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Pediatrics

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This article is about the branch of medicine. For the journal of the American Academy of Pediatrics, see Pediatrics (journal).
Clinical Examination

Pediatrics (also spelled paediatrics) is the branch of medicine that deals with the medical care of infants, children, and adolescents. The upper age limit ranges from age 14 to 21, depending on the country.

A medical practitioner who specializes in this area is thus known as a pediatrician (also spelled paediatrician).

The word pediatrics and its cognates mean healer of children; they derive from two Greek words: παῖς (pais = child) and ιατρός (iatros = doctor or healer).

Pediatric polysomnography patient
Children's Hospital (Saint Louis), 2006

Differences between adult and pediatric medicine

Pediatrics differs from adult medicine in many respects. The obvious body size differences are paralleled by maturational changes. The smaller body of an infant or neonate 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.

Many inherited diseases are more often treated by pediatricians than by adult physicians because only recently did the majority of these patients survive into adulthood. Well-known example are the thalassemias, sickle cell anemia and cystic fibrosis. Issues revolving around infectious diseases and immunizations are also dealt with primarily by pediatricians.

Childhood is the period of greatest growth, development and maturation of the various organ systems in the body. Years of training and experience (above and beyond basic medical training) goes into recognizing the difference between normal variants and what is actually pathological.

Treating a child is not like treating a miniature adult. A major difference between pediatrics and adult medicine is that children are minors and, in most jurisdictions, cannot make decisions for themselves. The issues of guardianship, privacy, legal responsibility and informed consent must always be considered in every pediatric procedure. In a sense, 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 only, though this is in legal flux and varies by region.

Training of pediatricians

The training of pediatricians varies considerably across the world.

Main articles: Medical education and Physician

Like other medical practitioners, pediatricians begin their training with an entry-level medical education: a tertiary-level course, undertaken at a medical school attached to a university. Such a course leads to a medical degree.

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. Entrants to graduate-entry courses (as in the USA), 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" or "conditional registration".

Within the United States, the term physician also describes holders of the Doctor of Osteopathic medicine (D.O.) degree. However, outside the United States, osteopaths are not physicians who practice medicine. For further information on osteopathic medicine, see the entry on Comparison of allopathic and osteopathic medicine.

Pediatricians must undertake further training in their chosen field. This may take from three to six or more weeks, depending on jurisdiction and the degree of specialization. The post-graduate training for a primary care physician, including primary care pediatricians, is generally not as lengthy as for a hospital-based medical specialist.

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 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, with varying degrees of government input, depending on jurisdiction.

"Pediatrician" versus "Paediatrician"

There is a slight semantic difference associated with the difference in spelling. In the USA, a pediatrician (US spelling) is a specialist physician, but one who generally functions in a primary care setting for children. A similar situation exists in Germany: a kinderarzt is commonly a primary care pediatrician.

In the Commonwealth and in much of the rest of the world, a paediatrician (British spelling) does not normally see patients in primary general practice: he or she sees patients who are either urgently admitted to a hospital or who are referred by general practitioners, who see the bulk of primary care patients. A paediatrician in this sense could fairly be described as an internist who has subspecialized in infants & children, and who has usually had longer post-graduate training in child health than a primary care pediatrician.

Subspecialists in pediatrics

Specialist pediatricians may undergo further training in sub-specialties. Practising a subspecialty in pediatrics is similar in some respects to practising the relevant adult specialty, but a major difference is in the pattern of disease. Typically, diseases commonly seen in children are rare in adults (eg bronchiolitis, rotavirus infection), and those seen in adults are rare in children (eg coronary artery disease, deep vein thrombosis). Hence, pediatric cardiologists deal with the heart conditions of children, particularly congenital heart defects, and pediatric oncologists most often treat types of cancer that are relatively common in children (eg certain leukemias, lymphomas and sarcomas), but which are rarely seen in adults. Every subspecialty of adult medicine exists in pediatrics (with the obvious exception of geriatrics).

Adolescent medicine is a growing sub-specialty. The pattern of diseases in adolescents in part resembles that seen in older adults, and specialists or sub-specialists in adolescent medicine are also drawn from practitioners of internal medicine or family medicine. Another major sub-specialty, which is unique to pediatrics, is neonatology: the medical care of newborn babies.

Pediatric organizations

Most pediatricians are members of a national body. Examples are the American Academy of Pediatrics, the Canadian Paediatric Society, the Royal College Of Paediatrics and Child Health, Norsk barnelegeforening (The Norwegian society of pediatricians) or the Indian Academy of Pediatrics. In Australia and New Zealand, paediatricians are fellows of the Royal Australasian College of Physicians, which covers both nations and which has adult & paediatric sections. This was the situation in the UK until the late 1990s, where specialist paediatricians were Members or Fellows of either the Royal College of Physicians or of the fraternal colleges in Scotland. In 1996, British paediatricians were granted a royal charter to form their own college, the Royal College of Paediatrics and Child Health.

Social role of pediatricians

Like other physicians, pediatricians are traditionally considered to be members of a learned profession, because of the extensive training requirements, and also because of the occupation's special ethical and legal duties.

Pediatricians commonly enjoy high social status, often combined with expectations of a high and stable income and job security. However, medical practitioners in general often work long and inflexible hours, with shifts at unsociable times, and may earn less than other professionals whose education is of comparable length. Neonatologists or general pediatricians in hospital practice are often on call at unsociable times for perinatal problems in particular — such as for Caesarean section or other high risk births, and for the care of ill newborn infants.

The U.S. Bureau of Labor Statistics estimates that general pediatricians earned an average of $141,440 in 2006.

In August 2000, a paediatrician in Wales had her car vandalised by 'vigilantes', believing her to be a paedophile.[1]

See also

Educational video

Dr. Jessica Mitchell ND discusses Pediatrics and Naturopathy in her practice

Click the link above to watch a full tv show on Naturopathic Pediatrics. Dr. Jessica Mitchell is a Naturopathic Pediatrician practicing in Scottsdale, Arizona. Dr. Mitchell answers frequently asked questions and discusses Pediatrics live on Internet tv.

References

  1. ^ Doctor driven out of home by vigilantes | UK news | The Guardian

Further reading

Wikimedia Commons has media related to Pediatrics.
Wikibooks has a book on the topic of: Pediatrics
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