Pediatrics & Pediatric Care

Neonatology is the subdivision of pediatrics that aims to provide intensive medical care to the newborn infants due to low birth weight, sepsis, pulmonary hypoplasia, congenital malformations, prematurity. It is the hospital-based specialty and is usually practiced in neonatal intensive care units. Perinatology is a subspecialty of obstetrics that aims to provide care to fetus, complicated and high-risk pregnancies. Perinatology is also known as maternal-fetal medicine. Perinatologists are specially trained to provide medical services such as diabetic care, management of multiple gestations, level II ultrasound of the fetus genetic amniocentesis.

Pediatric neurology, or neurological surgery, is the medical specialty concerned with the prevention, diagnosis, surgical treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system of children. Concussion, neonatal neurology, brain malformations, headache/migraine, metabolic diseases affecting the nervous system, neuro-oncology, sleep disorders, developmental disorders including autism, neuromuscular disorders including muscular dystrophy and congenital myopathies are some of the neurological disorders seen in children. Key treatments for neurological disorders CyberKnife, Deep Brain Stimulation, Gamma Knife Radiosurgery and Vagal Nerve Stimulation.

• Pediatric sleep disorders
• Developmental disorders including autism
• Muscular dystrophy and congenital myopathies
• Brain malformations
• Neuro-oncology
• Brain tumors
• Movement disorders
• Epilepsy & Seizures
• Phakomatosis

Pediatric endocrinology is the subdivision of Endocrinology which deals with the diagnosis and treatment of children with endocrine diseases and disorders. Commonly encountered endocrine disorders in childhood are diabetics’ mellitus, hypothyroidism, hyperthyroidism, calcium disorders and disorders of puberty. Obesity is also one of the endocrine disorders, so healthy diet and physical activity is necessary. The main signs include poor growth or abnormal pubertal development.

Endocrinology Disorders in children:

• Diabetes mellitus (Type 1 & Type 2)
• Hypothyroidism
• Hyperthyroidism
• Short Stature
• Disorders of Puberty
• Congenital Adrenal Hyperplasia (CAH)
• Turner Syndrome
• Calcium Disorders
• Disorders of Sexual differentiation

Childhood obesity is one of the major public health crises nationally and internationally. It is the condition where the child put on weight above the normal weight which he/she must be for their height and age. It is a serious medical condition that has impact on both physical and psychological condition of a child. The effects of childhood obesity can persist well into adulthood and more likely to develop several non-communicable diseases at younger age. So, parents should help children develop healthy eating habits, stay active and reduce sedentary time. Proper nutrition services are important when it comes to children, since they are habituating life-long patterns that will be very difficult for them to break later and in preventing disabilities as well as in the treatment of chronic illness. Poor nutrition leads to an increased risk for developing health conditions such as high blood pressure, cardiovascular disease, diabetes, osteoporosis and even hearing loss.

Vaccines play a vital role in keeping the children healthy whereas Immunization is the process of becoming immune to (protected against) a disease. Vaccinations can be done in the early stages of life to protect children before they are exposed to the diseases. Immunizations are a cornerstone of pediatric healthcare. The process of immunizations is implemented for the prevention of life-threatening infections was an important driver of improvements in infant and childhood morbidity and mortality.

• Complementary/Alternative vaccines
• Childhood and Adolescent Immunization
• Neonatal Immunization
• Adjuvants in Pediatric Vaccines
• Maternal Immunization

Pediatric orthopaedics is the branch of medicine (surgery) that deals with diagnosis, treatment, and management of children's musculoskeletal problems which include evaluating and treating bones, joints and muscle problems. Common orthopedic conditions in children are knee arthroscopy and meniscectomy, hip replacement, joints & bone infections, limb and spine deformities: Club foot, Scoliosis, Fractures, spinal deformity.

Most common orthopaedic conditions in children:

• Knee arthroscopy and meniscectomy
• Hip replacement
• Joints & Bone infections
• Limb and spine deformities: Club foot, Scoliosis
• Fractures
• Spinal Deformity

Pediatric cardiology is the subdivision of cardiology which is concerned with the study of disorders and diseases of the heart as well as circulatory system in children within the age limit of 0 to 18 years.  Some of the major cardiac problems in children are: Anomalous Coronary Arteries/Fistulas, Anomalous Pulmonary Venous Return, Aortic Stenosis/Bicuspid Aortic Valve, Atrial Septal Defect (ASD, Atrioventricular Septal Defect (AVSD), D-Transposition of the Great Arteries & Ebstein's Anomaly. About one in every 100 children has a heart problem these defects can be treated with medicine, surgery or other medical procedures.

Most common heart diseases in children:

• Congenital heart disease
• Atherosclerosis
• Arrhythmias
• Kawasaki disease
• Heart murmurs

Oral hygiene is very important in case of children and parents need to take complete care in this case. Pediatric dentist promote dental health of children from birth through adolescence and serve as educational resources for parents. Thumb sucking habit after the evolution of the permanent teeth, tongue thrusting, lip sucking can lead to dental complication. Tooth grinding, tooth decay and gum diseases are some of the common dental issues in children.

Types of Orthodontic problems encountered in children:

• Crowded teeth and spacing issues
• Buck teeth
• Underbite
• Overbite/deepbite
• Openbite
• Crossbite
• Ectopic teeth
• Impacted teeth
• Missing teeth

Pediatric nurses are directed to provide medical care to neonates and children up to adolescence in an in-patient hospital or day-clinic. Duties of a Pediatric nurse are: Normalize the life of the child during hospitalisation, minimise the impact of child’s unique condition, respect the roles of the families in the care of their children, prevention of disease and promotion of health of the child.

Types of Pediatric Nursing:

• Direct nursing care
• Neonatal nursing
• Pediatric emergency nursing
• Palliative Pediatric nursing

Infectious diseases are caused by microscopic germs (bacteria & viruses) that enter the body and produce harmful consequences. Children are often prone to infectious diseases, as they have less immunity to fight against the foreign bodies. Childhood infectious diseases are chickenpox, measles, mumps, whooping cough, diarrhoea, vomiting. Infection may be caused by bacteria or virus, in some cases it will be difficult to determine the origin but can be diagnosed through the “culture test” of blood or urine.

Most common Infectious diseases in Children:

• Chickenpox
• Fifth disease
• Hand-foot-and-mouth disease
• Flu, including H1N1 (Swine flu)
• Meningitis
• Whooping cough (pertussis)

Pediatric urology is the subspecialty of surgery in medicine that deals with the disorders of children’s genitourinary systems. Some of the major disorders include bladder control problems, urolithiasis, tumors of kidneys, urinary obstruction. Pediatric nephrology is one of the specialities of medicine that deals with the study of proper functioning of kidneys, prevention and treatment of kidney diseases including dialysis and kidney transplantation. Common renal disorders encountered in childhood are fluid and electrolyte disorders, hematuria/proteinuria, Posterior urethral valve obstruction, Fetal hydronephrosis, Polycystic kidney disease, Multicystic kidney disease, Nephritis.

Though these are different sections but do share few common symptoms:

• Pain during passing urine
• Frequent bed wetting
• Blood in urine
• High blood pressure
• Fever
• Swelling around the eyes, face, feet and ankles
• Significant increase in the frequency of urination

Psychological/mental deals with physical wellbeing and sickness of a child and the connection between mental/behavioural elements and wellbeing, ailment and infection, the most widely recognized mental clutters in children are anxiety issue, depression and attention deficit hyperactivity disorders (ADHD). Pediatric psychology is a multidisciplinary study of both scientific investigation and clinical practice which delivers psychological services to infants, toddlers, children and adolescents.

Symptoms of psychological disorders in children:

• Unexplained weight loss
• A sudden loss of appetite
• Frequent vomiting
• Eating Disorders
• Headache and stomach ache rather than sadness or anxiety

Pediatric pulmonology is the branch of medicine that provides exceptional care for children with various allergic and pulmonary diseases. Pediatric pulmonologists and allergists diagnose, and care children affected with various respiratory complications and allergies such as pneumonia, bronchitis, common cold, influenza, food allergies, hay fever and croup. Recurrent respiratory tract infections are one of the most frequent reasons for pediatric visits and hospitalization as the immunity in children is low.

Prevention for pulmonary diseases and allergies in children:

• Good hygiene
• Vaccination
• Avoid allergens
• Take medicines as prescribed   

Hematology is the branch of internal medicine that deals with the cause, diagnosis, treatment and prevention of the diseases related to blood. Pediatric hematology is the subdivision within hematology that is concerned with the blood diseases and cancer related to children. Some of the blood disorders are inherited such as Fanconi anemia. Due to poor nutrition children are often prone to blood disorders. Pediatric oncology is concerned with the cause, diagnosis and treatment of cancer in children. Mortality rate of children is more in under developed country when compared to developed country due to limited resources. Most of the common types of cancers in children are leukemia, lymphomas (hematologic oncology) and brain tumors. Treatment includes chemotherapy and radiation therapy.

Children are mostly prone to following hematological disorders:

• Thalassemia
• Fanconi Anemia
• Sickle Cell Disease
• Congenital Amegakaryocytic Thrombocytopenia
• Dyskeratosis Congenita
• Pediatric anemia
• Pediatric factor VII & XIII diseases
• Hereditary disorders of red cells permeability
• Pediatric myelodysplasia
• Pediatric myelofibrosis

Pediatric Gastroenterology is the subspecialty of pediatrics and gastroenterology that focuses on the disorders of digestive system of children. The proper function of the gastric tract and the internal health of a child are related to the nutrition it receives from its mother or its mother receives. There are fewer common issues that can cause children to have digestive problems, including: celiac disease, bowel obstruction, pancreatitis, hepatitis, Crohn's disease & ulcerative colitis. Pediatric hepatology is the subdivision of internal medicine that focuses the study of liver, gallbladder, biliary system and pancreas including diagnosis, treatment and management of their disorders.

Common gastrointestinal diseases in children: 

• Appendicitis
• Diarrhea
• Constipation
• Malabsorption
• Gastroenteritis
• Food intolerance

A rheumatologist is a paediatrician who is specially trained to diagnose and treat musculoskeletal diseases and systemic autoimmune conditions commonly referred as rheumatic disease which include joint, muscles and bone disorders. Juvenile idiopathic arthritis is considered as the most common form of arthritis. The treatment includes medication, physical therapy, splints, and in severe cases surgery to reduce swelling, relieving pain, and maintaining full movement of joints.

• Oligoarthitis
• Polyarthritis
• Systemic
• Enthesitis-related
• Juvenile psoriatic arthritis
• Juvenile dermatomyositis

Child abuse or child maltreatment is causing a physical, sexual or psychological harm to a child, and can occur in a child's home, or in the organizations, schools or communities the child interacts with. Parents must educate the children to spot the signs of abuse often children are afraid to share these incidents so they stay silent as they may feel trapped or due to fear and this is one of the reasons why only few incidents are reported, and many more cases are undetected. If the child is not sharing these matters with their parents, it’s the responsibility of the parent to notice the change in their behaviour and take necessary action.

• Child labour
• Child trafficking
• Gender based violence against girls
• Child marriage

Pediatric Emergency Medicine is the branch of medicine that deals with providing highly specialized acute health care to children of all ages and developmental levels, which includes triage, stabilization, diagnosis, treatment and appropriate follow-up care. These problems are commonly serious and may be life-threatening.  The Pediatric Emergency Medicine subspecialist is dedicated to progress the science of the field through primary and multidisciplinary research.

Preventive pediatrics refers to prevention of disease and promotion of physical, mental and social well-being of children with the aim of attaining a positive health. By preventing disease, the child can attain its genetic potential. Prevention of disease can be best achieved through primary care activities such as growth monitoring, immunization, health education, and promotion of breastfeeding. The concept of preventive pediatrics is broadly divided into antenatal preventive pediatrics and postnatal preventive pediatrics. Preventive care aims to keep away the occurrence of diseases, to detect a disease, to avoid or delay complications when the condition is already present, to avoid premature deaths and to improve efficiency. The objective of maternal and child health program is to reduce maternal, infant and childhood mortality, and morbidity to promote reproductive health.

Pediatric physiatrists are physicians who specialize in the rehabilitation and medical care of children with brain injuries, spinal cord injuries, neuromuscular disorders, and an array of musculoskeletal conditions. The Child Development and Rehabilitation Center (CDRC) combine clinical excellence with innovative research to provide the best care for children with special health needs.

<p style="\&quot;text-align:" justify;\"="">Autism or autism spectrum disorder (ASD) is a broad range of conditions characterized by a serious developmental disorder that impairs the ability to communicate and interact, challenges with social skills, repetitive behaviour; speech and nonverbal communication. Several medical and mental health issues frequently accompany autism such as epilepsy, OCD, gastrointestinal problems and feeding.