Paediatrics: Wikis

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Pediatrician
Occupation
Names Doctor, Medical Specialist
Type Specialty
Activity sectors Medicine
Description
Education required Degree in Medicine, plus postgraduate Speciality training
Fields of employment Hospitals, Clinics, Primary care (varies with jurisdiction)
Related jobs Physician, Medical specialist
Average salary AUD $300,000-600,000

Pediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. The upper age limit of such patients ranges from age 12 to 21. A medical practitioner who specializes in this area is known as a pediatrician. The word pediatrics and its cognates mean healer of children; they derive from two Greek words: παῖς (pais = child) and ἰατρός (iatros = doctor or healer).

In Commonwealth countries, the respective spellings paediatrics and paediatrician are usually preferred. There may be a slight semantic difference: in the USA, a pediatrician (US spelling) is often a primary care physician who specializes in children, whereas in the Commonwealth a paediatrician (British spelling) generally is a medical specialist not in primary general practice. For further detail, see discussion on the broad and narrow meanings of physician.

Contents

History

An infant at the 3 months check-up.

In Europe in the Enfants-Trouvés (1674-1838) in Paris (French = Hospice for Found-Children, ie Foundlings). There was a gradual move to found separate institutions specifically for ill children, partly to avoid exposing them to adults in adult hospitals. [1][2]

In the Western world, the first generally accepted paediatric hospital is the Hôpital des Enfants Malades (French = Hospital for Sick Children), opened in Paris in June 1802, on the site of a previous orphanage.[3] From its beginning, this famous hospital accepted patients up to the age of fifteen years,[1] 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 Pavillion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (now Wroclaw), 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.[3] In the USA, the first similar institutions were the Children's Hospital of Philadelphia, which opened in in 1855, and then Boston Children's Hospital (1869). [4]

Differences between adult and pediatric medicine

Pediatrics differs from adult medicine in many respects. [5] 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 pediatricians than they often are to adult physicians.

Treating a child is not like treating a miniature adult. A major difference between pediatrics 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 pediatric procedure. In a sense, pediatricians 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.

Training of Pediatricians

The training of pediatrician varies considerably across the world.

Like other medical practitioners, pediatricians begin their training with an entry-level medical education: a tertiary-level course, undertaken at a medical school attached to a university. Such a course leads to a medical degree.

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".

Within the United States, the term physician also describes holders of the Doctor of Osteopathic medicine (D.O.) degree. For further information on osteopathic medicine, see the entry on the comparison of MD and DO in the US.

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) wale than universities, with varying degrees of government input, depending on jurisdiction.

Paediatric organizations

Social role of paediatric specialists

Like other medical practitioners, pediatricians 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.

Pediatricians commonly enjoy high social status, often combined with expectations of a high and stable income and job security. However, 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 pediatricians 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.

See also

References

  1. ^ a b offical history site (in French) of nineteenth century paediatric hospitals in Paris
  2. ^ Laplane, Robert (1991). "'French paediatrics'". in Nichols, Burford L. et al. (eds). History of Paediatrics 1850–1950. Nestlé Nutrition Workshop Series. 22. New York, NY: Raven Press. pp. 39-48. ISBN 0-88167-695-0. 
  3. ^ a b Ballbriga, Angel (1991). "'One century of pediatrics in Europe (section: development of pediatric hospitals in Europe)'". in Nichols, Burford L. et al. (eds). History of Paediatrics 1850–1950. Nestlé Nutrition Workshop Series. 22. New York, NY: Raven Press. pp. 6-8. ISBN 0-88167-695-0. 
  4. ^ Pearson, Howard A. (1991). "'Pediatrics in the United States'". in Nichols, Burford L. et al. (eds). History of Paediatrics 1850–1950. Nestlé Nutrition Workshop Series. 22. New York, NY: Raven Press. pp. 55-63. ISBN 0-88167-695-0. 
  5. ^ "Children are not just small adults: the urgent need for high-quality trial evidence in children". PLoS Medicine. http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050172. Retrieved 2009-09-04. 

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