Pediatric Development Stages Quiz

Introduction to Pediatrics & Adolescent Medicine

• Pediatrics is the medical specialty focusing on the physical, mental, and social well-being of children from birth to young adulthood.
• Pediatric care encompasses a wide range of health services including preventive care and the diagnosis/treatment of acute & chronic diseases.

Roadmap

• The course covers introductions to the syllabus, differentiating pediatric and adult patients, mortality, and ethical and legal concerns.
• Communication is also a key aspect.

Subspecialties

• Adolescent medicine, pediatric cardiology, child abuse pediatrics, pediatric critical care medicine, developmental-behavioral pediatrics
• Pediatric emergency medicine, pediatric endocrinology
• Pediatric gastroenterology-oncology, 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

• Immunizations, full adult potential, growth & development, nutrition.
• Diagnosis and treatment of disease are also areas of importance.

How Old is a Pediatric Patient?

• Infants (0-2 years old)
• Children (2-11 years old)
• Adolescents (11-21 years old)
• Neonate: (0-28 days)
• Note: Age ranges vary by classification systems (AAP, others).

Adolescence Classifications

• Early adolescence: 11-14 years old
• Middle adolescence: 15-17 years old
• Late adolescence: 18-21 years old
• Note: Different classification systems use different age ranges.

Pop Quiz (Examples)

• 2 month old, 17 year old, 11 year old, 3 year old, 18 month old, 7 day old, 21 year old.

How is Pediatrics Different from Adult Medicine?

• Patient histories, physical examinations, physiological development, prevention & safety, disease and injury, legal/ethical considerations.

The Pediatric History

• Parent as primary historian, differences between parent & child histories, prenatal & birth histories, maternal/family history's, developmental history, and social history, including immunization history.

The Pediatric Physical Exam

• Exam specific to age & condition, general vs focused exam, newborn, infant, toddler/child, adolescent, and physical milestones.

Examples of Physiological Differences

• Body Surface Area (BSA), thinner skin, immature blood-brain barrier
• Respiratory & heart rates are faster, obligate nasal breathers, smaller airways, prone to lung collapse.

Examples of Pediatric Vital Signs

• Vital signs vary by age (BP, RR, HR).
• The table details different age ranges with associated typical vital signs.
• Note: Ranges may vary by individual.

Examples of Physiological Differences (cont'd)

• Metabolism & Absorption, Tissue growth, Dehydration, Temperature control, Immune system immaturity, Water/Nutrient requirements that differ.
• Immature organ systems affect medication metabolism.

Examples of Medication Pharmacokinetics

• Reduced Gastro Intestinal (GI) motility, increased stomach pH; longer time to reach peak concentration, thinner moister skin, increased cutaneous perfusion.
• Less muscle mass, less muscle blood flow; increased skin absorption, reduced bioavailability
• Reduced metabolic enzyme activity, changing distribution, lower drug clearance, increased water volume, elevated renal clearance.
• Changes in renal clearance of drugs, also noted.

Medications in Pediatrics

• Smaller doses compared to adults; weight-based dosing, limited clinical trial information, medications often used "off-label."

Examples of Pediatric Lab Values

• Tables provide examples of variations in ALT, U/L, creatinine clearance, bilirubin, glucose, related to different age groups. Note: Individual lab variations occur.

Developmental Differences

• Development varies by age, notably egocentric thinking of children with limited resilience, limited attention span, sensory dependence, developmental windows, longer life expectancy.
• Central Nervous System (CNS) development continues throughout adolescence.

Examples of Prevention and Safety Differences

• Need adult assistance and protection, unique environmental exposures, placental & breastfeeding, time spent outdoors, vaccinations, exposure to media.

Examples of Disease & Injury Differences

• Higher likelihood of illness or injury, some diseases child/adult-specific, younger onset may increase severity, head/neck injuries more common, fractures requiring more force, infants & children, medication metabolism differences, fewer clinical trials for children.

Common Childhood Acute Illnesses

• Includes viral upper respiratory infections (URI), Respiratory Syncytial Virus (RSV), ear infections, roseola, gastroenteritis, Hand-Foot-Mouth Disease, Fifth Disease, Group A Strep, influenza, conjunctivitis, and fevers.

Common Childhood Chronic Diseases

• Includes dental caries, asthma, cystic fibrosis, diabetes, obesity, overweight, malnutrition, developmental disabilities, cerebral palsy, consequences of prematurity, and mental/behavioral disorders.

What Are Vital Statistics and Why Do We Use Them?

• Vital statistics are continuous data on births, deaths, marriages, and other health information.
• Vital statistics include tracking locally through the states up to the national level.
• Maternal and infant mortality data indicate the health status of a national population.
• Vital statistics inform understanding of quality of medical care, access to care, and disparities
• Also help guide public health & health policy decisions.

U.S. Infant Mortality Rate

• Table providing U.S. infant mortality (1930-2017) rates, neonatal, and post neonatal rates.
• Also includes New Mexico infant mortality rate data.

U.S. and New Mexico Infant Death by Cause (2017)

• Table providing the contributing causes of infant deaths in the U.S. and New Mexico in 2017.

Infant Mortality Rates by State (2017)

• Map showing infant mortality rates, based on per 1000 live births, across the various states.

Ethical & Legal Concerns

• The United States Supreme Court's perspective on parental decisions regarding children's well-being.

Group Work: Ethical & Legal Concerns

• Instructions for group work on the topic, including group division & responsibilities.

Communication

• Role-playing instructions: Parent & Doctor Communication.

Group Work: Communication

• Quotes on communication practice: Advice on the practice of doctor-patient communication.