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Introduction 曹励之 Physical and emotional health of infants、children、and adolescents;their growth and development;their disease prevention; and treatment. Development、Prevention、Clinic pediatrics Perinatology(围生医学) 、Neonatology(新生儿学)、Adolescent medicine(青春期医学) Principles: protect childrens health, improve the life quality Three differences: individual, age and sex Good recovery ability Weak self protection vPediatrics is not the miniature of internal medicine vDifferent development regulations in different ages vDifferent normal data about physiology and biochemistry in different ages vImmune system is not as perfect as adults vBigger water and nutrition requirement vDifferent pathological changes between adult and children vSingle child policy (China) Clinical Manifestation and Diagnosis Infective Diseases Children Severe Cant be limited multisystem involvement Neonate Not specific Losing definite location vDose being connected with different ages vTreating the primary and the complications vNursing and supporting vChanging quickly vGood capacity of restore vLess sequelae(后遗症) than that of adult except nervous system vEmphasize guarding of younger, weakness and critically ill v Monitoring of perinatal period v Planned immunization v Four of the most ordinary disease( malnutrition, anemia, diarrhea and pneumonia) v Preventing the adult disease( obesity, hypertension, diabetes or coronary heart disease) GOBI Growth, Oral rehydration, Breastfeeding, Immunization IMCI (integrated management of childhood illness) Pneumonia(19%) Diarrhea(18%) Malaria(8%) Measles(4%) HIV/AIDS(3%) Neonatal diseases(37%): preterm, asphyxia, infection Infectious diseases Mental problems in children Prevention of adult diseases in children Accidental injury in children Environmental pollution Adolescent medicine and other subjects immersion into the Pediatrics Genetic diagnosis and prevention of childrens diseases q Fetal period From fertilization to the birth of the baby Stages of Development (Second) q Newborn period From umbilical cord ligation to 28th day (Early newborn period is younger than 7 days) vBad ability of adjusting and adapting vHigh morbidity and mortality vImportance of health protection, nursing and planned immunization vPerinatal period :from 28 weeks of pregnancy to 7th day after birth vPerinatal mortality(死亡率) is an important guide line of judging developing degree of one country. Mouth Skin Apgar score Mother/infant binding(rooming in) Rule out congenital genetic and metabolic diseases Function analysis Immunization should be postponed if the child has an acute febrile illness. Premature babies can be immunized following the recommended schedule according to chronological age,i.e. immunization should not be postponed. Being treated with chemotherapy or radiotherapy for malignant disease On immunosuppressive treatment after organ or bone marrow transplant. On high-dose systemic steroids. With impaired cell-mediated immunity, e.g. severe combined immunodeficiency syndrome or Di George syndrome. Stages of Development (Third) q Infancy period After delivery to 1 year old v Rapidest period of growth v Larger requirement of nutrition and energy Too much: obesity, diarrhea Deficiency: anemia, malnutrition v Breast milk v Planned immunization v Susceptive to the infectious disease in the latter 6 months v Physical examination: age 6 months: every 2-3 months Stages of Development (Fourth) q Toddlers age From 1 year to 3 years v Faster intelligence development Elementary education v Poorer ability of identifying danger Thunderbolt injury v Changing of food Malnutrition, disorders of digestion v Immune deficiency Being apt to infective disease v Physical examination: every 6 months Stages of Development (Fifth) q Preschool age From 3 years to 6-7 years vSlower growth vMore mature development of intelligence plasticity culture(可塑性培养) vTraining of good habit and independent ability (sleeping, eating, stool, health habit) vPrevention of infectious diseases and accidents (learn self protection 119,110,120) vMore immune disease Stages of Development (Sixth) q School age From 6-7 years to 12- 14 years v Physical growth being similar as adults Except genital system v Comprehensive development of the morals, intelligence and bodies v Lower morbidity v Cultivation of the sanitation habit Stages of Development (Seventh) q Adolescence Girl:11-12y17-18y Boy:13-14y18-20y v The second peak of development and growth. v The peak development of the genital system- health care v The instability of neuroendocrine system- psychology ; behavior ; spirit Scientific breeding: newborns and infants Suitable breeding: later stages Early education: infants and toddlers Injury prevention: toddlers, pre-schools and school ages Psychiatric education: pre-schools, school ages and puberty Sex education: school ages and puberty Growth and Development Growth Morphological growth of organs and systems Quantitative change Development Differentiation and mature function of cells , organizations and organs Qualitative change Definition Continued process and segmental Unbalance development of systems and organs 抬头(抬头(3m3m) 独坐(独坐(6-8m6-8m) 扶站(扶站(9-11m9-11m)独走(独走(13-15m13-15m) 独坐持物(独坐持物(1212月月 ) 翻身(翻身(6-76-7个月)个月) 探身取物(探身取物(6 6个月个月 ) 单手持物(单手持物(9 9个月)个月) Influencing Factors Inheritance Sex Nutrition Disease PregnancyEnvironment Weight Total weight of all organs, systems and liquid in body Reflecting conditions of growth and nutrition Calculating the dose of drug and transfusion Weight of birth Boy : 3.3 0.4 kg Girl : 3.2 0.4 kg Normal weight loss Weight loss during the first 10 days (3 to 9 percent ) Two peaks From birth to 6 months 3m: 700 800g/m 46m: 500 600g/m 712m: 300 400g/m Adolescence 45 kg/y 23y Ages Weight(kg ) Increased weight( kg) 112y Ages28 3m6 12m9 24m12 Birth3 3/(03月) 1 3/(312月)2 33/(12岁) Growth on weight Pars Inferior (0.40) (上部量) (下部量) 12 years old Pars Superior = Pars Inferior Sitting Height Height from the top of head to hucklebone tuber Representing the development of skull and spine height 1 2cm Head Circumference At birth:3334cm 1 y:46 cm (the first 3m=latermcm) 2 y:48 cm 5 y:50 cm 15y:5458cm Chest Circumference At birth : 32cm head circumference 12cm 1y: Head Circumference y: Head Circumference Age Age CCCC(cmcm) comparing comparing with with HCHC(cmcm ) Chest circumference At birth 32 1y HC+(age-1) (age-1) CC= chest circumference, HC= head circumference Growth curve of CC and HCGrowth curve of CC and HC cmcm Upper Arm Circumference y : Reflecting childrens nutrition conditions 13.5cm:Fine 12.513.5cm:Medium 12.5cm:Malnutrition Proportion of Body Proportion of the head and height: infants(1/4)-adults (1/8) Weight by Stature (体形匀称) Weight-For-Height (身高的体重) Chest Circumference/Height (身高胸围指数) EMI/age (年龄的体块指数) Trunk-Leg Ration (身材匀称) Sitting Height/Standing Height . At birth:0.6714 years :0.53 Span and Standing Height 常用的统计学表示方法 +2SD-2SD均值离差法 P3rd P50th P97th百分位法 界值点的选择(界值点的选择(cut-off pointcut-off point) (1)均值离差法: 2SD (2)百分位法: P3rd P97th X 测量值的表示测量值的表示 (1 1)表格)表格 (2 2)生长曲线生长曲线 生 长 曲 线 评价结果表示 均值离差法: 百分位法: 等级法 三分法 下 (异常) 中 上 (异常) 五分法 下 (异常) 中下 中中上 上 (异常 ) p3rd p25th p50th p75th p97th -2SD -1SD 1SD 2SD X Growth and Development of Systems Closing of bone sutures Closing of bone sutures and and fontanelles AreaAt birthClosed age 1.52cm18m 0.5cm12m Palpable34m Bone gap Posterior Fontanelle Frontal Fontanelle Spinal developmentSpinal development AgeActivityMusclesSpinal curve 3m Lift head 颈后肌 颈曲 (颈部脊柱前凸) 6mSit腰肌 胸曲 (胸部脊柱后凸) 12mWalk下肢肌 腰曲 (腰部脊柱前凸) 78m : Primary Teeth appears 2y : Deciduous Teeth = moons age (46) It is unusual if no teeth at 1 year. 2.5y : Completed The first molar at 6y , the second at 12y, the third after 18y. Sensory and Perceptual, Behavioral Development Brain weightweight% Adult brain weight% Birth 350g10%12%25% 6m 600700g50% 12m60% 23y75% 45y80%90% Adult 1500g2%3% Development of brain function: Get closed to the adults level: 3yrs old Obtain adults full functions: 8yrs old Congenital unconditioned reflex 紧张性颈反射 握持反射爬行反射 踏步反射 拥抱反射 Summary Development of morphology is earlier than the function in the cerebral cortex; Lower excitement in cerebral cortex and higher in subcortical center ; Unconditioned reflex; Incomplete myelinization of nerve fibers Sensory and Perceptual Development Ability of obtaining information from environment through sensor organs and is essential to other areas development. Newborns The best focus distance is 20cm.Eyes and heads are capable of following the focused objects. Distinction of size and shape is also possible. 听感知的发育 皮肤感觉的发育 Skin sensation Sense Perception Development Sense of Taste(味觉) At birth : Rather mature of taste 4 5 months: Key period of development Sense Perception Development Sense of Smell(嗅觉) v At birth: Looking for nipples when smelling milks taste v 3 4m: Differentiation odor v 7 8m: Response to sweet-smell Sense Perception Development Tactile Sensation (触觉) Newborns are very sensitive in multiple areas 23y Distinct property 56y Distinct objects of different size and weight Sense of pain Newborns are not sensitive to the pain because of incomplete myelinization of nerve fibers which will be improved after 2 months. Motor Development Lift head 2m Lift head 3m Stable 4m Very stable, freely rotation Roll over 12m 侧卧至 仰卧 45月 仰卧至 侧卧 68月 仰卧至 俯卧 12mNewborn 68m Walk、Run、Jump 6月 扶站 912月 扶物走 1岁 独走几步 1.52岁 跑 2岁 双足跳 34.5岁 独足跳 大运动发育 二抬 lifts head 十站 stands alone 四翻 rolls over 周岁走 walks alone 六坐 sits 二岁跑 runs well 八爬 creeps 三岁独足跳 hops Fine Motor Development 三玩手 plays hands 一岁乱画 scribbles 五抓 grasps object 二岁折纸 folds paper 七换手passes object 三岁搭桥 builds bridge 九月对指 picks up with thumb-index finger Speech and Language Development Conditions of lingual development Hearing CNS Pronouncing organs | | | Acceptance Understanding and expression pronunciation Advanced conditions:Adequate language Environmental irritation 16m Pronounce single syllable 711m Pronounce repeated syllables 1013m Say:“mom” 13y Say vocabularies, simple sentences and sing short songs 45y Say compound sentences and sing nursery rhyme 724m lingual interpret 23y lingual expression Suspicious delayed 14m problems with single word 24m problems of combining 2 words 30m difficulties of speaking simple sentences Screening standard 24m Vocabulary 3 years old: unconscious imagination preschool period: conscious and creative imagination Objective expressions and subjective reflections to scenes or sense Positive mood Negative mood Experiences of the relation between humans and objects on the basis of mood Emotion of trust, safety, friends

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