Introduction to

Pediatrics
Dr sumera akram
SR pediatrics
SMC
  Earlier treated as small adults, but unique
problems, definitive approach
 Treating children 0-21 yrs/ 18 yrs/14 yrs/ 12 yrs
 Human child vs animals
Pediatrics  Population pyramid
 Population of India?
 42% of population is below 18 yrs
  Treating children (birth to 21 yrs);
 Growing / developing individuals
 Need to remember doses/ intakes by weight/size
 Diseases of children affect G&D  disorders of G&D
as a symptom
What’s  Primary disorders of G&D
 Child’s metabolism is different (faster)
different?  Drug doses are higher
 Fluid/ calorie intake higher
 Parameters (HR, RR higher, BP lower in younger)
 Higher proportion of body water
  Spectrum of disease in children is different
 Congenital/inherited
 Infectious
What’s  Nutritional
different? 

Less of degenerative – atherosclerosis/ CAD/ HT
Less psychiatric
 Still, overlap with adult medicine is there
  Child’s response to disease and treatment is
different:
What’s  Deteriorate very quickly – need careful watching
different?  Improve also very quickly – gratifying
 Hold more true for younger kids
  Taken 2nd hand, from caregiver
 Some symptoms maybe nonspecific – eg crying,
vomiting, diarrhea
 Sequence
Pediatric  4 extra histories
History  Feeding
 Antenatal, natal, neonatal
 Developmental
 Immunization
  Rapport important
 Do not follow set sequence, leave unpleasant parts
to the end
 Some signs are different in children – eg palpable
liver, brisk tendon reflexes, extensor plantar
Pediatric  Sometimes, just not possible – eg neurological,
examination percussion, auscultation, JVP, AF
 Abdominal palpation easier
 ENT examn

 Nonspecific signs in younger kids

  Lower threshold for investigation
 Lower threshold for treatment
 Remember, uncommon presentation of a common
ailment is more likely than a rare disease
 Make a list of possibilities, with points for and
against
Approach
Procedures
 Generally easier, except in the very tiny
 Drips difficult
 Sedation, analgesia
  Major subject in Part II MBBS
 Separate subject since 1997, need to pass
separately
Examination  Internal assessment
 One theory paper
 Practical – long case, short case, newborn, viva,
OSCE
  Embryogenesis: 1st eight weeks after fertilization
 Fetal period: the stage between the third and ninth months of in utero human
development, during which there is growth of preformed structures
 Perinatal period: 22 completed weeks (154 days) of gestation
(the time when birthweight is normally 500 grams) and
Some
ends seven completed days after birth'.
definitions
 Newborn 0-1 month
 Infant birth to 1 year
 Toddler 1-3 years
 Child - primary school, middle and high
 Adolescent 10-21 yrs
  LBW 28%
 Underweight 43%
Stats  Stunted 48%
 One third of all malnourished children live in India –
malnutrition capital
 Contributory cause for child mortality
  IMR 47.5/1000
 Under 5 mortality 62.7/1000
 Neonatal mortality rate 32/1000 – accounts for
2/3rd of IMR and ½ of under 5 mortality
Stats
 90% of all deaths are easily preventable
 Neonatal causes – sepsis/pneumonia, LBW, birth
asphyxia
 ARI
 Diarrhea
  Early breast feeds
 Exclusive breast feeds
Child Survival  Appropriate weaning
Strategies  Vaccination
 Antenatal, intrapartum and neonatal care
 Case management of pneumonia and diarrhea
  Very vast, varied
 Tough
 Satisfying – incorporates the Art and Science of
medical practice
 Ambulatory, indoor, emergency, intensive care
Careers in
 Subspecialties – neonatology, neurology, PHO
Pediatrics
 Research
 Community/ public health
 Even a lifetime is not enough to master even one
specialty
 If the quest continues, you will enjoy the journey
 Remember, you always learn something new from
each patient, however mundane you think his
problem is
Department
of pediatrics
at Sahiwal
medical
college
Faculty of
pediatrics at
Sahiwal
medical
college