Introduction to Pediatrics & Adolescent Medicine

Introduction to Pediatrics & Adolescent Medicine

• Pediatrics is the medical specialty focused on the physical, mental, and social health of children from birth to young adulthood.
• Pediatric care ranges from preventative healthcare to diagnosing and treating acute and chronic diseases.
• The study of pediatrics includes the full spectrum of health services.

Roadmap

• The course covers an introduction to the syllabus.
• Topics include comparisons of pediatric vs. adult patients.
• Mortality rates are highlighted.
• Ethical and legal concerns are discussed.
• Communication skills are included.

Subspecialties

• Adolescent Medicine
• Pediatric Cardiology
• Child Abuse Pediatrics
• Pediatric Critical Care Medicine
• Developmental-Behavioral Pediatrics
• Pediatric Emergency Medicine
• Pediatric Endocrinology
• Pediatric Gastroenterology
• Pediatric Hematology-Oncology
• Pediatric Hospital Medicine
• Pediatric Infectious Diseases
• Neonatal-Perinatal Medicine
• Pediatric Nephrology
• Pediatric Pulmonology
• Pediatric Rheumatology
• Pediatric Surgery
• Hospice and Palliative Medicine
• Medical Toxicology
• Sleep Medicine
• Sports Medicine
• Pediatric Transplant Hepatology

Areas of Importance

• Immunization is important.
• Full adult potential is important.
• Growth and development are crucial.
• Proper nutrition is essential.

How Old is a Pediatric Patient?

• Infants: 0-2 years old
• Children : 2-11 years old
• Adolescents: 11-21 years old

Adolescence Classifications

• Early adolescence: 11-14 years old
• Middle adolescence: 15-17 years old
• Late adolescence: 18-21 years old

Pop Quiz

• Ages in the quiz include 2 months, 11 years, 17 years, 18 months, 3 years, 7 days, 21 years old.

How is Pediatrics Different from Adult Medicine?

• Histories, physical exams and physiologic elements are different
• Developmental elements
• Prevention & safety
• Disease and injury are different
• Legal and ethical concerns need extra attention

The Pediatric History

• Parents are the initial historians.
• Prenatal, birth, maternal/family history are important.
• Developmental and social histories are collected.
• Immunization history is crucial too.

The Pediatric Physical Exam

• Exams focus on age and condition specifics.
• The exam varies by newborn, infant, toddler/child, and adolescent.
• Physical milestones are a key aspect.

Physiological Differences between Pediatrics & Adults

• Body surface area (BSA) is larger in proportion in relation to total body size.
• Skin is thinner and more permeable.
• Blood-brain barrier is immature.
• Respiratory and cardiac rates are faster.
• Airways are shorter and narrower.
• Lungs are more prone to collapse.

Examples of Pediatric Vital Signs vs Adult

• Vital signs including blood pressure (BP), respiratory rate (RR), and heart rate (HR), and temperatures vary with age.

Examples of Physiological Differences

• Metabolism and absorption are higher.
• Tissue growth is rapid.
• Dehydration is a risk.
• Maintaining temperature is a concern.
• Immune systems are not fully developed.
• More water and calories are required.
• Medications are metabolized differently.
• Organ systems are immature.

Examples of Medication Pharmacokinetics

• Gastrointestinal (GI) motility and stomach pH affect drug absorption.
• Skin thickness and perfusion affect drug absorption.
• Muscle mass and blood flow affect intramuscular (IM) injection absorption.
• Drug absorption varies by route.
• Drug distribution, metabolism, and elimination differ.
• Renal function is immature, affecting drug clearance.

Medications in Pediatrics

• Dosage needs are adjusted to reflect weight-based considerations.
• Often, medications are used "off-label.”
• Limited clinical trial data exists for children.

Examples of Pediatric Lab Values

• Lab values vary with age and developmental stage for liver enzymes (ALT), creatinine clearance, bilirubin, glucose, etc., and may differ in the premature infant.

Developmental Differences

• Development varies significantly by age, demonstrating differences in mental and emotional capabilities.
• Cognitive development and concrete thinking are crucial.
• Limited concentration span exists.
• Development follows a specific timeline that needs to be kept in mind.

Examples of Prevention & Safety Differences

• Children require adult assistance for safety.
• Children might not understand safety.
• Unique environmental exposures to risks and dangers are different from adults.

Examples of Disease & Injury Differences

• Children are more prone to illness or injury.
• Disease onset is often earlier.
• Severity of impacts on head and neck can be more serious.
• Medication metabolism can differ in children, leading to greater variability in treatment response.

Common Childhood Acute & Chronic Diseases

• Common childhood illnesses like the common cold (viral URI), respiratory syncytial virus, ear infections, roseola, gastroenteritis, hand-foot-mouth disease, fifth disease, group A strep, influenza, conjunctivitis, and fevers.
• Common chronic diseases include dental caries, asthma, cystic fibrosis, diabetes, obesity, malnutrition, developmental disabilities, cerebral palsy, and premature birth consequences or mental health disorders.

What are Vital Statistics and Why?

• Vital statistics provide continual data on events like births, deaths, and health conditions.
• Data is collected at local, state levels and nationally through agencies such as the Centers for Disease Control and Prevention (CDC).
• Maternal and infant mortality are crucial vital statistics.

U.S. Infant Mortality Rate

• Infant mortality rates have decreased significantly from 1930s to 2017.
• Neonatal and post-neonatal mortality rates are included in this aspect.

U.S. & New Mexico Infant Death by Cause

• Leading causes of infant deaths include congenital malformations, short gestation, Sudden Infant Death Syndrome (SIDS), maternal complications, accidents, and assault.
• Data for 2017 is presented.

Infant Mortality Rates by State

• U.S. infant mortality rates and those in individual states show varying rates.

Ethical & Legal Concerns

• Parents have the right to make decisions for their children but are not free to make martyrs out of their children before they are of legal age.
• Ethical and legal concerns around decisions involving children depend upon the age as these legal and ethical issues can be debated and different perspectives exist.

Group Work Guidelines

• Instructions for organizing and carrying out group activities.

Communication

• Role-playing is recommended for practicing parent/doctor communication in these situations.
• Importance of specific communication skills is underscored.

Group Work: Communication

• Quote about communication in healthcare.