Pediatrics (also spelledpaediatrics or pædiatrics) is the branch of medicine that deals with the medical care of infants, children, and adolescents, and the age limit usually ranges from birth up to 18 years of age (in a few places until completion of secondary education, and until age 21 in the United States). A medical practitioner who specialises in this area is known as a pediatrician, or paediatrician. The word paediatrics and its cognates mean "healer of children"; they derive from two Greek words: παῖς (pais "child") and ἰατρός (iatros "doctor, healer"). Pediatricians work both in hospitals, particularly those working in its specialised subfields such as neonatology, and as primary care physicians who specialise in children.
Pediatrics is known as a new modern medicine in the society today. Hippocrates, Aristotle, Celsus, Soranus, and Galen, understood the differences in growing and maturing organisms that necessitated different treatment: Ex toto non sic pueri ut viri curari debent ( "In general, boys shouldn't be treated in the same way as men."Celsus).
Some of the oldest traces of paediatrics can be discovered in Ancient India where children's doctors were called kumara bhrtya. Sushruta Samhita an ayurvedic text, composed throughout the sixth century BC contains the text about pediatrics. An Additional ayurvedic text from this period is Kashyapa Samhita.
A second century AD manuscript by the Greek physician and gynaecologist Soranus of Ephesus dealt with neonatal pediatrics. Byzantine physicians Oribasius, Aëtius of Amida, Alexander Trallianus, and Paulus Aegineta contributed to the field. The Byzantines additionally built brephotrophia (crêches). Islamic writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own, especially Haly Abbas, Serapion, Avicenna, and Averroes. The Persian scholar and doctor al-Razi (865–925) published a short treatise on diseases among children. The first book about paediatrics was Libellus [Opusculum] de aegritudinibus et remediis infantium 1472 ("Little Book on Children Diseases and Treatment"), by the Italian paediatrician Paolo Bagellardo. In sequence came Bartholomäus Metlinger's Ein Regiment der Jungerkinder 1473, Cornelius Roelans (1450-1525) no title Buchlein, or Latin compendium, 1483, and Heinrich von Louffenburg (1391-1460) Versehung des Leibs written in 1429 (published 1491), together form the Pediatric Incunabula, four great medical treatises on children's physiology and pathology.
The Swedish physician Nils Rosén von Rosenstein (1706–1773) is considered to be the founder of modern paediatrics as a medical specialty, while his work The diseases of children, and their remedies (1764) is considered to be "the first modern textbook on the subject". Pediatrics as a specialised field of medicine continued to develop in the mid-19th century; Abraham Jacobi (1830–1919) is known as the father of paediatrics in the USA because of his a large number of contributions to the field. He was born in Germany, where he received his medical training, but later practised in New York City.
The first generally accepted paediatric hospital is the Hôpital des Enfants Malades (French: Hospital for Sick Children), which opened in Paris in June 1802 on the site of a previous orphanage. From its beginning, this famous hospital accepted patients up to the age of fifteen years, and it continues to this day as the paediatric division of the Necker-Enfants Malades Hospital, created in 1920 by merging with the physically contiguous Necker Hospital, founded in 1778.
In additional European countries, the Charité (a hospital founded in 1710) in Berlin established a separate Pediatric Pavilion in 1830, followed by similar institutions at Sankt Petersburg in 1834, and at Vienna and Breslau (now Wrocław), both in 1837. In 1852 Britain's first paediatric hospital, the Hospital for Sick Children, Great Ormond Streets. The first Children's hospital in Scotland opened in 1860 in Edinburgh. In the US, the first similar institutions were the Children's Hospital of Philadelphia, which opened in 1855, and then Boston Children's Hospital (1869).
Differences between adult and paediatric medicine
The body size differences are paralleled by maturation 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 paediatricians than they often are to adult physicians. A common adage is that children aren't simply "little adults". The clinician must take into account the immature physiology of the infant or child when considering symptoms, prescribing medications, and diagnosing illnesses.
A major difference between the practise of paediatric and adult medicine is that children, in most jurisdictions and with certain exceptions, can't make decisions for themselves. The issues of guardianship, privacy, legal responsibility and informed consent must always be considered in every paediatric procedure. 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. The concept of legal consent combined with the non-legal consent (assent) of the child when considering treatment options, especially in the face of conditions with poor prognosis or complicated and painful procedures/surgeries, means the paediatrician must take in to account the desires of a large number of people, not just the patient.
Training of pediatricians
The training of paediatricians varies considerably across the world. Depending on jurisdiction and university, a medical degree course might 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 US), 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 licenced or registered under the laws of that particular country, and at times of several countries, subject to requirements for "internship" or "conditional registration".
Pediatricians must undertake further training in their chosen field. This might take from four to eleven or more years, (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 the United States, a medical school graduate wishing to specialise in paediatrics must undergo a three-year residency composed of outpatient, inpatient, surgical, and critical care rotations. Specialties within paediatrics require further training in the form of 2-3 year fellowships. Specialties include critical care, gastroenterology, neurology, infectious disease, hematology/oncology, rheumatology, pulmonology, child abuse, emergency medicine, endocrinology, neonatology, and others.
In most jurisdictions, entry-level degrees are common to all branches of the medical profession, but in a few jurisdictions, specialisation in paediatrics might begin before completion of this degree. In a few jurisdictions, paediatric training is begun immediately following completion of entry-level training. In additional jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing paediatric (or any other) specialization. Specialist training is often largely under the control of pediatric organizations (see below) rather than universities,and depending on jurisdiction.
Subspecialties of paediatrics include:
- Adolescent medicine
- Child abuse pediatrics
- Developmental-behavioral pediatrics
- Pediatric allergy and immunology
- Pediatric cardiology
- Pediatric critical care
- Pediatric emergency medicine
- Pediatric endocrinology
- Pediatric gastroenterology
- Pediatric hematology
- Pediatric infectious disease
- Pediatric nephrology
- Pediatric neuropsychology
- Pediatric oncology
- Pediatric pulmonology
- Pediatric rheumatology
- Social pediatrics
- Sports medicine
Other specialties that care for children include:
- Child neurology, a specialty in its own right
- Child psychiatry, subspecialty of psychiatry
- Pediatric dermatology, subspecialty of dermatology
- Pediatric ophthalmology, subspecialty of ophthalmology
- Pediatric rehabilitation medicine, subspecialty of physical medicine and rehabilitation
- Pediatric surgery, subspecialty of surgery