《儿科学》（第4版）第1章 绪论

OverviewofPediatrics何晓琥XiaohuHe,MD.北京儿童医院BeijingChildren’sHospital儿科医学院PediatricMedicalCollege

首都医科大学CapitalMedicalUniversityScopeofPediatricsPediatricsisaspecialtyofmedicineconcerningwith:thehealthofinfants,children,andadolescentstheirgrowthanddevelopment

thepreventionandtreatmentoftheirdiseases

Missionof

PediatriciansAssumearesponsibilityforchildren’sphysical,mental,andemotionalprogress,Mustbeconcernedwithsocialandenvironmentalinfluences,whichhaveamajorimpactonthehealthandwellbeingofchildrenandtheirfamilies.Theyoungareoftenamongthemostvulnerableordisadvantagedinsocietyandthustheirneedsrequirespecialattention.

Taskin21’Century

infectivediseasepsycho-behaviorproblemaccidentalinjurycongenitalanomaliespreventionofadultdiseaseinchildhoodTheFieldofPediatricsDevelopmentalPediatricsPreventivePediatricsClinicalPediatrics

DevelopmentalPediatricsStudyon:

theregularityofphysicaland

psychologicaldevelopmentofawellchildandit’sinfluentialfactors,inordertopromotethenormalandtreattheabnormaldevelopment,toelaborategreatpotentialstophysicalandmentalhealthinchildren.PreventivePediatrics

Studyonpreventivestrategyofvariouskindofdiseases,including:

♦immunization

♦accidentprevention

♦healtheducation

♦screeningofinborndiseases.ClinicalPediatricsSubspecialtiesinPediatricsinclude:

♦pulmonology♦gastroenterology

♦cardiology♦hematology

♦neurology♦nephrology

♦endocrinology♦infectiousdisease

♦criticalcaremedicine

♦convalescencemedicine

and

♦neonatology♦perinatology

♦adolescentology.ClinicalPediatricsCoordinationwith:

sociology,pedagogy,psychology,nursingcare,epidemiologyandmedicalstatisticsCollaborationwith:

microbiology,genetics,embryology,nutrition,immunology,psychology,behavioralscience,etc.especiallygenomicdiagnosis,treatmentaswellasvaccine.

CharacteristicsinPediatrics

Differencesbetweenadultmedicine:Childrenandadolescenceareunderprogressiveincreasesingrowthanddevelopment.Therearedifferencesnotonlybetweenindividuals,butevenmoreprominentbetweenages.Theimmunesystemhasnotbeenwelldeveloped.CharacteristicsinPediatrics

Childrenarenottheminiatureofadults.Theyoungertheage,themorethedifferencebetweenadults.

AnatomyThechangeofproportionofheadandbodylengthwithageProgressiveincreasesofweight.height(length)andcircumferenceofheadandchest.Variationofskeletons,muscles,lymphatic,nervousandgenitalsystemswithage.Thesizeandlocationoforgansalsodifferentfromadults.

前囟、牙齿胃肠道蠕动较快消化酶缺乏肾脏重量、位置

Imagesfrom/ProcedureDetails.cfm?BR=4&Proc=19PediatricAnatomyNOTTOSCALEPediatricAnatomyImagesfrom/faculty/Michael.Gregory/files/Bio%20102/Bio%20102%20lectures/Motor%20Systems/infant_skull.jpgand/online/prodimg/49090.jpgNOTTOSCALEBiochemistry&Physiology

Immaturityofrenalfunction:easytodevelopwaterandelectrolytesdisturbances.WeakabsorptionofGItract:easytodevelopdiarrhea.Differentagewithdifferentnormalrangeofvalue:suchasHR,RR,BP,bloodcountsandvalueofhumoralimmunity.Theyoungertheage,themoretheneedofnutrition.

PediatricRespiratoryRates

Age

Rate(breathsperminute)

Infant(birth–1year)

30–60

Toddler(1–3years)

24–40

Preschooler(3–6years)

22–34

School-age(6–12years)

18–30Adolescent(12–18years)

12–16PediatricPulseRates

Age

Low

High

Infant(birth–1year)

100

160

Toddler(1–3years)

90

150Preschooler(3–6years)

80

140

School-age(6–12years)70120

Adolescent(12–18years)

60

100

Low-NormalPediatricSystolicBloodPressure

Age*

LowNormal

Infant(birth–1year)

greaterthan60*

Toddler(1–3years)

greaterthan70*

Preschooler(3–6years)

greaterthan75

School-age(6–12years)

greaterthan80

Adolescent(12-18years)

greaterthan90ImmunityNotwelldevelopedimmunesystem:easytoobtaininfectiousdiseases.VanishedacquiredIgGfrommotherandinsufficientsecretoryIgAat3-5monthsofage:easytoobtainrespiratoryandGIinfections.Theabilityofself-syntheticIgGreachedadultlevelatage6-7.PathologySamepathogenicfactorscauseddifferentdiseasesbetweenadultsandchildren:VitaminDinsufficiencycausedricketsininfants,butosteomalaciainadults.Pneumococcalinfectioncausedbronchopneumoniaininfants,butlobarpneumoniainolderchildrenandadults.DiseasePatternBigdifferencesbetweenchildrenandadults:Inborndiseasesandhyperbilirubinemia

more

commonin

newborn

andfebrileseizures

more

common

ininfants,but

muchless

in

adults.Leukemia

commonlyseeninchildren;pulmonary,nasal-pharyngealandesophagealcarcinomasmorecommonlyseen

in

adults.Congenitalheartdiseases

commonlyseen

in

children;coronaryheartdiseases

morecommon

in

adults.ClinicalManifestationCloseobservationisneeded,becausepatient’sconditionchangesrapidlyandfrequently:

Itiscommontodevelop

septicmeningitisinnewbornwith

septicemia,whichiseasytobemisdiagnosed

becauseof

lessclinicalmanifestations,onlypresentingwith

refusaltoeat

and

hypothermia.

DiagnosisChildrencannotcomplainactivelyanddescribesymptomscorrectly.Pediatricianshouldmakediagnosisaccordingtotheanalysesof

medicalhistorygivenbyparents,epidemicinformation,physicalexaminationandlaboratorydata.Ageisanimportantissue.Samesymptomfordifferentage,thediagnosisisdifferent,suchasseizures:Inearlynewborn,itshouldbeconsideredasbirthinjury,hypoxicischemicencephalopathy(HIE),intracranialhemorrhage.

Ininfant,itshouldbeconsideredasinfantiletetanyandfebrileseizures.Inolderchildren,itshouldbeconsideredasepilepsy.

TreatmentThedosageofmedicationvarieswithage.Sometreatmentisspecialforchildren.Forexample:Phototherapy(bluelight)andexchangetransfusionisonlyfortreatingneonatalincompatibilityhemolyticanemia.Fluidtherapyininfantwithwaterandelectrolytesdisturbanceshouldbequantitative,qualitativeandconfinedthespeedofinfusion.Nursingcareisalsoimportantinpediatrictreatment.

DiseaseOutcomeTheabilityoftissuerepairisexcellentinchildren.Ifthediseaseisdiagnosedintimeandtreatedappropriately,patientwillrecoversoonandwithlessresidue.Thediseaseconditioninneonatesandweakinfantoftenisworsenedquickly,ifmisdiagnosed,itiseasytocausesuddendeath.PreventionPreventionis

veryimportantinpediatrics.Hereditarydiseasescanbepreventedbyhereditaryconsultationandneonatalscreening,suchasPKU(苯丙酮酸尿症),congenitalhypothyroidism.Attentionstartstobepaidtothepreventionofadultdiseasessuchasatherosclerosis(动脉粥样硬化),hyperlipidemia(高脂血症),hypertension(高血压)anddiabetesmellitus(糖尿病),whichstartatchildhood.Psychologicalhealthinchildhoodshouldbetakencareoftopreventpsychologicalproblemsinadults.

AgebyPeriods(Stages)Sevenperiodsfetalperiod胎儿期neonatalperiod新生儿期infantperiod婴儿期

toddler’sage幼儿期

preschoolage学龄前期

schoolage学龄期

adolescence青春期FetalperiodDuration:fromfertilizationofovatobirth,altogether40weeks(embryonicweeks),whicharedividedontothreestages:

Firsttrimesterofpregnancy(妊娠早期):first12weeks.Duringthisstage,fertilizedovamotivateintouterusandcompleteformationoforgans.

Secondtrimesterofpregnancy(妊娠中期):fromweek13toweek28(16weeks).Allmajororgansdeveloprapidlyandbecomemature.

Thirdtrimesterofpregnancy(妊娠晚期):

fromweek29toweek40(12weeks).Fetalweightincreasesrapidly.NeonatalperiodDuration:

fromligationofumbilicalcordto28daysafterbirth.Itiswithininfantperiod.Highmorbidityandmortalityhappenduringthisperiod.Themortalityaccountsfor1/3~1/2ofinfantmortality,especiallyduringearlyneonatalperiod.Perinatalperiod(围生期):

from28weeksofembryonicageto7daysafterbirth,includinglatepregnantperiod,deliveryprocessandearlyneonatalperiod.Itisanimportantperiodofchildrenexperiencingremarkablechangeandlifethreats.

Infantperiod

Duration:fromligationofumbilicalcordafterdeliveryto1yearofage,whichincludesneonatalperiod.

Duringthefirstyearoflife,physicalgrowthanddevelopmentisrapid.

Higherneededdailytotal

caloriesandprotein,butpoorerdigestive

function:easytodevelopdigestiveandnutritionaldisturbance,aswellasrickets,anemia,malnutritionanddiarrhea.Vanishedimmuneantibodiesfrommotherandimmaturityofself

immunesystem:easytodevelopinfectiousdiseases.

Itisimportanttoencouragebreastfeeding,guiderationalnutritionandsupplycomplementaryfood,ExpandedProgrammedImmunization(EPI)andpreventinfection.

Toddler’sageDuration:

from

1to3yearofage

Thegrowthrateslows,cognitivedevelopment

increases.Starttowalkwhichincreasesaccesstointerestthings,butlackoftheabilitytoprotectthemselvesagainstinjury.Itisimportanttopreventinjuryandaccidentaswellasinfectiousdiseases.

PreschoolagePhysicalgrowthslowsfurther。Cognitivedevelopmentisbeingperfected,

cravingforknowledge,fullofcuriosity，raisingquestionsandimitativeThemostdramaticdevelopmentsarelinguistic,whichallowsthemtoexpressfeelingsandemotion.

Duration:

from3~6yearsofage÷

PreschoolagePhysicalgrowthslowsfurther。Cognitivedevelopmentisbeingperfected,

cravingforknowledge,fullofcuriosity，raisingquestionsandimitativeThemostdramaticdevelopmentsarelinguistic,whichallowsthemtoexpressfeelings&emotion.Itisimportanttoprovideenoughnutrition,preventaccidentanddiseasesaswellastrainagoodhabit.

Duration:

from3~6yearsofageSchoolageDuration:

from6to10~12yearsofage

The

appearanceofmostorgansisclosetoadult’s,butsexualorgansremainphysicalimmature.Cognitivedevelopmentmaturatesfurtherandisreadytolearnscientificandculturalknowledge.Itisimportanttopreventmyopia,dentalcariesaswellasproblemsinpsycology,behaviorandemotion.AdolescenceDuration：Girls:f