Paediatrics - the study about Paediatrics - the study about doctoring of child (pais - boy, doctoring of child (pais - boy, child and of iatria - doctoring) - child and of iatria - doctoring) - the first half of the the first half of the Х Х I I Х Х century century S.F.Khotovitskiy - the first S.F.Khotovitskiy - the first Russian management on the Russian management on the children's diseases “Of children's diseases “Of paediatrics” (1847) - child - the paediatrics” (1847) - child - the not reduced copy of adult, but not reduced copy of adult, but special in each development stage special in each development stage system system ХХ ХХ century century – – the study of the the study of the special features of the development special features of the development of healthy child of healthy child ХХ ХХ I I century century – – high technologies in high technologies in the pediatrics the pediatrics
Transcript
Paediatrics - the study about Paediatrics - the study about doctoring of child (pais - boy, child doctoring of child (pais - boy, child and of iatria - doctoring) - the first and of iatria - doctoring) - the first half of the half of the ХХIIХХ century century
S.F.Khotovitskiy - the first Russian S.F.Khotovitskiy - the first Russian management on the children's management on the children's diseases “Of paediatrics” (1847) - diseases “Of paediatrics” (1847) - child - the not reduced copy of adult, child - the not reduced copy of adult, but special in each development but special in each development stage system stage system
ХХ ХХ centurycentury – – the study of the special the study of the special features of the development of features of the development of healthy childhealthy child
ХХХХII centurycentury – – high technologies in the high technologies in the pediatrics pediatrics
PATRONAGE OF HEALTHY CHILD (1)PATRONAGE OF HEALTHY CHILD (1)
During the first 3 days after extraction from house During the first 3 days after extraction from house On the 1st month of life every week On the 1st month of life every week On the 2nd month of the life of 1 times in 2 weeks On the 2nd month of the life of 1 times in 2 weeks From the 3rd through 12 mo. of life monthly From the 3rd through 12 mo. of life monthly In 1, 3 mnth. and 1 year - neuropathologist, In 1, 3 mnth. and 1 year - neuropathologist,
orthopaedist, oculistorthopaedist, oculist in 3 mo. - analysis of the blood and urine (before the in 3 mo. - analysis of the blood and urine (before the
vaccination) vaccination)
. .
PATRONAGE OF HEALTHY CHILD PATRONAGE OF HEALTHY CHILD (2)(2)
On the 2nd year- the quarterly On the 2nd year- the quarterly inspectionsinspections
On the 3rd year - 1 times in half a yearOn the 3rd year - 1 times in half a year From the 4th year and further - the From the 4th year and further - the
yearly professional examinations yearly professional examinations Before entering into the school- Before entering into the school-
complete inspection by all specialistscomplete inspection by all specialists further - observation by the school further - observation by the school
doctor doctor
PERIODS OF THE PERIODS OF THE CHILDHOODCHILDHOOD
1) 1) prenatal development prenatal development - 10 lunar - 10 lunar monthsmonths
2) neonatal – 4 weeks4 weeks; 3) breastfeed – up to 1 yearup to 1 year; 4) crib or nursery– from 1 year to the from 1 year to the
3rd years3rd years; 5) pre-schoolpre-school - - from 3 to 7 yearsfrom 3 to 7 years; 6) school - from 7 to 18 years (periods - from 7 to 18 years (periods
of the young and elder school age). of the young and elder school age).
NEONATAL PERIOD
28 days or 4 weeks 28 days or 4 weeks Process of adaptation to the new Process of adaptation to the new
conditions of environment (early conditions of environment (early adaptive - to 10 days of life) adaptive - to 10 days of life)
Transitory (boundary) states Transitory (boundary) states Reflexes of the newborns Reflexes of the newborns
NEWLY BORN CHILDNEWLY BORN CHILD (1) Mature infantMature infant ((38-42 weeks. Gestation 38-42 weeks. Gestation )) Weight - 3300 g (virgins.), 3500 g (boys)Weight - 3300 g (virgins.), 3500 g (boys) Length of 50-51 cm Length of 50-51 cm It is minimal - 2900 g/of 49 cm It is minimal - 2900 g/of 49 cm Dist. of head -35 cm, breast -33 cm Dist. of head -35 cm, breast -33 cm Loud emotional cry Loud emotional cry Living reflexes (sucking and swallowing) Living reflexes (sucking and swallowing) Steady and correct rhythm of respiration Steady and correct rhythm of respiration
and palpitation and palpitation
NEWLY BORN CHILD NEWLY BORN CHILD (2)
PREMATUREPREMATURE ( (less than 38 weeks. gest less than 38 weeks. gest ).).
Morphological signs Weight of < 2500 Length of < 45 cm Lanugos throughout entire
body Cerebral part of skull>
facial Exophthalmoses Lateral fontanel Nails do not reach tips of it
is finger the low arrangement of
umbilical ring cryptorchism, the hiatus of
the sexual
Functional signs Weak cry or its
absence Sluggish
physiological reflexes (sucking and swallowing) or their absence
arrhythmic respiration with the protracted is apnoea
Expressed thermo labile
Care of the premature childCare of the premature child M<M<2000 2000 gg – кювез – кювез ((incubatorincubator) ) Т Т airair
< 1000< 1000 gg -34,5 – -34,5 – 3535 degreedegree CC 1500-1700 1500-1700 gg- 33 – 34 - 33 – 34 degree degree СС Further to descend by 1 deg in 7-10 daysFurther to descend by 1 deg in 7-10 days Humidity of airHumidity of air 1-3 1-3 daysdays – 80-90% – 80-90% 4-7 4-7 daysdays – 70-80% – 70-80% 2-2-nd week of lifend week of life- 60%- 60% 3-43-4 -- week week – 50%– 50%
О2 – 25-30%, О2 – 25-30%, flow 2-3 l/min (to 40% with the flow flow 2-3 l/min (to 40% with the flow 4 l/min)4 l/min)
Nourishment of the Nourishment of the premature childpremature child
the 1st feeding of [ch]/[z] of 4-6 hours (> the 1st feeding of [ch]/[z] of 4-6 hours (> 12 hours - introduction to 5% of glucose 12 hours - introduction to 5% of glucose of 5[ml]/3 of hour per os or [v]/[v] 10% of 5[ml]/3 of hour per os or [v]/[v] 10% glucose of 3-5 [ml]/3 of the hour glucose of 3-5 [ml]/3 of the hour
Multiplicity of feedings - 7-8 times (3 h Multiplicity of feedings - 7-8 times (3 h interval) Severe premature babies- 10 interval) Severe premature babies- 10 times (2 h interval) times (2 h interval)
Mt. with [rozhd]. < 1500 g (there is no Mt. with [rozhd]. < 1500 g (there is no reflex) - the probe feeding reflex) - the probe feeding
Mt. of > 2000 g of 1-2 breast feedings, Mt. of > 2000 g of 1-2 breast feedings, rest - from the nipples rest - from the nipples
Nourishment of the premature Nourishment of the premature child (2)child (2)
2,5-2,92,5-2,9 5,5-65,5-6 12-1412-14 From 3From 3rdrd month month
5 5 KcalKcal//kgkg//monthmonth
NEW BORN CHILD (3)NEW BORN CHILD (3) IMMATURE (morphologically and (morphologically and
functionally not corresponding to functionally not corresponding to the period of gestation) - as the the period of gestation) - as the consequence [V]/[U] of infection, consequence [V]/[U] of infection, unfavorable flow of the pregnancyunfavorable flow of the pregnancy
V/U HYPOTROPHY- reduction in reduction in the mass- growth indices with the the mass- growth indices with the generation is less than 60generation is less than 60
NEW BORN CHILD (4)NEW BORN CHILD (4) POST MATURED ( > 42 weeks. gestation.) Trophic disturbances (flabbiness and Trophic disturbances (flabbiness and thinning [PZHK], dryness and the thinning [PZHK], dryness and the exfoliation of the skin - especially - palms exfoliation of the skin - especially - palms and feet)and feet)
Absence of lubricantAbsence of lubricant Dense bones of the skullDense bones of the skull Closed cranial seamsClosed cranial seams Small sizes of the fontanelSmall sizes of the fontanel Sometimes - jaundice with the greenish Sometimes - jaundice with the greenish tinttint
BORDER LINE CONDITIONS Loss of initial mass (3-5-10%)Loss of initial mass (3-5-10%) Transit. the disturbance of heat balance (hypo- in Transit. the disturbance of heat balance (hypo- in
first 30 min. hyperthermy on 3-5 day) first 30 min. hyperthermy on 3-5 day) Changes in the skin (childbirth tumor, the Changes in the skin (childbirth tumor, the
physiological or toxic erythema of the skin, the physiological or toxic erythema of the skin, the peeling)peeling)
Hyper-bilirubinemia ( Hb-100-140 of Mkmol/L on Hyper-bilirubinemia ( Hb-100-140 of Mkmol/L on 3-4 days of life) 3-4 days of life)
Hormonal crisisHormonal crisis Transit. the special feature of the functions of Transit. the special feature of the functions of
kidneys (oliguria, proteinuria, urate infarction) kidneys (oliguria, proteinuria, urate infarction) Transitory dysbacteriosis and the physiological Transitory dysbacteriosis and the physiological
reflexes or the reflexes or the automatisms, which automatisms, which only appear and only appear and therefore not always therefore not always revealed immediately revealed immediately after the next after the next generation. generation.
corneal, conjunctival, throaty, corneal, conjunctival, throaty, swallowing, the tendinous swallowing, the tendinous reflexes of the extremities reflexes of the extremities
mesencephalitic adjusting mesencephalitic adjusting automatisms (labyrinth reflexes, automatisms (labyrinth reflexes, simple and chain neck and body simple and chain neck and body reflexes)reflexes)
BREAST FEEDING AGEBREAST FEEDING AGE
11stst year of life year of life The explosion of child (weight in 1 year The explosion of child (weight in 1 year
of ~10 kg , increase in height ~75 cm)of ~10 kg , increase in height ~75 cm) The intensive formation of the psycho-The intensive formation of the psycho-
motor habits ( up to 1 year he walks motor habits ( up to 1 year he walks and he speaks)and he speaks)
Predominantly milk food with the Predominantly milk food with the gradual introduction of the luresgradual introduction of the lures
Maximum immunizationMaximum immunization
CRIB AND PRE-SCHOOL AGECRIB AND PRE-SCHOOL AGE
Height up to 4 years on 8 cm Height up to 4 years on 8 cm yearly, further on 6 cm yearly, further on 6 cm
Intensive functional development Intensive functional development of cerebral cortex of cerebral cortex
Knowledge of the surrounding Knowledge of the surrounding placeplace
Increase in the frequency of the Increase in the frequency of the traumatismtraumatism
SCHOOL AGESCHOOL AGE
YOUNGERYOUNGER Increase growth and Increase growth and
development of development of musculaturemusculature
Social adaptationSocial adaptation Physical and psycho-Physical and psycho-
emotional overload in the emotional overload in the schoolschool
ELDERELDER Maturity and Maturity and
beginning of the beginning of the function of sexual function of sexual glandsglands
Girls~12 years oldGirls~12 years old Boys~13-15years Boys~13-15years
oldold Overestimation of Overestimation of
the valuesthe values
SKINSKINThin epidermis (2-3 layers)Thin epidermis (2-3 layers)Basal layer is developed well (rapid regeneration Basal layer is developed well (rapid regeneration of the skin) of the skin)Basal membrane is friable and Basal membrane is friable and tender(epidermolysis during pemphigus of tender(epidermolysis during pemphigus of newborn)newborn)Richly vascularized,insufficient sweatRichly vascularized,insufficient sweatIncomplete/imperfect thermoregulationIncomplete/imperfect thermoregulationSebaceous gland is functioning wellSebaceous gland is functioning wellNewborn’s lanugo(Newborn’s lanugo(пушокпушок),),eyebrows and eyebrows and eyelashes develop badly(grow till 3-5years)eyelashes develop badly(grow till 3-5years)
SUBCUTANEOUS FATSUBCUTANEOUS FATAccumulated in the duration of 1.5-2 last months Accumulated in the duration of 1.5-2 last months of the prenatal developmentof the prenatal developmentIntensively increases for the 1Intensively increases for the 1stst half year of the life half year of the lifeContains lot of fatty tissues(fat denser and higher Contains lot of fatty tissues(fat denser and higher than melting temperature)than melting temperature)Disappears more rapidly on the stomach,then Disappears more rapidly on the stomach,then extremities,later on entire face and then cheeksextremities,later on entire face and then cheeksDuring puberty,girls apparently bigger than boys.During puberty,girls apparently bigger than boys.
LYMPHATIC SYSTEMLYMPHATIC SYSTEM Small connective tissue and imperfection of Small connective tissue and imperfection of
cellular structure in newborn’s lymph nodes.cellular structure in newborn’s lymph nodes. Palpate 3-4 groups of lymph nodePalpate 3-4 groups of lymph node Insufficiency of barrier function(generalized Insufficiency of barrier function(generalized
infections)infections) Mature cells,stroma and septa to age of 7-8Mature cells,stroma and septa to age of 7-8 Complete haemopoetic and barrier functionComplete haemopoetic and barrier function
BONE SYSTEMBONE SYSTEM Bone tissueBone tissue - - lots of water,organic lots of water,organic
compounds,fibrous,rich in vessels(less compounds,fibrous,rich in vessels(less fragility).Periosteum elastic(periosteum fractures)fragility).Periosteum elastic(periosteum fractures)
HeadHead – smaller frontal part,sutures and – smaller frontal part,sutures and fontanelles(large to 12-18 months,small-25% of fontanelles(large to 12-18 months,small-25% of newborns-1newborns-1stst 3months),proportional 4/1(adults 8/1) 3months),proportional 4/1(adults 8/1)
TeethTeeth - - с 6-ти мес. (к-во зубов = n-4), где n-возраст в мес. (в год- 8 зубов). К 2м годам-20 шт.
Spine – curvature are formed till 1.5-2 years Chest – conic(al),horizontal arrangement of ribs(малая
MUSCULAR SYSTEMMUSCULAR SYSTEM23.8% of the weight (adults 42-43%)23.8% of the weight (adults 42-43%)In the 1In the 1stst 3months – physiological 3months – physiological hypertone(especially flexors)hypertone(especially flexors)Histologically:increase thickness and number of Histologically:increase thickness and number of muscular fibers,decrease quantity of interstitial muscular fibers,decrease quantity of interstitial tissuestissuesMost intensive development of school age(top to Most intensive development of school age(top to bottom-from neck to the extremities)bottom-from neck to the extremities)
RESPIRATORY ORGAN (1)RESPIRATORY ORGAN (1)Narrow upper respiratory tractNarrow upper respiratory tractNasal concha – to 3 yearsNasal concha – to 3 yearsMucous is rich of blood and lymph vesselsMucous is rich of blood and lymph vesselsSinuses – maxillary(Haymory) grow from age of 2Sinuses – maxillary(Haymory) grow from age of 2
frontal formed till age of 12-15frontal formed till age of 12-15Larynx,trachea and bronchi-narrow,plethoric/full-blooded Larynx,trachea and bronchi-narrow,plethoric/full-blooded croup,obstructive bronchitiscroup,obstructive bronchitisLung volume of newborn 20 times < adultLung volume of newborn 20 times < adultAnatamo-functional unit of lung is sackAnatamo-functional unit of lung is sackUndeveloped elastic tissues-emphysemaUndeveloped elastic tissues-emphysema
RESPIRATORY ORGAN (2)RESPIRATORY ORGAN (2) Type of respiration – up to age of 3 is abdominalType of respiration – up to age of 3 is abdominal
after age of 3 is chestafter age of 3 is chest Character of respiration – puerileCharacter of respiration – puerile
from age of 5-7 is vesicularfrom age of 5-7 is vesicular Percussion – vesiculotympanic resonancePercussion – vesiculotympanic resonance Respiratory rate : newborn – 40 per minRespiratory rate : newborn – 40 per min
age of 1 - 30 per minage of 1 - 30 per min
age of 5 – 25 per minage of 5 – 25 per min
age of 10 – 20 per minage of 10 – 20 per min
CARDIOVASCULAR ORGANS Reconstruction of blood circulationReconstruction of blood circulation ( (АранциАранций й andand БоБо--
талл талл ductsducts, , fenestra vestibulifenestra vestibuli stopstop organisationorganisation.).) Children’s heartChildren’s heart - - 0,7%0,7% ofof body mass body mass,, Adult’s heart Adult’s heart - - 0,5%0,5% Borders Borders : : leftleft isis 1-1,5 см 1-1,5 см to outwardsto outwards fromfrom left medial left medial
clavicular lineclavicular line, , rightright- - along along right parasternalright parasternal line line Heart rateHeart rate- - new bornnew born-140 -140 bpmbpm, 1 , 1 year oldyear old- 120 - 120 bpmbpm, , 5 5 years oldyears old- 100 - 100 bpmbpm, 10 , 10 years oldyears old- 80 - 80 bpmbpm.. Arterial pressure of infantsArterial pressure of infants--80/50, 80/50, Arterial pressure of elder ageArterial pressure of elder age = 80 + 2 = 80 + 2nn,, wherewhere n n – –
adolescentsadolescents- - left cardiogramleft cardiogram
BLOOD
Indexes New Borns Infants Schooling Children
Hb(g/l) 160 -180 120 - 140 120-130
Erythro-cytes (million)
5,5 – 6,0 4,0 – 5,0 3,5 – 4,5
Leuco-cytes (thousand)
Up to 30 Up to 12 Up to 7
PECULIARITIES OF WHITE BLOOD
neutrophils
lymphocytes
5 days 1 year 5 years 10 years
65-70%
30-35%
30%
70%
45% 45%
DIGESTIVE SYSTEM (1)
Weakening of protective function of mucous membraneWeakening of protective function of mucous membrane Decrease of secretory functional glandsDecrease of secretory functional glands Hyposalivation up to 3-4 monthsHyposalivation up to 3-4 months ( ( no amilase and no amilase and
decrease ofdecrease of ptyalinptyalin)) VV of stomachof stomach – – on 2on 2ndnd day day – 10 – 20 – 10 – 20 mlml tilltill 10 10th daysth days – 80 – 80 mlml till 3rdtill 3rd monthmonth. – 120 . – 120 mlml till till 66th monthsth months. – 200-250 . – 200-250 mlml Content of digastric juice = similar to adults’Content of digastric juice = similar to adults’ Decrease activity of pepsin Decrease activity of pepsin ( ( inin 10-15 10-15 timestimes ) ) Less lipaseLess lipase ( ( difficulties in fat difficulties in fat digestiondigestion))
DIGESTIVE SYSTEM (2) Total acidityTotal acidity ЖС ЖС – – new bornnew born- 3-6 - 3-6 mlml 0,1 0,1NN КОН, КОН,
1 1 year oldyear old- 15-20 - 15-20 mlml, 12-15 , 12-15 years oldyears old- 40-60 - 40-60 mlml PancreasPancreas – – low activity of enzymeslow activity of enzymes IntestinesIntestines – – active contamination during and active contamination during and
after birthafter birth ( (coccicocci, , E.coliE.coli, , acidoacido. . bacbac.) .) Natural feedingNatural feeding- - bifido-bacteriabifido-bacteria Artificial feedingArtificial feeding- - enterocoocienterocooci, , E.coliE.coli StoolStool- - aftaft 30-40 30-40 hrshrs. . after birthafter birth– – meconiummeconium first half yearfirst half year – 5-7 – 5-7 timestimes to end of 1to end of 1stst year year – 1-2 – 1-2 timestimes elder than 1 year oldelder than 1 year old – 1 – 1 timetime
URINARY SYSTEM (1)
Embryonic structure of kidneysEmbryonic structure of kidneys ( (up toup to 5-6 5-6 years oldyears old)) Filtration and concentration abilities of kidneys Filtration and concentration abilities of kidneys
decreasedecrease Volume of urine relatively higher than adult’s Volume of urine relatively higher than adult’s
(intensive exchange process(intensive exchange process)) Number of urinationNumber of urination 10 10 dayday – 20-25 – 20-25
tilltill 1 1 yr oldyr old – 15 – 15
tilltill 2-3 2-3 yrs oldyrs old- 1- 100
elder than 3 yrs oldelder than 3 yrs old – 6-7 – 6-7 times per daytimes per day
URINARY SYSTEM (2)
Density of urineDensity of urine – – new born-new born-1002-10041002-1004
10 10 yrs oldyrs old - 1020 - 1020 Daily volume of urineDaily volume of urine ––
new born - new born - 350350mlml
1 yr old1 yr old - 600 - 600 mlml
elder than 1 yr oldelder than 1 yr old: :
600600mlml + 100 х + 100 х n n ( (nn - - ageage))
ENDOCRINAL SYSTEM Prenatal and after birthPrenatal and after birth- - influence of mothers’ influence of mothers’
hormoneshormones Thyroid glandThyroid gland-- during birth relatively larger during birth relatively larger (congenital hypothyroidism)(congenital hypothyroidism) HypophysisHypophysis – – satisfactory growth satisfactory growth ThymusThymus- - too bigtoo big, , regress tillregress till 4-5 4-5 yrs of ageyrs of age
((thymomegaly combine with hyperplasia of thymomegaly combine with hyperplasia of lymph nodeslymph nodes))
Suprarenal glands-Suprarenal glands- differentiate till end of 1differentiate till end of 1stst yr yr Sexual glandsSexual glands are formed till birthare formed till birth. . Girls reach Girls reach
puberty earlier than boyspuberty earlier than boys
NERVOUS SYSTEM
Morphological and functional immaturityMorphological and functional immaturity ((dynamicaldynamical perfectionperfection))
Reflexes of new bornReflexes of new born ( (change on deliberate change on deliberate daysdays))
Convolutions of brain of new born lessConvolutions of brain of new born less apparentapparent CerebrumCerebrum new born new born – 1/8 – 1/8 of body mass of body mass
adultadult– 1/40 – 1/40 of body massof body mass By By 9-10 9-10 yrs old weight of brainyrs old weight of brain ~~ 1300 1300 gg
increase of weight ends when reaches 18 yrs oldincrease of weight ends when reaches 18 yrs old
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