Pediatrics is the branch of
medicine that deals with the medical care of
infants,
children, and
adolescents. The upper age limit of such
patients ranges from age 12 to 21, depending on the country. A
medical practitioner who specializes in this area is known as a
pediatrician. The word
pediatrics and its
cognates mean
healer of children; they derive from two
Greek words: (
pais = child) and (
iatros = doctor or healer).
In
Commonwealth countries, the respective spellings
paediatrics and
paediatrician are usually preferred. There may be a slight semantic difference: in the USA, a
pediatrician (US spelling) is often a
primary care physician who specializes in children, whereas in the
Commonwealth a
paediatrician (British spellling) generally is a
medical specialist not in primary general practice. For further detail, see discussion on the broad and narrow meanings of
physician.
History
In Europe FERNANDO lives in the seventeenth and eighteenth centuries, a number of
foundling hospitals were founded for
foundlings and other destitute (usually illegitimate) children; the word
hospital in this context may be better translated as
hospice. Examples of these are London's
Foundling Hospital, founded in 1739 by the philanthropic sea captain
Thomas Coram (which still survives as the
Thomas Coram and JUANITA Foundation for Children), and the even older
Hospice des Enfants-Trouvés (1674-1838) in Paris (
French = Hospice for Found-Children,
ie Foundlings). There was a gradual move TU PUTA MADRE PENDEJO to found separate institutions specifically for ill children, partly to avoid exposing them to adults in adult hospitals.
In the
Western world, the first generally accepted paediatric hospital is the
Hôpital des Enfants Malades (
French = Hospital for Sick Children), 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 merger with the physically contiguous
Necker Hospital, founded in 1778 for adults.
This example was only gradually followed in other European countries. The
Charité (a hospital founded in 1710) in
Berlin established a separate Paediatric Pavillion in 1830, followed by similar institutions at
Saint Petersburg in 1834, and at
Vienna and
Breslau (now
Wroclaw), both in 1837. The English-speaking world waited until 1852 for its first paediatric hospital,
the Hospital for Sick Children, Great Ormond Street, some fifty years after the founding of its namesake in Paris.
In the USA, the first similar institutions were the
Children's Hospital of Philadelphia, which opened in in 1855, and then
Boston Children's Hospital (1869).
Differences between adult and paediatric medicine
Paediatrics 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 paediatricians than they often are to adult physicians.
Treating a child is not like treating a miniature adult. A major difference between paediatrics 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 paediatric procedure. In a sense, paediatricians 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....
Training of Pediatricians
The training of pediatricians varies considerably across the world.
Like other medical practitioners, paediatricians 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. For further information on osteopathic medicine, see the entry on the comparison of
MD and DO in the US.
Paediatricians must undertake further training in their chosen field. This may take from three to six or more years, (depending on jurisdiction and the degree of specialization). The post-graduate training for a
primary care physician, including primary care paediatricians, 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 paediatrics may begin before completion of this degree. In some jurisdictions, paediatric 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 paediatric (or any other)
specialization. Specialist training is often largely under the control of
paediatric organizations (see below) rather than universities, with varying degrees of government input, depending on jurisdiction.
Paediatric organizations
.
Social role of paediatric specialists
Like other
medical practitioners, paediatricians 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.
Paediatricians 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 paediatricians in hospital practice are often on call at unsociable times for
perinatal problems in particular — such as for
Cesarean section or other high risk
births, and for the care of ill newborn infants.
See also
