Understanding Pediatrics: Health and Care for Children

1. Introduction & Infant Feeding YANG FAN (杨凡) Professor of Pediatrics

2. http://219.221.200.61/2008/xj/ekx/index.html http://www.ekjpkc.com/

4. What is Pediatrics? Paediatrics is a relatively new medical specialty, developing only in the mid-19th century. Abraham Jacobi (1830–1919) is known as the father of paediatrics.

5. Contributions to Midwifery and Diseases of Women and Children (with E. Noeggerath; New York, 1859) • Dentition and its Derangements (1862) • The Raising and Education of Abandoned Children in Europe (1870) • Infant Diet (1874) • Treatise on Diphtheria (1880)

6. By Dr Ananya Mandal, MD • Pediatrics is the branch of medicine dealing with the health and medical care of infants, children, and adolescents from birth up to the age of 18. • The word “paediatrics” means “healer of children”; they are derived from two Greek words: (pais = child) and (iatros = doctor or healer).

7. Age cut-off point

8. The young are often among the most vulnerable or disadvantaged in society and thus require special attention.

9. Facilitate optimal health and well-being for children and their family • Focus on the growth and development of children • Focus on the prevention of diseases of children • Focus on the treatment of diseases of children

10. Preventive Pediatrics • Developmental Pediatrics • Clinical Pediatrics

11. Aims • Raise child’s physical endowment • Decrease the morbidity and mortality rate • Improve the living quality of the children

12. The infant mortality rate (IMR) is the ratio of the number of deaths among children less than one year old during a given year to the number of live births during the same year.

13. The death of an infant is often dependent on external factors, especially in developing countries. Poor water quality, an inadequate food supply, substandard health services, and a high level of infectious diseases such as malaria all contribute to a high IMR.

14. The IMR is therefore considered a good indicator of the level of health in a community • The current worldwide average is just under sixty per thousand live births

15. In the developed and developing world, poor children suffer a disproportionate burden of morbidity and mortality. • An estimated 70% of child deaths are preventable. • Success has been achieved by identifying cost-effective best practices in child and infant health.  

17. Characteristics of pediatrics Physiology HR: 1m-1y： 110-130bpm >8y: 70-90bpm BR: neonate: 40-45bpm >8y: 18-20bpm BP (mmHg): SBP: = age ×2+80

18. Pathology Pneumococcal infection Vitamin D deficiency

19. clinical medicine disease pattern clinical manifestation

20. Age Period Infant Period Preschool Toddler Age School Age Adolescence Neonatal Birth 28day 1y 2y 3y 6y 12y 18y

21. Childhood Age Staging • Fetal period first trimester of pregnancy first 12 weeks second semester of pregnancy 13~28weeks third semester of pregnancy 29~40weeks

22. mother’s medical history (chronic medical conditions, medications taken during pregnancy thalidomide event) smoking, dietary habits occupational exposures to chemicals infections

24. ToRCH infection： T Toxoplasma R Rubella C Cytomegalovirus, CMV H Herpes virus O Others

25. Neonatal period the first 28 days of life experience great changes from inside uterus to outside the functions are not mature the diseases usually caused by maladjustment high mortality rate

26. Infancy From birth to 1 year old The most rapid growth period High incidence of malnutrition, dyspepsia, infectious diseases, etc immunization

27. Toddler’s age from 1 to 3 years old Intelligence development is very fast high incidence of accidental injury

28. Preschool period from 3 to 6/7 years old School age from 6/7 to preadolescence

29. Adolescence • Biological changes – onset of puberty • Cognitive changes – emergence of more advanced cognitive abilities • Emotional changes – self image, intimacy, relation with adults and peers group • Social changes – transition into new roles in the society

31. Early adolescence(10 -13yrs): Spurt of growth of development of secondary sex. • Middle adolescence(14-16yrs): Separate identity from parents, new relationship to peer groups, with opposite sex and desire for experimentation. • Late adolescence(17-19yrs): Distinct identity, well formed opinion and ideas

32. SMR(Sexual Maturity Rating) • Genitalia stage for boys(G1 to G5) • Pubic hair stage(PH1 to PH5) • Breast development for girls(B1 to B5)

33. Immunization • Denotes the process of inducing or providing immunity artificially by administering an immunologic substances • Active • Passive

34. Immunization • Routine immunization dramatically decreased morbidity and mortality from a variety of infectious diseases

35. Vaccination • Denotes the physical act of administrating any vaccine or toxoids

36. Immunobiologic Substances • Vaccine - a suspension of live or inactivated microorganism or fractions there of administered to induce immunity and prevent infectious disease or its sequela • Toxoid – modified bacterial toxin that has been made nontoxic but retains the ability to stimulate the formation of antitoxins

37. Antitoxins – a solution of antibodies derived from the serum of animals immunized with specific antigens • Passive immunization • Diphtheria antitoxin • Tetanus antitoxin

38. VACCINES Hepatitis B Bacille Calmette--Guerin BCG Diphtheria Pertussis Tetanus DPT Poliomyelitis Measels

39. Immunization schedule age <1d 1m <2 m 2 m 3 m 4 m 5 m 6 m 8 m vaccine HB 1 HB 2 BCG Polio 1 Polio 2 DPT 1 Polio 3 DPT 2 DPT 3 HB 3 Measles

40. Infant Feeding Children need food of appropriate quantity and quality for optimal growth and development

41. The nutritional vulnerability Infants and children are more vulnerable to poor nutrition than are adults Low nutritional stores High nutritional demands for growth Rapid neuronal development Illness

42. Category of nutrients （2000 Chinese Dietary Reference Intakes） • Energy： • Macronutrients: PRO、FAT、CHO • Micronutrients: minerals vitamins (Fat-soluble-vitamins, water-soluble-vitamins) • Other diet elements: cellulose, water

43. CHO FAT PROTEIN Macronutrients Energy produced

44. Gross Energy Intake Activity Energy Stored “growth” **TEF Metabolizable Energy Intake Growth *BMR Tissue Synthesis Excreta *Basal metabolism rate **Thermic effect of food

45. Infant feeding

46. BREAST-FEEDING

47. WHO definition Exclusive breastfeeding is fed no foods or fluids, even water. Partial breast-feeding isdefined as breast milk plus either solid foods or other milks.

48. Summary of differences between milks Human milk Animal milks Infant formula correct amount, easy too much, difficult to Protein partly corrected to digest digest enough essential fatty lacks essential fatty Fat no lipase acids, lipase to digest acids, no lipase Water enough extra needed may need extra Anti-infective present absent absent properties Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6). Slide 2.2

49. Two patterns for partial breast-feeding To supply with formular within 4~6 months Fordeficient B.M intake To replace B.M with formular after 4~6 months preparation for weaning

50. Components of human milk Colostrum : "first milk"; immature milk produced in 4-5 days post-partum Transitional  Milk:2weeks The composition is midway between colostrum and mature milk . Mature Milk: