical neurophysiology
**
Epilepsy
Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...
**
Headache medicine
** Neurocritical care
** Neuroimmunology
** Neuromuscular medicine
**
Pain medicine
Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals pr ...
(multidisciplinary)
**
Palliative care
Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wit ...
(multidisciplinary)
** Pediatric neuro-oncology
**
Sleep medicine
Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and sleep disorder, disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many ...
(multidisciplinary)
*
Child and adolescent psychiatry
Child and adolescent psychiatry (or pediatric psychiatry) is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial fac ...
, subspecialty of
psychiatry
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry.
Initial psych ...
* Neurodevelopmental disabilities
* Pediatric anesthesiology, subspecialty of
anesthesiology
Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...
*
Pediatric dentistry
Pediatric dentistry (formerly pedodontics in American English or paedodontics in Commonwealth English) is the branch of dentistry dealing with children
from birth through adolescence. The specialty of pediatric dentistry is recognized by the Ameri ...
, subspecialty of
dentistry
Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions o ...
* Pediatric dermatology, subspecialty of
dermatology
Dermatology is the branch of medicine dealing with the skin.''Random House Webster's Unabridged Dictionary.'' Random House, Inc. 2001. Page 537. . It is a speciality with both medical and surgical aspects. A dermatologist is a specialist medical ...
*
Pediatric gynecology
Pediatric gynaecology or pediatric gynecologySee American and British English spelling differences. ''Gynecology'' is the American spelling, but it is also common in international contexts, e.g. International Federation of Gynecology and Obstet ...
* Pediatric neurosurgery, subspecialty of
neurosurgery
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peri ...
*
Pediatric ophthalmology
Pediatric ophthalmology is a sub-speciality of ophthalmology concerned with eye diseases, visual development, and vision care in children.
Training
In the United States, pediatric ophthalmologists are physicians who have completed medical school, ...
and Pediatric optometry, subspecialty of
ophthalmology
Ophthalmology ( ) is a surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders.
An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a medic ...
* Pediatric orthopedic surgery, subspecialty of
orthopedic surgery
Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
* Pediatric otolaryngology, subspecialty of
otolaryngology
Otorhinolaryngology ( , abbreviated ORL and also known as otolaryngology, otolaryngology–head and neck surgery (ORL–H&N or OHNS), or ear, nose, and throat (ENT)) is a surgical subspeciality within medicine that deals with the surgical a ...
*
Pediatric plastic surgery
Pediatric plastic surgery is plastic surgery performed on children. Its procedures are most often conducted for reconstructive or cosmetic purposes. In children, this line is often blurred, as many congenital deformities impair physical function as ...
, subspecialty of
plastic surgery
Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofa ...
* Pediatric radiology, subspecialty of
radiology
Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiat ...
* Pediatric rehabilitation medicine, subspecialty of
physical medicine and rehabilitation
Physical medicine and rehabilitation, also known as physiatry, is a branch of medicine that aims to enhance and restore functional ability and quality of life to people with physical impairments or disabilities. This can include conditions su ...
*
Pediatric surgery
Pediatric surgery is a subspecialty of surgery involving the surgery of fetuses, infants, children, adolescents, and young adults.
History
Pediatric surgery arose in the middle of the 1879 century as the surgical care of birth defects required ...
, subspecialty of
general surgery
General surgery is a surgical specialty that focuses on alimentary canal and abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile ducts, and often the thyroid ...
*
Pediatric urology
Pediatric urology is a surgical subspecialty of medicine dealing with the disorders of children's genitourinary systems. Pediatric urologists provide care for both boys and girls ranging from birth to early adult age. The most common problems are ...
, subspecialty of
urology
Urology (from Greek οὖρον ''ouron'' "urine" and '' -logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive org ...
See also
*
American Academy of Pediatrics
The American Academy of Pediatrics (AAP) is an American professional association of pediatricians, headquartered in Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C.
Background
The Academy was founded ...
*
American Osteopathic Board of Pediatrics
*
Center on Media and Child Health
The Center on Media and Child Health (CMCH) is a non-profit organization based at Boston Children's Hospital. CMCH was founded in 2002, by Michael Rich, pediatrician; Associate Professor of Pediatrics at Harvard Medical School; and Associate Pro ...
(CMCH)
*
Children's hospital
A children's hospital is a hospital that offers its services exclusively to infants, children, adolescents, and young adults. In certain special cases, they may also treat adults. The number of children's hospitals proliferated in the 20th ...
*
List of pediatric organizations
*
List of pediatrics journals
*
Medical specialty
A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children (paediatrics), cancer (oncology), ...
*
Pediatric Oncall
*
Pain in babies
Pain in babies, and whether babies feel pain, has been a large
subject of debate within the medical profession for centuries. Prior to the late nineteenth century it was generally considered that babies Threshold of pain, hurt more easily than a ...
*
Royal College of Paediatrics and Child Health
The Royal College of Paediatrics and Child Health, often referred to as the RCPCH, is the professional body for paediatricians (doctors specialising in child health) in the United Kingdom. It is responsible for the postgraduate training of paed ...
References
Further reading
''BMC Pediatrics''- open access
''Clinical Pediatrics''''Developmental Review''- partial open access
''JAMA Pediatrics''''The Journal of Pediatrics''- partial open access
External links
Pediatrics Directory at CurliePediatric Health Directory at OpenMD
{{Authority control
Childhood