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Pediatrics | History and definition of Pediatrics

Pediatrics | History and definition of Pediatrics
Pediatrics (also spelled paediatrics or pædiatrics) is the branch of medicine that deals with the medical care of infants and children. Most pediatricians are members of a national body, such as the Canadian Paediatric Society, the British Association of Paediatric Surgeons or the American Academy of Pediatrics.

One of the major challenges facing pediatricians is that the range of body sizes (and weights) that they face in pediatrics is much greater than in adult medicine. For example, a preterm neonate can be less than 2kg in weight while an obese adolescent may be larger than the typical adult.

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.

Another major difference between pediatrics and adult medicine is that children are minors and, in most jurisdictions, cannot make decisions for themselves. The issue of guardianship, 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), not just the child.

Abraham Jacobi is considered the father of pediatrics.

Paediatrics is a relatively new medical specialty, developing only in the mid19th century. Arthur Jacobi (1830–1919) is known as the father of paediatrics because of his many contributions to the field., he was a Prussian-American.

According to A.B. Desai, "Soraneus in Greece in the 2nd century AD wrote the first known manuscript devoted to paediatrics...The first printed book on paediatrics was in Italian (1472) – Bagallarder's Little Book on Disease in Children." Rhazes (865–925) in Persia wrote The Diseases of Children, the first book to deal with paediatrics as an independent field of medicine.

In the Western world, 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 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 Pavilion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (now Wrocław), 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 1855, and then Boston Children's Hospital (1869).

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.
The training of paediatricians varies considerably across the world.

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".

Pediatricians must undertake further training in their chosen field. This may take from four to eight 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.

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.

A common misconception is that Paediatricians enjoy high social status, often combined with expectations of a high and stable income and job security. However, paediatric 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.

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