医学精品课件：01 儿科学绪论.ppt

1、1Overview of Pediatrics Prof.Cheng Qian Dept.of Child Health Care CMUC 2Pediatrics is concerned with the childs physical,mental,and psychosocial health.The field of pediatrics is about childrens health and the factors that affect their health.3Children:0-18years42009年世界各国年世界各国15岁以下人口排名岁以下人口排名 排名国家排名

2、国家 15岁以下人口（万）岁以下人口（万）占世界比例占世界比例 占该国总人口比例占该国总人口比例 1 印度印度 38370 20.9%32%2 中国中国 25360 13.8%19%3 尼日利亚尼日利亚 6834 3.7%45%6 美国美国 6147 3.3%20%7 巴西巴西 5361 2.9%28%15 俄罗斯俄罗斯 2121 1.2%15%18 日本日本 1658 0.9%13%美国全球健康政策协会（美国全球健康政策协会（global health policy)global health policy)20092009年世界共有年世界共有1515岁以下儿童人口岁以下儿童人口18.361

3、8.36亿，占世界总人口亿，占世界总人口27%27%5A state of complete physical,mental,and social well-being and not merely the absence of disease or infirmity.-WHO,1948HEALTH6Childrens health should be defined as the extent to which individual children or groups of children are able or enabled to:develop and realize their

4、 potential satisfy their needs develop the capacities to allow them to interact successfully with their biological,physical,and social environmentRudolphs Pediatrics,20107Developmental PediatricsPreventive PediatricsClinical Pediatrics Community pediatricsThe Scope of Pediatrics8Its the science to s

5、tudy of growth and development of child from moment of conception through adolescence,including physical growth and neuro-psychological development.Research on various factors that will influence growth and development and promotion to achieve full potential in adult.Developmental Pediatrics9Prevent

6、ive pediatricsPreventive in the health care of infants,children,and adolescents is at the core of the field of pediatrics.10 Primary Preventionthe measures of health promotion:e.g.nutrition,health education,physical activity,Immunization,accident prevention,mental health and well environment,etc.Sec

7、ondary Preventionthe measures of preventing diseases to happen.e.g.growth supervision,newborns screening,prenatal examination etc.treatment of ill children and rehabilitation Tertiary Prevention11Clinical pediatricsPrimarily focused on diagnosis and treatment of diseases in childhood.12Clinical pedi

8、atrics divides into sub-speciality according to diseases related to organ systemDigestive systemRespiratory systemCardiovascular systemNephrology and urology Endocrinology Dermatology Hematology Neurology.Infectious disease Metabolic disordersImmunologyAllergy ect.13Clinical pediatrics divides into

9、sub-speciality based on childs agePerinatologyNeonatologyAdolescent medicine14Pediatrics divides into sub-speciality basing on health care system Primary health care Intensive care Emergency care Rehabilitation care15Community pediatricsResearch on social factors influence child health,e.g.economic,

10、education,environment,family and so on.16 Is a kid miniature of a adult?17Anatomye.g.size and proportion of body18PhysiologyNormal resting pulse rate and respiratory rate in children Age beats/min breaths/min newborn 140 40 5ys 100 25 15ys 70 20 19e.g.Typical sleep requirements in children20Patholog

11、yacute lobar pneumonia bronchopneumonia21miliary tuberculosisadvanced pulmonary tuberculosis(Arrows indicate the location of cavities within these light areas)Pathology22Clinical aspectthe category of diseases ex.congenital Infectiousthe manifestation of diseasesex.acute changeful23the diagnosis of

12、diseaseThe treatment of diseasethe prognosis of diseaseClinical aspect24 Is a kid miniature of a adult?25The Developmental Periods Across ChildhoodFETUSINFANCYTODDLERPRE-SCHOOLSCHOOL CHILDRENADOLESCENCE26The illnesses and problems children encounter are highly age-dependent.The childs age will deter

13、mine the questions you ask on history-taking,how you conduct the examination,the diagnosis or differential diagnosis and your management plan.27Embryo:0-12 wsMiddle fetus:13-28 wsLate fetus:29-40 wsFetal PeriodFetal periodEmbryonic period28 致畸敏感期致畸敏感期29Full-term infant 37 ws GA 42wsPreterm infant GA

14、 37ws Post-term infant GA 42ws*the meaning of several termsGA:gestational age30Infant Period(0-12mo)neonatal period(0-28ds)Infancy is a period of rapid but decelerating growth rate.Growth of brain occurs rapidly.Attention on nutrition and rearing.31Perinatal PeriodThis period is the interval from 28

15、ws of gestation until the 7th day after birth.This period is the time of life with the highest mortality rate of any age interval.*Close cooperation between the professionals involved in the care of pregnant women and those for caring for the newborn infants.32Toddler period(1-3y)Growth rate slows d

16、own.Psychological changes are in bursting phase.Mobility increases;Walking independently;Interested in imitation.Attention on education(nature,nurture and nutrition).33Preschool years(3-5y)Physical growth further slows down.Development of cognition and widening social sphere.Emphasizing the behavior

17、 and emotional development.Prevention of accident.34School age(6-11y)Wide range presents normally in this age group.Physical coordination and mental maturity.Emphasizing school fundamental education and social ability.35Adolescence(teenager)10-20year36胎儿后期胎儿后期胎儿中期胎儿中期胚胎期胚胎期围产期：胎儿围产期：胎儿28周周-新生儿新生儿1周周

18、40周周 28周周 12周周0幼儿期幼儿期（1-21-2岁组）岁组）不足不足1岁岁28日日 1周周 婴儿期婴儿期（0岁组）岁组）学前期学前期（3-53-5岁组）岁组）不足不足6岁岁 学龄期学龄期（6-116-11岁岁组）组）不足不足12岁岁青春后期青春后期（3-43-4年）年）青春期青春期（2-42-4年）年）青春前期青春前期（2-32-3年）年）21岁岁 18岁岁13岁岁体格生长停止体格生长停止第二性征性发育成熟第二性征性发育成熟第二性征出现第二性征出现 女女9-11岁岁,男男11-13岁岁 婴儿婴儿 新生儿新生儿不足不足3岁岁*summary37 Health disparitiesUnd

19、er 18 year:constitute approximately 1/3 of whole populationCurrent Challenges In Pediatrics38based on UNICEF,State of the Worlds Children,2011 Health disparities39The category of disease has changeda greater percentage of preterm,low birth weight,or very low birth weight newborns are surviving conge

20、nital malformations mental retardation40Environmental factors that affect optimal outcome of child healthe.g.natural and social environmentothers41Change in Role and Practice Environment beween 20th and 21st Centuries20th-century Pediatrician 21st-Century PedatricianFocus of clinical knowledgeInfect

21、ions and syndromes,empiric behavior and developmentGenomics,environment,neuroscience-based behavior and developmentWho controls carePhysicianPatient/familyConsistency of careHighly variable:individual provider basedHighly reliable:system based and evidence basedSetting of careInpatient and outpatien

22、tInpatient,outpatient,or communityRole in child healthInsular,focused on biological and developmental healthCollaborative,integrates biologic and developmental aspects of health with broader domainsAccess to and application of knowledgeDelayed(months/years)Immediate and ongoing42Lets do our best for children.Childrens Health,The Nations Wealth.43Reference1.Illustrated Textbook of pediatrics,the 3rd.Edition 2.Nelson Essentials of Pediatrics,the 5th.Edition3.Nelson Textbook of Pediatrics,the 18th.Edition 4.Rudolphs Pediatrics,the 22nd.Edition 5.儿童保健学儿童保健学 第二版第二版 人民卫生出版社人民卫生出版社E-mail: