陈德晖2016儿科绪论医本

1、PEDIATRICS Chen Chen DehuiDehui(1030412)(1030412) Pediatric Department Pediatric Department The first Affiliated Hospital of The first Affiliated Hospital of Guangzhou Medical UniversityGuangzhou Medical University OVERVIEW CHAPTER 1 The Scope of Pediatrics Pediatrics is concerned with the health of

2、 infants, children, and adolescents; their growth and development; and their opportunity to achieve full potential as adults. It is the science and art of prevention, diagnosis, and treatment of the diseases of children from birth through adolescence, whether these disturbances be physical, mental,

3、or emotional. 儿科学是一门关于从出生到青春期儿童疾病预防、诊 断与治疗的科学和艺术，这些儿童期的疾病可以是肉 体的，也可以是精神方面的。 The Scope of Pediatrics The most characteristic feature of pediatrics is that it deals with the growth and development of the child, comprising all those changes in size and form and in complexity of function that constitute

4、 growing up. 儿科学最主要的特征是要研究儿童的生长发育，儿科学最主要的特征是要研究儿童的生长发育， 儿童的生长发育造成了其形体方面的变化，也儿童的生长发育造成了其形体方面的变化，也 是其功能复杂性的基础。是其功能复杂性的基础。 Subspecialty of Pediatrics Subgrouped by the emphasis of health care： Developmental Pediatrics （发育儿科学）（发育儿科学） Preventive Pediatrics（预防儿科学）（预防儿科学） Clinical Pediatrics（临床儿科学）（临床儿科学）

5、Rehabilitation in Pediatrics（儿童康复医学）（儿童康复医学）, etc Subgrouped by age： Perinatology（围生医学）（围生医学） Neonatology（新生儿学）（新生儿学） Adolescence Medicine（青春医学）（青春医学）, etc The Goal Of Pediatrics To be certain of the health of children. To promote the life quality of children. Difference between Child and Adult A ch

6、ild is in continuous growth and development. “A CHILD IS NOT A LITTLE MAN” Functions of various organ systems 各系统功能差异各系统功能差异 Degree of immunity to disease 机体免疫反应程度机体免疫反应程度 Response to the effects of disease 对疾病的应激反应对疾病的应激反应 Dosage of drugs and tolerance to drugs 对药物剂量及对药物剂量及 耐受性耐受性 Mental and motor

7、ability 精神运动的能力精神运动的能力 Patten of emotional response 心理反应心理反应 Disparity in Occurrence and Progression of Disease between Children and Adult Disparity in anatomy, physiology, and immunologic function between children and adult The younger, the more different Disparity in occurrence and progression of

8、disease between children and adult Disparity in spectrum of disease 不同的疾病谱不同的疾病谱 Congenital anomalies、inborn errors of metabolism (more common in children) 先天畸形、先天代谢性疾先天畸形、先天代谢性疾 病多见病多见 Newborns and infants is vulnerable to infection 新生儿、婴儿易发生感染新生儿、婴儿易发生感染 Sinusitis is rare in infancy 鼻窦炎在婴儿相对少见鼻窦炎在

9、婴儿相对少见 Infants and young children are vulnerable to obstruction in respiratory tract 婴幼儿易发生气道阻婴幼儿易发生气道阻 塞塞 Disparity in Occurrence and Progression of Disease between Children and Adult Disparity in type of disease Pneumonia Children: bronchial pneumonia 支气管肺泡炎症支气管肺泡炎症 Adult: lobar pneumonia 大叶性肺炎大叶性

10、肺炎 Vit D Deficiency Children: rickets(佝偻病佝偻病) Adult: malacosteon(骨软化骨软化) Disparity in occurrence and progression of disease between children and adult Disparity in manifestation of disease Disparity in occurrence and progression of disease between children and adult Stages Of A Child By Age Embryo p

11、eriod（胚胎期）（胚胎期）: the first 8 weeks of gestation, the formation of tissues and organs 怀孕8周 Fetus period: from the 9th week of gestation to the delivery of the neonatal infant, the growth and development of the fetus 第9周分娩出生 pFetus（胎儿期）（胎儿期）: from conception to the birth of the neonate, 40 weeks.从受精卵形

12、从受精卵形 成成出生为止，出生为止，40周。周。 Early neonates: Early neonates: the first week after birth PerinatalPerinatal period period（围产期）（围产期）: : from the 28th weeks of gestation to the 7th day of the neonate after birth. pNeonates（新生儿期）（新生儿期）: from delivery and cutting off the umbilical cord of the newborn to the

13、28th day after birth 从胎儿娩出脐带结扎从胎儿娩出脐带结扎 时开始时开始28天天 Birth injury, apnea, infections, hemorrhage, hyperbilirubinemia, etc are common medical problems in this stage. Carefully taking care of the neonatal infant is of great importance. pInfantsInfants（婴儿期）（婴儿期）: : the 1 the 1st st year after birth year

14、after birth Infectious diseases, Infectious diseases, malnutrition, malnutrition, and indigestion and indigestion are common in this are common in this period period 感染、营养不良、消感染、营养不良、消 化不良多见化不良多见 Health Health care: care: Proper feeding Proper feeding 合理喂养合理喂养 Vaccination Vaccination in in time time

15、 按时预防接种按时预防接种 pYoung child (toddlers age，幼儿期，幼儿期): from 1 year old to 3 years old Begin to walk, quick linguistic and intelligence development, strong curiosity 学习行走，语言、动作、思维发育迅速，强烈学习行走，语言、动作、思维发育迅速，强烈 的好奇心的好奇心 Health care: Prevention of accidents and infectious diseases 防意外、感染防意外、感染 Proper nutritio

16、n 合理营养合理营养 pPreschool（学龄前期）（学龄前期）: from 3 years old to 67 years old Growth rate slows down but language and emotion, as indicators for intelligence, continue to develop quickly. Health care: Encouraging good behavior Suitable timing to begin early education Disease prevention: rheumatic fever, acute

17、 glomerulonephritis, etc. pSchool age（学龄期）（学龄期）: aged 67 to pre- adolescence System and organs development have been almost reached to the level of adults (except for sexual organs). Self-esteem plays very important role in the psychological development. Health care: Encouraging good attitude and ha

18、bits for study and behaviors. Prevention of nearsightedness（近 视）, decayed teeth（ 龋齿）, etc. pAdolescence (early youth，青春期，青春期): from 10 yrs old to 20 yrs old. The adolescence of a girl may begin and end about 2 yrs earlier than that of a boy. 女孩青春期 的开始与结束时间均比男孩的早2年左右。 Children in this period undergo

19、rapid changes in body size, shape, physiology, and psychological and social functioning. The second peak of physical growth rate after birth Health care: nutrition, exercises and normal psychological development. DEVELOPMENT AND FUTURE OF CHILDREN v18yr in total population developed countries 22.4%

20、developing countries 35.7% china 30% ( UNCF 1999 ) vv 18yr 400 million( china) Infant Mortality in China and Developed Country 1949199920002003 City15%1.18%0.55% Rural area20%3.7% Developed Countries 0.40.7% year area Mortality of Children under Age 5 in China and Developed Country 1949199920002003

21、city2.1%1.4 % 0.7% Rural area7.1%4.6 % Developed Countries 0.40.8% year area The Change of Mortality of Children in China Mortality Comparison of China with Other Countries Children account for a high percentage in the total population. In our country, the health care of children has been in great p

22、rogression. Analysis of Death under Age 5 in China（2000） Death 5 yrs: 93% in rural Infant death: accounting to 80 newborn death 65 of total infant death Leading death cause: Pneumonia（肺炎）、asphyxia（窒息）、 prematurity（早产儿）、diarrhea（腹泻）、 congenital anomalies（先天畸形） The World Summit for Children in 1990 he

23、 World Declaration on the Survival, Protection and Development of Children in the 1990s Plan of Action for Implementing of the declaration “（2011201120202020）中国）中国儿童发展儿童发展纲要纲要” The Children Are Often Among the Most Vulnerable or Disadvant-aged in Society and Their Needs Require Special Attention. Pr

24、inciples and Objectives A World Fit For Children- 2002 Put children first Eradicate poverty Leave no child behind Care for every child Educate every child Protect children from harm and exploitation Protect children from war Combat HIV/AIDS Listen to children and ensure their participation Protect t

25、he Earth for children Control of infective disease Focus on psycho-behavior problem Management of Accidence and injury Prevention and treatment of congenital anomalies Preventive measures in childhood for adult disease Tasks of pediatrician in 21 Century References: References: KEY POINTS IN THIS CH

26、APTER Characteristic features of pediatrics Stage of children by age Question An infant can move his head from side to side while following a moving object, can lift his head from a prone position 45 degrees off the examining table, smile when encouraged, and makes cooing sounds. He cannot maintain

27、a seated position. The most likely age of the infant is a.1 month b.3 months c.6 months d.9 months e.12 months Thank You for Your Attention!Thank You for Your Attention! PEDIATRICS Chen Chen DehuiDehui(1030412)(1030412) Pediatric Department Pediatric Department The first Affiliated Hospital of The f

28、irst Affiliated Hospital of Guangzhou Medical UniversityGuangzhou Medical University GROWTH AND DEVELOPMENT CHAPTER 2 Assessment indicators for growth and development as well as their measure-ments Key motors indicating for ages of infant development KEY POINTS IN THIS CHAPTER Growth And Development

29、 Growth The changes of form and increases in size of the body and organs of a child 儿童各器官、系统的长大 Development Maturation of cells, tissues and organs 组织、器官、功能的分化成熟 Patterns of Growth and Development Growth and development is a continuous and staged process Different rate of development in various syst

30、ems Individual variation in growth and development Growth and development show Cephalocaudal pattern Factors Influencing Growth And Development Genetics 基因遗传基因遗传 Nutrition 营养状况营养状况 Health status during pregnancy 母体怀孕时母体怀孕时 的健康状况的健康状况 Living environments 生活环境生活环境 Effects of diseases 疾病影响疾病影响 Indicato

31、rs For Assessment of Growth And Development Body Weight 体重体重 Height 身高身高 Sitting Height 坐高坐高 Head Circumference 头围头围 Chest Circumferenc 胸围胸围 Upper Arm Circumference 上臂围上臂围 Subcutaneous Fat 皮下脂肪皮下脂肪 Body Weight Body Weight A sensitive indicator for growth and nutritional status 评估生长及营养状况评估生长及营养状况 An

32、important variable for calculation of drug dosage, energy and fluid supplement 用于计算儿童用药剂量、能量及液体治疗用于计算儿童用药剂量、能量及液体治疗 Examination Baby balance for infants (accuracy in 50g），）， weighing scale for children（accuracy in 100g） 婴儿测体重精确：婴儿测体重精确：50g；儿童儿童:100g Infants and children should be weighed without the

33、ir clothes on. 需要去掉衣服的重量需要去掉衣服的重量 Normal Weight Gain AgeAge Normal BW Normal BW（kgkg） NewbornNewbornMaleMale3.33.30.40.4 FemaleFemale3.23.20.40.4 3 34months 4months Double body weight Double body weight after birth after birth of birthof birth 1 year old1 year old1010 2 year old2 year old1212 Averag

34、e body weight for children of 1Average body weight for children of 112 old12 old： BWBW（kgkg） Age(years)Age(years) 2 28 8 Physical Weight Loss A newborns weight may decrease 10% below birthweight in the 1st week as a result of excretion of excess extravascular fluid and possibly poor intake. 生生 后后1周生

35、理性体重下降，水分丢失、胎粪排出、摄入不足周生理性体重下降，水分丢失、胎粪排出、摄入不足 有有 关，下降约关，下降约3%9% Intake improves as colostrum is replaced by high-fat milk and the amount of milk infant suck increase, Infant should regain or exceed birthweight by 710 days of age and should grow at approximately 30g/day. 及时喂养，生后及时喂养，生后710天体重恢复出生时体重，后体

36、重增长约天体重恢复出生时体重，后体重增长约 30g/天天 Height The length from the top of the head to the planta pedis 测量方法：头顶测量方法：头顶平足底部平足底部 An parameter for body growth and growth velocity, an assessment for skeleton growth 评估儿童生长、生长速度骨骼生长评估儿童生长、生长速度骨骼生长 Measurement 3 years old Measuring in recumbent position (Body length)

37、3岁以下卧位测量岁以下卧位测量 3 years old Measuring in standing position（Height) Body Length Scale Body Length Scale Normal Height Gain Age Normal Height （cm） Gaining Height(Length) by Age Newborn503 months after birth 11 13cm are increased and 1213cm during the following 9 months, so in the 1st year the height w

38、ill increase 25cm.1012cm in the 2nd year. From age 2 10, 57cm/year will be gained. 1 year old75 2 years old85 Some Concepts About Height Setting Height（坐高）：（坐高）：The length from the top of head to ischial tuberosity which means the length of the head and spinal column 头顶部头顶部坐骨结节的距离坐骨结节的距离 Upper Lengt

39、h（上部量）（上部量）：The length from the top of head to the upper edge of symphysis pubis 头顶部头顶部 耻骨联合上缘的距离，评估耻骨联合上缘的距离，评估扁骨扁骨的生长的生长 Lower Length（下部量）：（下部量）：The length from the upper edge of symphysis pubis to dorsal decubitus.耻骨联耻骨联 合上缘合上缘脚底，评估长骨脚底，评估长骨的生长。的生长。 Upper Length & Lower Length 新生儿的上部量占身长的新生儿的上部量占

40、身长的60%，下部量占身长的，下部量占身长的40%，12 岁以前各年龄期有一定的岁以前各年龄期有一定的比例。比例。 对矮小症患儿，除对矮小症患儿，除测量身长外，尚需测量测量身长外，尚需测量上、下部上、下部量，如量，如 下部量过短表示长骨发育障碍，见于下部量过短表示长骨发育障碍，见于克汀病（甲状腺功能克汀病（甲状腺功能 低下）及软骨营养障碍。低下）及软骨营养障碍。 Head/Head/ Trunk+legTrunk+leg Upper length in Upper length in body lengthbody length MidpointMidpoint Lower length in

41、 Lower length in body lengthbody length Newborn1/460%Above navel40% Age 2Below navel Age 6 Between navel and the upper edge of symphysis pubis Age 12 50% the upper edge of symphysis pubis 50% Adult1/8Lower lengthUpper length Head Circumference & Chest Circumference Head Circumference（头围）：（头围）：Indica

42、tor for growth and development of brain and cranium 评估脑与颅骨的发育。出生时约评估脑与颅骨的发育。出生时约3334cm，1岁时岁时 46cm，2岁时岁时48cm。 Chest Circumference（胸围）（胸围）： Indicator for growth and development of thorax and lung. 评估肺与胸廓的生长。出生胸围约评估肺与胸廓的生长。出生胸围约32cm，1岁时岁时 约等于头围。约等于头围。1岁岁青春前期胸围青春前期胸围=头围头围+年龄年龄-1cm Head Circumference Mea

43、surement Measuring the grea-test occipitofrontal circumference 眉弓上缘、枕骨结节环绕一周的长度眉弓上缘、枕骨结节环绕一周的长度 Reflecting the volume of intracranial con-tents as well as the thickness of the skull and scalp Chest Circumference Examination Measuring the thoracic circle around nipples and inferior angle of scapula a

44、nd taking the average value between inspiration and expiration 平乳头下缘经肩胛骨下缘平绕胸一周平乳头下缘经肩胛骨下缘平绕胸一周 Normal Values of Head Circumference & Chest Circumference HCCC Newborn323432 12 1 year old4646 0 1 year later48（age 2） HC+（age-1） （age-1） qHC: During the 1st 3 months of life HC will increase about 6cm wh

45、ich will the amount of increase during the following 9. HC grows about 67cm from age 2 to 15. Growth Curve of Head Circumference & Chest Circumference （cm） 年龄 Age HCCC Assessment of Growth ASSESSMENT OF GROWTH 均值（Mean）标准差Standard（SD） 正常分布 1SD +2SD +3SD 68.3% 95.4% 99.7% ASSESSMENT OF GROWTH 百分位数 （Pe

46、rcentile） P3P97 95% 表格与生长曲线 （Growth chart） 多参数指标 年龄别体重年龄别体重 （Weight for age） 年龄别身高年龄别身高 （Height for age） 体重别身高体重别身高 （Weight for height） Developments of Skeleton and Teeth Cranial Bones The mature of cranial bones（颅骨）（颅骨） can be reflected by: Head circumference 头围头围 Fontanel 囟门囟门 Closing of suture 骨缝

47、闭合骨缝闭合 Bone, Fontanels, Sutures Of Cranial Frontal bone Occipital bone Parietal bone Normal Fusion of Cranial Bones Posterior fontanel（后囟门）（后囟门）: 68wks after birth 出生时很小或已闭合，出生时很小或已闭合，68周闭合周闭合 Sutures of cranial bones（颅骨缝）（颅骨缝）: 34 months after birth Anterior fontanel（前囟门）（前囟门）: 12 cm in newborn, Th

48、e anterior fontanel usually tends to enlarge during the first few months of life, lessen after 6 months old. It closes completely in 11.5 years old. 出生时出生时12cm， 11.5岁闭合岁闭合 Spinal Column 正常情况正常情况 During the first year of life, spinal grow up faster than extremities. Later on, the situation is reverse

49、d. 新生儿的脊柱弯曲不新生儿的脊柱弯曲不 明显，呈轻度后凸，明显，呈轻度后凸，3 3 个月的婴儿能抬头时出个月的婴儿能抬头时出 现凸向前的颈曲，现凸向前的颈曲，6 6个个 月后会坐时，出现凸向月后会坐时，出现凸向 后的胸曲，后的胸曲，1 1岁开始走岁开始走 路时，出现凸向前的腰路时，出现凸向前的腰 曲。曲。 Ossification Center 骨化中心骨化中心 The appearance of ossification center (endochondral ossification ) is one of the marks for skeletal. 长骨的生长主要由长骨干骺端的

50、软骨骨化，骨膜下成长骨的生长主要由长骨干骺端的软骨骨化，骨膜下成 骨，使长骨长长、增粗，当骨骺与骨干融合时，标志骨，使长骨长长、增粗，当骨骺与骨干融合时，标志 长骨停止生长。长骨停止生长。 骨化中心的出现评估长骨的生长成熟程度。骨化中心的出现评估长骨的生长成熟程度。 Bone Age 骨龄骨龄 Bone age is the measurement of skeletal matura-tion. A radiograph of the left hand and wrist is obtained and compared with the published standards of Gr

51、eulich and Pyle. Knee films are sometimes added for younger children. 用用X线检查测定不同年龄儿童长骨干骺端骨化中线检查测定不同年龄儿童长骨干骺端骨化中 心的出现时间、数目、形态的变化，并标准化，心的出现时间、数目、形态的变化，并标准化， 为骨龄。为骨龄。 Bone Age 骨龄骨龄 Reference standards for bone maturation facilitate estimation of bone age. 骨龄反映长骨的生长成熟程度骨龄反映长骨的生长成熟程度 The bone age is low

52、and is comparable to the height age: Constitutional growth delay, Endocrinologic short stature, Undernutrition. 骨龄延迟：生长发育迟缓，生长激素缺乏症，营养不骨龄延迟：生长发育迟缓，生长激素缺乏症，营养不 良等良等 The bone age is normal (compared to chronological age): Familial short stature. 骨龄正常：家族性身材矮小骨龄正常：家族性身材矮小 Development of Ossification Cen

53、ters 腕骨骨化中心的出现时间 年龄年龄骨化中心骨化中心 3M3M 头骨头骨、钩骨钩骨 1 1岁岁 下桡骨下桡骨 2 23 3岁岁 三角骨三角骨 3 3岁岁 月骨月骨 3.5 3.55 5岁岁 大大、小多角骨、小多角骨 5 56 6岁岁 舟舟状骨状骨 7 79 9岁岁 豆豆状骨状骨 骨龄骨龄测定在临床上有重要意义，骨龄落后见于生长激素缺乏症、测定在临床上有重要意义，骨龄落后见于生长激素缺乏症、 呆小病、肾小管酸中毒等；骨龄超前见于中枢性性早熟、先天性肾呆小病、肾小管酸中毒等；骨龄超前见于中枢性性早熟、先天性肾 上腺皮质增生症等。上腺皮质增生症等。 3 3月头、钩骨；月头、钩骨； 1 1岁下桡

54、骨（够）；岁下桡骨（够）； 加了加了2 2与与3 3（三角骨）（三角骨） 等约（月骨）多少？等约（月骨）多少？ 答案：大小多（骨）答案：大小多（骨） 3-53-5岁岁 周（舟）周（舟）5 5舟舟6 6下尺骨下尺骨 （6-76-7岁）；逗岁）；逗9 9豆豆1010 全都齐全都齐 Dentition Primary dentition（乳牙）（乳牙） Time of eruption of primary teeth: About 6 months (410 months) of age, all primary teeth should be erupted at 22.5 years old

55、Number of primary teeth: 20 in total Calculation of eruption of primary teeth: Number of primary teeth = Age(month) - 6 Time And Order of Dentition Dentition Permanent teeth Time of growing permanent teeth Beginning: at 67 years old Finish: at 2030 years old Number of permanent teeth: 2832 (depending on whether the wisdom tooth are erupted or not and how many they are erupted. NEURO-PSYCHOLOGI