Paediatrics

1. 1
PAEDIATRICS
Definition:
 Medical Science (Science of right living)
which enables an anticipated newborn to
grow into a health adult, useful to the
society .
 In other words, it is a study of the
child from conception through
childhood and adolescence.

2. 2
 It is concerned with the health of infants,
children and adolescents in order to enable
them to reach their full potential as adults.
 Thus, it includes childcare, prevention and
treatment of diseases.

3. 3
Doctor’s Role in Pediatrics
1. Care of the physical, mental and
emotional health from conception to
maturity.
2. Demonstrate concern for social,
environmental and cultural
influences that are known to have
considerable influence on the health
of children and their families

4. 4
Factors which Affect Health:
Climate
Environment
Geography
Prevalence and ecology of
infectious agents and hosts
Education
Social and cultural considerations
Stage of urbanization and
industrialization
Gene frequencies

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WHY PAEDIATRICS
 Pediatrics is an independent subject
because:-
 Problems of children differ from those of
adults in many ways.
 Children’s response to an illness is
influenced by age.

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WHY PAEDIATRICS cont.
 Management of childhood illness is
significantly different from that of
adults.
 Children need special care because
they are among the most vulnerable in
the society.

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 MODERN CONCEPT OF
PAEDIATRICS
The modern concept of paediatrics
lends it a unique status. Unlike other
specialties, it deals with the exciting
dynamic process of continuous care
of the growing child. In literal terms, it
deals with the whole child.

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 The concept of “whole child” according to
UNICEF means that assistance for
meeting the needs of children should no
longer be restricted to nutrition which is of
immediate benefit to them. Instead, it
should be broad based and geared to their
long-term development and to the
development of the countries in which they
live.

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 The differences between a child and an
adult are appropriately summarized this
statement “the child is not a little adult”

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HISTORY OF PAEDIATRICS
 Paediatrics was born just over a century
ago in the prosperous countries of the
West. It is, however, young in Tanzania
and other developing countries. The first
pediatric ward in Tanzania was
operational in1970 at Muhimbili National
Hospital. Training of paedricians and
other Medical Specialists in Tanzania
started in 1973.

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RIGHTS OF THE CHILD
Read and know the basic rights of children
as per United Nations declaration of 1959.

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DISEASES PATTERN IN
DEVELOPING COUNTRIES
Relative frequency of diseases responsible for
admissions in developing countries.
The major causes of admissions include:-
 Protein energy malnutrition (severe)
 Acute watery diarrhea
 Malaria
 Pneumonia(severe)
 HIV/AIDS (paediatric Aids)
 Tuberculosis

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These account for 75% of the admissions.
Miscellaneous diseases account for only
25% of the cases.
At the OPD, the following dominate the list.
 Malaria
 Acute watery diarrhea
 Acute respiratory infections (ARI)
 Protein Energy Malnutrition
 HIV/AIDS
 TB
 Measles

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Miscellaneous
Mortality
Infant mortality and under 5 mortality are very
high.
In Tanzania, IMR stands at 68/1,000 live births
and the
under 5 mortality 112/1000 live births. The
main causes
of death are:
 Malaria

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Complications of
newborns
 Asphyxia Neonatorum
 Neonatal Septicaemia
 Low birthweght

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Pattern of Paediatric diseases in
Western Europe and North America
Childhood accidents (including
poisoning)
Congenital malformations
Neoplasms
Hereditary diseases (inborn errors
metabolism)
Obesity (Not under nutrition)

17. The pattern in developed countries is very
different from that seen in developing
countries.
The pattern seen in developing countries
today was seen in Europe many decades
ago. We therefore, anticipate a change of
pattern in developing countries too with
passage of time.
17

18. 18
Factors which influence health and nutrition of
children in developing countries:
 Illiteracy
 Ignorance
 Superstitions
 Cultural and religious influences
 Poverty, lack of resources nutrition,clean water
supply, environmental ….
 Diseases are thought to be caused by witchcraft
and people still relay on witch medicines for
their treatment.

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New problems
 Drug abuse among adolescents
 Child abuse and neglect
 Street children
 Child labour
 Discrimination against the female child
 Female circumcision

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HEALTH SERVICE IN
DEVELOPING COUNTRIES
 Most of the causes of morbidity and
mortality in these countries are largely
preventable, thus treatment to hand in hand
with prevention.

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Strategies to improve
child survival
1. Primary health care (PHC) – Alma Ata
declaration Health for all by the year
2000
2. Reproductive Health (maternal and
child health)
3. ARI Management
4. Treatment of AWD
5. Immunizations
6. IMCI

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6. Control of malaria
7. Control of HIV/AIDS
8. Essential drugs program
9. Control of TB
10.IMCI.(Integrated Management of child
illness’ )scheme
11.breast feeding
Millennium development goals roll back-malaria

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PAEDIATRIC HISTORY
TAKING AND PHYSICAL
(CLINICAL) EXAMINATION
HISTRORY
The best person to give the history (“informant”)
is the mother of the child or someone else
responsible for the care of the child. If the child
is old enough to communicate he should also
be interviewed. History obtained from father,
uncles, aunts or grandparents, who have not
been deeply involved in Childs care is less
reliable.

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Approach should be
friendly
The best place to exam chills is on the
mother’s lap (not on the bed) or on the
shoulders. The history recorded should be
clear and in chronological order. Main
items in the history are:

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a) Particulars of the patient: name, age,
sex, Parents names, address etc.
b) Presenting complaints must be brief in
informants own wards and must include
duration eg. Cough, fear,
breathlessness, vomiting, diarrhea,
abdominal pain rashes, jaundice,
cyanosis, inability to suck etc.

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History of present illness. Record the details of the
present illness. Start by asking the informant when
was the child quite well? How and when did the
present problem start? How was its further
progression? Was it stationary, improving or
worsening, what the new symptoms, any aggravating
were or alleviating factors. Pertinent negative data
that might have bearing on the diagnosis you keep in
mind. DIRECT questioning. Any treatment given.
b) Review of other systems.
Review of other systems in turn so that nothing vital
is missed. These should be done on the following
lines.

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Heart: Breathlessness in exertion, palpitations,
cyanosis left chest pain
Chest: chest pain, cough, sputum, wheezing
breathlessness
GIT: Diarrhea, vomiting, constipation,
abdominal lunar lack of appetite,
Nausea.

28. Liver: Jaundice deep urine, light stool
smell in breath.
Genitor-urinary vaginal discharge, menses,
visible anomalies of the penis, testicles or
labia clitoris, dysuria, frequency, polyuria,
haematuria, pyuria,enuresis
28

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Headache, dizziness, convulsion’s ataxia,
paralysis.
Musculoskeletal: muscle or joint pains,
postural deformities
ENT: ear discharge, earache, shifty or
running nose, sneezing, frequent colds,
mouth breathing, sore throat.Special
senses: taste, hearing, vision, smell, pain.
General: weight loss or gain, easy
fatigability etc.

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Past Medical History
Child’s previous illness before onset of the
present illness. Any major illness,
admission or operations? If so give
duration dates and the type of the illness.
Was any treatment given?

31. Birth History
Indicate the factors that may have bearing on
the child health before, during and after birth.
Prenatal
Mother’s health during pregnancy. Any history
of illness such as rubella, syphilis, EPH
gestosis, hypertension, diabetes mellitus, TB,
exposure to radiation or drug intake?
31

32. 32
 Natal
Was it hospital or home delivery? Who
conducted it? Was the delivery normal or
abnormal? What was the baby’s birth
weight; did he look healthy or sick? Any
cyanosis. Any respiratory distress? What
about the cry, was it immediate or
delayed. Was resuscitation needed? If
so, what type and how long.

33. Post natal
APGAR SCORE: any complication such as fever
33
hyperthermia, jaundice, cyanosis convulsions
inability to suck, any resuscitation done after
deliver.
Birth weight
Excessive weight loss. Was passing of
…………… delayed? Was passing urine
delayed?

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Immunization
History: Breast feeding. When were solids
added? Food allergy, current diet
Personal History: relation with other family
members and children in school. Is he
difficult? He is negative? Is he outgoing?
Habits: how is his eating, sleep, bowel and
bladder habits, History of pica, enuresis,
breath holding, tics and temper function.

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Family History
Health status of other sibs, parents, grandparents
etc. in case of infectious and genetic (family
diseases) history of such illness in the family
members in INHERITED Disorders, history of
the family tree. In down syndrome, age of the
parents.
Socioeconomic
Family income occupation property

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PHYSICAL EXAMINATION
Pre-requisite
Friendly attitude
Infants and young children while held in the
mother’s lab of over the shoulders.
Older children: on the examination bed.

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General Appearance
G.C. Good,health
Fair, unwell
Poor, sick
Very poor: very sick, critical condition
(…………..)
Mentally retarded?
Morphology – normal
Abnormal

38. Comfortable – co-operative and interested in
surrounding
Wasted, obese or average
Calm or crying, type of cry
Dyspnoea, pallar, jaundice, cyanosis
Digital disbbing, oedema, skin rash, lymphadenopathy
skin pinch
38
Anthropometry
Body weight
Height/length
OFC
Chest circumference

39. 39
HEAD
Size (OFC) A
Shape: scaphocephaly, oxycephaly,
brardycephaly, plagiocephaly.
Palpation of sutures
Transillumination incase of hydrocephaly
Percussion
Auscultation
Hair: co lour, texture, sparseness and easy
phickability Alopecia

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Face: ExpressionAsymmetry, paralysis,
nasal bridge hyperterorism Dull &
expression less mental retarding typical
facies (cramiofacial) Composite in Down
syndrome hurler’s syndrome

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Eye- photophobia, palpabral slunt, cataract
exaphltahmous, exophthalmoses etc
Nose: unusual shape, cleft lip palate,
dental carries, trial occlusion, tonsils, ulcers
etc.
Ear: size, shape and position Deformities
Low set ears – Down syndrome,
treachery Collin, aperts carpenters and
Noonan’s Syndrome
Neck: head holding swelling …………
simises or

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SYSTEMIC EXAMINATION
Inspection
Nasal flaring
Chest- type of breathing - normal
- Fast
- Irregular

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Retraction –lower chest, syprasternal,
intercostals
Deformity- asymmetry
- Chest deformity
- Barrel / chest (emphysema)
- Funnel chest (pectus excavation)
- Pigeon chest (pectus carivetum
- Rachitic rosary