儿科学

理论课 35 学时 见习课 25 学时 主讲教师 8 位 见习带教教师 王廉文 钱继红 儿科学

Key points Characteristic feature of pediatrics Stage of children by age Tasks of pediatrics

Pediatrics is the study of growth and development of the child from the genetic background and moment of conception through adolescence. 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, or emotional.

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 growing up.

fetal period intrauterine life: embryonic and fetal period intrauterine life: embryonic and fetal period first trimester first 12 wk first trimester first 12 wk second trimester 13 ～ 28wk third trimester 29 ～ 40wk third trimester 29 ～ 40wk Stage of children by age

neonatal period after birth ～ 4wk neonatal period after birth ～ 4wk perinatal period 28wk of gestation ～ 1wk after birth perinatal period 28wk of gestation ～ 1wk after birth infancy 4wk ～ 1yr Todlerhood 2nd yr ～ 3rd yr Stage of children by age

preschool age 3 yr ～ 6(7) yr school age 6 （ 7 ） yr ～ 11(12)yr school age 6 （ 7 ） yr ～ 11(12)yr adolescence 11 ～ 12yr--17 ～ 18yr(femal) adolescence 11 ～ 12yr--17 ～ 18yr(femal) 13 ～ 15yr---19 ～ 21yr(male) 13 ～ 15yr---19 ～ 21yr(male) Stage of children by age

 <18yr in total population of children and adult and adult developed countries 22.4% developed countries 22.4% developing countries 35.7% developing countries 35.7% china 30% china 30% ( UNCF 1999 ) ( UNCF 1999 )  <18yr 400 million( china)

There are differences for these various age levels in ⑴ Function of various organ system; (2) Degree of immunity to disease; (3) Response to the effects of disease; (4) Drug dosages and tolerance to drugs; (5) Mental and motor ability, and (6) Pattern of emotional response.

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 anatomy, physiology

生后 1 小时 2岁2岁 disparity in anatomy, physiology

Cardiothoracic ratio disparity in anatomy, physiology

Heart rate disparity in anatomy, physiology

nervous system Kernig sign, Babinski sign signs of meningeal irriatation neonatal period Kernig sign, Babinski sign(+) within 3 ～ 4m Kernig sign (+) within 2yr Babinski sign (+) disparity in anatomy, physiology

neonatal period rooting reflex, Moro reflex infancy abdominal reflex ( － ) possible tendon reflex ( ↑) nervous system reflex reflex disparity in anatomy, physiology

disparity in immunology

 age-dependent lab data, physical exam  age-dependent lab data, physical exam Disparity in occurrence and progression of disease between children and adult

 congenital anomalies inborn errors of   congenital anomalies inborn errors of metabolism more common in children metabolism more common in children  newborn, infants vulnerable to infection   newborn, infants vulnerable to infection  sinusitis rare in infancy   sinusitis rare in infancy  infants vulnerable to obstruction in respiratory   infants vulnerable to obstruction in respiratory tract tract  Disparity in spectrum of disease Disparity in occurrence and progression of disease between children and adult

 pneumonia bronchial pneumonia,   pneumonia bronchial pneumonia, lobar pneumonia lobar pneumonia  vit D difficiency rickets( 佝偻病 ),   vit D difficiency rickets( 佝偻病 ), malacosteon ( 骨软化 ) malacosteon ( 骨软化 )  Disparity in type of disease Disparity in occurrence and progression of disease between children and adult

   diarrhea dehydration ； fever seizure  Disparity in manifestation of disease Disparity in occurrence and progression of disease between children and adult

   hepatomegaly, splenomegaly common in infancy ( anemia, infection) Disparity in occurrence and progression of disease between children and adult

Progression Recovery deterioration

Infant mortality ~ China city 15% 1.18% 0.55% rural 20% 3.7% 0.4~0.7% Developed Countries

<5yr death China city 2.1% 1.4 % 0.7 % rural 7.1% 4.6 % 0.4~0.8% Developed Countries

<5yr death 93% in rural infant accounting to 80 ％ infant accounting to 80 ％ newborn death 65 ％ of total infant death newborn death 65 ％ of total infant death Leading death cause: pneumonia, Leading death cause: pneumonia, asphyxia, prematurity, diarrhea, asphyxia, prematurity, diarrhea, congenital anomalies, (2000) congenital anomalies, (2000)

Birth defect is the first cause in newborn death Incidence of total birth defect 3%-5 ％ in Shanghai million congenital defects seen after birth each year in China million several months or years after birth

Leading causes of death <1yr 1. perinatal conditions intrauterine growth retardation intrauterine growth retardation respiratory distress syndrome respiratory distress syndrome intrauterine hypoxia/birth asphyxia intrauterine hypoxia/birth asphyxia birth trauma birth trauma 2. congenital anomalies 2. congenital anomalies 3. sudden infant death syndrome 3. sudden infant death syndrome 4. pneumonia 4. pneumonia 5. gastrointestinal disorders 5. gastrointestinal disorders

1yr ～ 4yr 1. accidental injuries 2. congenital anomalies 2. congenital anomalies 3. malignant neoplasms 3. malignant neoplasms 5 yr ～ 14yr 1. accidental injuries 2. malignant neoplasms 2. malignant neoplasms Leading causes of death

The young are often among the most vulnerable or disadvantaged in society and their needs require special attention 年首次世界儿童问题首脑会议 “ 儿童生存保护和发展世界宣言 ” 及 “ 推行计划 ” “ 儿童生存保护和发展世界宣言 ” 及 “ 推行计划 ” 中国政府相继制定 “ 九十年代中国儿童发展规划纲要 及（ 2001 ～ 2010 ）中国儿童发展纲要 ”

Genetics, embryology, nutriology, pshychology Pediatrics (health care) Child health education Social services

1. infective disease 2. psycho-behavior problem 3. accidental injury 4. congenital anomalies 5. prevention of adult disease in childhood childhood