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Paediatrics ( also spelled pediatrics or pædiatrics) is the branch of
medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts ( descriptive knowledge), skills (proced ...

medicine
that involves the medical care of
infant 222x222px, Eight-month-old sororal twin sisters An infant (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is the more formal or specialised synonym for the common term ''baby'', meaning the very young offspring ...

infant
s,
child Biologically, a child (plural children) is a human being between the stages of childbirth, birth and puberty, or between the Development of the human body, developmental period of infancy and puberty. The legal definition of ''child'' generall ...

child
ren, and
adolescents Adolescence ()''Macmillan Dictionary for Students'' Macmillan, Pan Ltd. (1981), page 14, 456. Retrieved July 15, 2010. is a transitional stage of physical Physical may refer to: *Physical examination, a regular overall check-up with a doctor ...
. The
American Academy of Pediatrics The American Academy of Pediatrics (AAP) is an American professional association of pediatricians, headquartered in Itasca, Illinois, Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C. Background The Ac ...
recommends people seek pediatric care through the age of 21. In the
United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain,Usage is mixed. The Guardian' and Telegraph' use Britain as a synonym for the United Kingdom. Some prefer to use Britain as shorth ...

United Kingdom
, paediatrics covers patients until age 18. Worldwide age limits of pediatrics have been trending up year over year. A
medical doctor A physician (American English American English (AmE, AE, AmEng, USEng, en-US), sometimes called United States English or U.S. English, is the set of varieties of the English language native to the United States. Currently, American Eng ...

medical doctor
who specializes in this area is known as a pediatrician, or paediatrician. The word ''pediatrics'' and its
cognates In linguistics Linguistics is the science, scientific study of language. It encompasses the analysis of every aspect of language, as well as the methods for studying and modeling them. The traditional areas of linguistic analysis includ ...
mean "healer of children"; they derive from two
Greek#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ελλάδα, , ), officially the Hellenic Republic, is a country located in Southeast Europe. Its population is approximately 10.7 million as of ...
words: (''pais'' "child") and (''iatros'' "doctor, healer"). Pediatricians work in
hospital A hospital is a health care institution providing patient treatment with specialized Medical Science, health science and Allied Healthcare, auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospit ...

hospital
s and
children's hospitals Biologically, a child (plural children) is a human being between the stages of childbirth, birth and puberty, or between the Development of the human body, developmental period of infancy and puberty. The legal definition of ''child'' generall ...

children's hospitals
particularly those working in its subspecialties (e.g.
neonatology Neonatology is a subspecialty of pediatrics Paediatrics (American and British English differences, also spelled pediatrics or pædiatrics) is the branch of medicine that involves the medical care of infants, children, and Adolescence, ado ...
), and as outpatient
primary care physician A patient having his blood pressure measured A primary care physician (PCP) is a physician A physician (American English), medical practitioner (English in the Commonwealth of Nations, Commonwealth English), medical doctor, or simply do ...
s.


History

The earliest mentions of child-specific medical problems appears in the ''
Hippocratic Corpus The Hippocratic Corpus (Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken in the area around Rome, known as Latium. Through the power of th ...
'', 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''; ''fl.'' 175–177 CE) was a 2nd-century Ancient Greek philosophy, Greek philosopher and Criticism of Christianity, opponent of early Christianity. His literary work, ''The True Word'' (al ...
,
Soranus of Ephesus Soranus of Ephesus ( grc-gre, Σωρανός ὁ Ἑφέσιος; 1st/2nd century AD) was a Greek physician. He was born in Ephesus Ephesus (; gr, Ἔφεσος, Éphesos; tr, Efes; may ultimately derive from hit, 𒀀𒉺𒊭, Apaša) wa ...
,
Aretaeus
Aretaeus
,
Galen Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized Linguistic anglicisation (or anglicization, occasionally anglification, anglifying, or Englishing) is the practice of modi ...
, and
Oribasius Oribasius or Oreibasius ( el, Ὀρειβάσιος; c. 320 – 403) was a Greek medical writer and the personal physician of the Roman emperor Julian the Apostate Julian ( la, Flavius Claudius Julianus; grc-gre, Ἰουλιανός; 331 – ...
, 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#REDIRECT Greek Greek may refer to: Greece Anything of, from, or related to Greece Greece ( el, Ε ...

Hippocrates
,
Aristotle Aristotle (; grc-gre, Ἀριστοτέλης ''Aristotélēs'', ; 384–322 BC) was a Greek philosopher A philosopher is someone who practices philosophy Philosophy (from , ) is the study of general and fundamental questio ...

Aristotle
,
Celsus Celsus (; grc-x-hellen, Κέλσος, ''Kélsos''; ''fl.'' 175–177 CE) was a 2nd-century Ancient Greek philosophy, Greek philosopher and Criticism of Christianity, opponent of early Christianity. His literary work, ''The True Word'' (al ...
, Soranus, and
Galen Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized Linguistic anglicisation (or anglicization, occasionally anglification, anglifying, or Englishing) is the practice of modi ...
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"). Even though some pediatric works existed during this time, they were scarce and rarely published due to a lack of knowledge in pediatric medicine. It was in 1472, in Padua, that Paolo Bagellardo, an Italian physician, authored the first medical book entirely about childhood illnesses - "''De infantium aegritudinibus ac remediis''." 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 mod ...

Ancient India
where children's doctors were called ''kumara bhrtya''. ''
Sushruta Samhita The ''Sushruta Samhita'' (सुश्रुतसंहिता, IAST The International Alphabet of Sanskrit Transliteration (IAST) is a transliteration scheme that allows the lossless romanisation of Brahmic family, Indic scripts as employ ...
'' an
ayurvedic Ayurveda () is an alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine Medicine is the Art (skill), art, science, and Praxis (process) , practice of caring for a patient and mana ...

ayurvedic
text, composed during the sixth century BC contains the text about pediatrics. Another ayurvedic text from this period is '' Kashyapa Samhita''. 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 Ephesus (; gr, Ἔφεσος, Éphesos; tr, Efes; may ultimately derive from hit, 𒀀𒉺𒊭, Apaša) wa ...
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 the Apostate Julian ( la, Flavius Claudius Julianus; grc-gre, Ἰουλιανός; 331 – ...
, Aëtius of Amida, Alexander Trallianus, and Paulus Aegineta 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 The history of Islam concerns the political, social, economic, and cultural developments of Muslim world, Islamic civilization. M ...
writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own, especially Haly Abbas, Yahya Serapion, Abulcasis,
Avicenna Ibn Sina ( fa, ابن سینا), also known as Abu Ali Sina (), Pur Sina (), and often known in the West as Avicenna (;  – June 1037), was a Persian polymath who is regarded as one of the most significant physicians, astronomers, t ...

Avicenna
, and
Averroes Ibn Rushd ( ar, ; full name Image:FML names-2.png, 300px, First/given, middle and last/family/surname with John Fitzgerald Kennedy as example. This shows a structure typical for the Anglosphere, among others. Other cultures use other struc ...

Averroes
. The Persian philosopher and physician al-Razi (865–925) published a monograph on pediatrics titled ''Diseases in Children'' as well as the first definite description of smallpox as a clinical entity. 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 Augsburg ( , , ; bar, Augschburg, links=https://en.wikipedia.org/wiki/Swabian_German, label=Swabian German) is a city A city is a large .Goodall, B. (1987) ''The Penguin Dictionary of Human Geogra ...
's ''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. 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 (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 . 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, opening the first pediatric, children's clinic in the United States. To date, he is the only foreign-born president of the American Medical Association. ...

Abraham Jacobi
(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 ) , image_map = , map_caption = , map_width = 250px , capital = Berlin Berlin (; ) is the Capital city, capital and List of cities in Germany by population, largest city of Germany by both area and population. Its 3,769,495 inh ...

Germany
and later practiced in
New York City New York, often called New York City to distinguish it from New York State New York is a state State may refer to: Arts, entertainment, and media Literature * ''State Magazine'', a monthly magazine published by the U.S. Department of ...

New York City
. 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 is one of Europe's largest university hospitals, affiliated with Humboldt University and Free University Berlin. With numerous Collaborative Research Centres (CRC) of the Deutsche Forschungsgemein ...
(a hospital founded in 1710) in
Berlin Berlin (; ) is the Capital city, capital and List of cities in Germany by population, largest city of Germany by both area and population. Its 3,769,495 inhabitants, as of 31 December 2019 makes it the List of cities in the European Union by ...

Berlin
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), ...

Saint Petersburg
in 1834, and at
Vienna Vienna ( ; german: Wien ; bar, Wean, label=Bavarian language, Austro-Bavarian ) is the Capital city, national capital, largest city, and one of States of Austria, nine states of Austria. Vienna is Austria's List of cities and towns in Austria, mos ...

Vienna
and Breslau (now
Wrocław Wrocław (; german: Breslau ; sli, Brassel; cs, Vratislav), ''Wratislavia''. 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 Centra ...

Wrocław
), both in 1837. In 1852 Britain's first pediatric hospital, was founded by Charles West. The first Children's hospital in Scotland opened in 1860 in
Edinburgh Edinburgh (; sco, 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 ...

Edinburgh
. 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 Image:The Children's Castle, Helsinki.jpg, Children's Castle (''Lastenlinna''), a former children's hospital, that preceded the current , in Helsinki, Finland A children ...

Children's Hospital of Philadelphia
, 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 Pediatrics, children's hospital located in Boston, Massachusetts, adjacent both to its teaching affiliate, Harvard M ...
(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 entrepreneur Entrepreneurship is the creation or extraction of value. With this definition, entrepreneurship is viewed as change, generally entailing risk beyond what is no ...

Johns Hopkins
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 222x222px, Eight-month-old sororal twin sisters An infant (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is the more formal or specialised synonym for the common term ''baby'', meaning the very young offspring ...

infant
or
neonate 222x222px, Eight-month-old sororal twin sisters An infant (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is the more formal or specialised synonym for the common term ''baby'', meaning the very young offspri ...
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 Ancient Greek includes the forms of the Greek language used in ancient Greece and the classical antiquity, ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following peri ...

pharmacokinetic
properties of drugs that enter the body. The
absorption Absorption may refer to: Chemistry and biology *Absorption (chemistry), diffusion of particles of gas or liquid into liquid or solid materials *Absorption (skin), a route by which substances enter the body through the skin *Absorption (pharmacolo ...
,
distributionDistribution may refer to: Mathematics *Distribution (mathematics) Distributions, also known as Schwartz distributions or generalized functions, are objects that generalize the classical notion of functions in mathematical analysis. Distr ...
,
metabolism Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life Life is a characteristic that distinguishes physical entities A bubble of exhaled gas in water In common usage and classical mechanics, a phys ...
, and
elimination Elimination may refer to: Science and medicine *Elimination reaction, an organic reaction in which two functional groups split to form an organic product *Bodily waste elimination, discharging feces, urine, or foreign substances from the body v ...
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 due to decreased
acid An acid is a or capable of donating a (hydrogen ion H+) (a ), or, alternatively, capable of forming a with an (a ). The first category of acids are the proton donors, or s. In the special case of , proton donors form the H3O+ and are ...
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 The gastrointestinal tract, (GI tract, GIT, digestive tract, digestion tract, alimentary canal) is the tract from the mouth to the anus which includes all the organs ...
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 (biocatalysts). Catalysts accelerate chemical reactions. The molecules upon which enzymes may act are called substrate (chemistry), substrates, and the enzyme converts the substrates in ...

enzyme
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 biomolecule , showing alpha helices, represented by ribbons. This poten was the first to have its suckture solved by X-ray crystallography by Max Perutz and Sir John Cowdery Kendrew in 1958, for which they received a No ...

protein
s, which leads to decreased metabolism and increased serum concentrations of specific drugs. However,
prodrug A prodrug is a Pharmaceutical drug, medication or compound that, after Drug administration, administration, is Drug metabolism, metabolized (i.e., converted within the body) into a pharmacologically active drug. Instead of administering a drug dire ...
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 Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology Biology is the natural science that studies life and living organisms, including their anatomy, physica ...
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 co ...
than adults, which directly affects the dosing of
hydrophilic A hydrophile is a molecule File:Pentacene on Ni(111) STM.jpg, A scanning tunneling microscopy image of pentacene molecules, which consist of linear chains of five carbon rings. A molecule is an electrically neutral group of two or more atoms ...

hydrophilic
drugs such as
beta-lactam antibiotics A beta-lactam (β-lactam) ring is a four-membered lactam. A ''lactam'' is a cyclic amide, and ''beta''-lactams are named so because the nitrogen atom is attached to the Β carbon, β-carbon atom relative to the carbonyl. The simplest β-lactam pos ...
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, pronunciation: or ) is a type of chemical reaction A chemical reaction is a process that leads to the chemical transformation of one set of chemical substance A chemical substance is a form of matter ...

oxidation
,
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 Substitution may refer to: Arts and media *Chord substitution, in music, swapping one chord fo ...

hydrolysis
,
acetylation Acetylation (or in IUPAC nomenclature The International Union of Pure and Applied Chemistry The International Union of Pure and Applied Chemistry (IUPAC ) is an international federation of National Adhering Organizations that represents chemi ...

acetylation
,
methylation In the chemical sciences, methylation denotes the addition of a methyl group A methyl group is an alkyl derived from methane, containing one carbon atom chemical bond, bonded to three hydrogen atoms — CH3. In chemical formula, fo ...

methylation
, etc.). Enzyme capacity, clearance, and
half-life Half-life (symbol ''t''1⁄2) is the time required for a quantity to reduce to half of its initial value. The term is commonly used in nuclear physics Nuclear physics is the field of physics Physics is the natural science that studies ...
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 An organ is a group of tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tissues can be broadly categorized ...
clearance of medications that are eliminated through urine. In
preterm Preterm birth, also known as premature birth, is the birth Birth is the act or process of bearing or bringing forth offspring, also referred to in technical contexts as parturition. In mammals, the process is initiated by hormones which cause ...
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 Latin (, or , ) is a classical language A classical language is a language A language is a structured system of communication Communication (from Latin ''communicare'', meaning "to share" or "to be i ...
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'' 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, Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C. Background The Ac ...
(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 In philosophy Philosophy (from , ) is the study of general and fundamental questions, such as those about reason, Metaphysics, existenc ...

Commonwealth
. 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 organization A no ...
" 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. 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 Drug rehabilitation, recovery of persons with Substance dependence, addiction, of those with Substance-related disorder, substance- ...
(multidisciplinary) *
Adolescent medicine Adolescent medicine also known as adolescent and young adult medicine is a medical subspecialtyA subspecialty or subspeciality (British English) is a narrow field of professional knowledge/skills within a specialty of trade (occupation), trade, a ...
* * Clinical informatics * Developmental-behavioral pediatrics *
Genetics Genetics is a branch of biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecular interactions, Physiology, ...

Genetics
and
Metabolism Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life Life is a characteristic that distinguishes physical entities A bubble of exhaled gas in water In common usage and classical mechanics, a phys ...

Metabolism
* *
Hospital medicine Hospital medicine is a 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 children (paediatrics Pediatrics (American and Briti ...
* Medical toxicology *
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, pain killer, pain medicine, pain control or algiatry, is a branch of medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awarenes ...
(multidisciplinary) *
Palliative care Palliative care (derived from the Latin root ''palliare, or'' "to cloak") is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex illness. Within the pub ...
(multidisciplinary) * Pediatric allergy and immunology * 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 Pediatrics ( also spelled paediatrics or pædiatrics) is the branch of medicine that involves the medical care of infants, children, and adolescents. The America ...
* Pediatric endocrinology * Pediatric gastroenterology ** hepatology, Transplant hepatology * hematology, Pediatric hematology * Infectious disease (medical specialty), Pediatric infectious disease * nephrology, Pediatric nephrology * Childhood cancer, Pediatric oncology ** Pediatric neuro-oncology * pulmonology, Pediatric pulmonology * Primary care * rheumatology, Pediatric rheumatology * Sleep medicine (multidisciplinary) * Social pediatrics * Sports medicine


Other specialties that care for children

(''not an exhaustive list'') * neurology, Child neurology **
Addiction medicine Addiction medicine is a medical subspecialty that deals with the diagnosis, prevention, evaluation, treatment, and Drug rehabilitation, recovery of persons with Substance dependence, addiction, of those with Substance-related disorder, substance- ...
(multidisciplinary) ** Brain injury medicine ** Clinical neurophysiology ** Epilepsy ** ** Neurocritical care ** Neuroimmunology ** Neuromuscular medicine ** Neuropsychiatry **
Pain medicine Pain management, pain killer, pain medicine, pain control or algiatry, is a branch of medicine Medicine is the science Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity, awarenes ...
(multidisciplinary) **
Palliative care Palliative care (derived from the Latin root ''palliare, or'' "to cloak") is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex illness. Within the pub ...
(multidisciplinary) ** Pediatric neuro-oncology ** Sleep medicine (multidisciplinary) * Child and adolescent psychiatry, subspecialty of psychiatry * Neurodevelopmental disabilities * Pediatric anesthesiology, subspecialty of anesthesiology *Pediatric dentistry, subspecialty of dentistry * Pediatric dermatology, subspecialty of dermatology * Pediatric gynaecology, Pediatric gynecology * Pediatric neurosurgery, subspecialty of neurosurgery * Pediatric ophthalmology, subspecialty of ophthalmology * Pediatric orthopedic surgery, subspecialty of orthopedic surgery * Pediatric otolaryngology, subspecialty of otorhinolaryngology, otolaryngology * Pediatric plastic surgery, subspecialty of plastic surgery * Pediatric radiology, subspecialty of radiology * Pediatric rehabilitation medicine, subspecialty of physical medicine and rehabilitation * Pediatric surgery, subspecialty of general surgery * Pediatric urology, subspecialty of urology


See also

*
American Academy of Pediatrics The American Academy of Pediatrics (AAP) is an American professional association of pediatricians, headquartered in Itasca, Illinois, Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C. Background The Ac ...
* American Osteopathic Board of Pediatrics * Center on Media and Child Health (CMCH) * Children's hospital * :Pediatric organizations, List of pediatric organizations * :Pediatrics journals, List of pediatrics journals * specialty (medicine), Medical specialty * Pediatric Oncall * Pain in babies * Royal College of Paediatrics and Child Health


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 Curlie

Pediatric Health Directory at OpenMD
{{Authority control Pediatrics, Childhood