Pediatrics and Neonatology

The nutritional requirements of babies and young adolescents differ from that of adults in a  number of aspects due to their energy expenditure (i.e., basal metabolism, high physical activity and metabolic response to food), rate of growth, body composition, and physiological changes (puberty, for instance). Due to the high nutritional needs of infants and adolescents, there is an increased risk for nutritional disturbances (i.e., undernutrition and overnutrition). This risk may become more complex by a lack of knowledge and/or awareness of signs and symptoms on the caregiver’s end. A pediatrcian can make a good nutritional assessment, which includes family.

Allergy symptoms commonly occur in children. Atopy is a tendency of exaggerated IgE antibody production and is defined by the presence of specific IgE in vivo or in vitro. Atopy represents a predisposition to atopic or allergic diseases including asthma, eczema, rhinitis and allergy. Scientific evidence of the systemic link between all of the atopic diseases has increased greatly. The atopy march starts early in life and it is widely believed that the fetal environment may be important for both the development of subsequent sensitization and disease manifestation. Early events under the influence of a spread of environmental factors, like exposure to environmental endotoxin, allergens, infections, and variations in nutrient intake, affect the expression of the atopy genotype. The age of onset of every atopic disease is different and may be influenced by the aforementioned factors. Typically, atopic eczema and allergy are commonly seen in young infants; while asthma usually starts after the age of three years, and rhinitis develops at a later stage in childhood.

The subspecialty of pediatric infectious diseases includes both pediatrics and infection. Bacterial, fungal, parasitic or viral infections are all infectious diseases that are reason for concern. These illnesses need to be treated by specialists who are committed to preventing and treating acute and chronic infectious diseases. These include Lyme disease HIV/AIDS, pneumonia, osteomyelitis tuberculosis persistent fever or fever of unknown origin, lymphadenopathy recurrent infections, complicated methicillin-resistant staphylococcus aureus (MRSA) infection.

Pediatric cardiology is an academic as well as clinical specialty and the pediatric cardiologist has a major role in the education of students, doctors, primary health care specialists, nurses and paramedical personnel. Close liaison with pediatrics, pediatric subspecialties, cardiothoracic surgery, adult cardiology, obstetrics, radiology and pathology is required.

Pediatric and Neonatal pulmonology is the study of lung diseases in infants and children. Pediatric pulmonologists are committed to provide special care for children with asthma, cystic fibrosis, and other chronic lung diseases. Pediatric pulmonology also emphasizes the importance of understanding respiratory physiology and paying detailed attention to the relevant physical exam. Pediatric pulmonology is also associated with providing care to patients with complex autodigestive disorders, those undergoing lung transplantation, and patients with tracheostomies who may or may not be technology dependent.

Traumatic wounds are a common reason for presentation to the emergency department. A wound could be defined as a physical disruption of tissue from trauma. They can be accidental as a result of trauma or intentional from surgery. Generally, wounds include abrasions, burns, lacerations, punctures, and larger wounds. Effective management of wounds requires a basic understanding of the physiologic process of wound healing. Pediatric and neonatal surgery may also be required for the surgical care of birth defects in a child or because of an injury or trauma. These may include pediatric cardiothoracic surgery, pediatric nephrological surgery, pediatric neurosurgery, pediatric urological surgery, pediatric emergency surgery, pediatric hematological and gastrointestinal surgery, pediatric orthopedic surgery, pediatric plastic and reconstructive surgery, pediatric oncological  surgery, surgery involving fetuses or embryos and surgery involving adolescents or young adults..

Pediatric nephrology deals with the diagnosis, investigation and management of chronic and acute kidney ailments, including the supply of dialysis and renal transplantation. Pediatric nephrology also encompasses all aspects of renal physiology, including fluid management and disturbances in electrolytes and acid-base equilibrium. Pediatric  nephrologist is skilled within the management of acute kidney injury (AKI), which can be managed conservatively or with renal replacement therapy (RRT), including haemodialysis (HD), peritoneal dialysis (PD), and continuous venovenous haemodialysis (CVVHD) and continuous venovenous haemodiafiltration (CVVHF). they're also committed to the management of chronic renal disorder (CKD), including the pre-dialysis phase, peritoneal dialysis, hemodialysis and transplantation.

Children account for only a small percentage of pre-hospital emergency patients but are a special challenge for the treating physician. The broad spectrum of diseases, the wide age range with the physiological and anatomical changes that occur in it, and the special psychological emotional, and communicative features of children make pediatric emergencies a special challenge for emergency physicians. A mastery of basic emergency techniques including clinical evaluation of the child, establishment of venous access, airway management, resuscitation, and drug dosing is essential for the successful emergency treatment of children. The common non-traumatic pediatric emergencies can be classified into four cardinal manifestations  respiratory distress, altered consciousness, seizure, and shock.

Pediatric ophthalmology may be a sub division of ophthalmology which is committed to the care of children’s eyes, and has the best knowledge of possible conditions that affect the pediatric patient and his/her eyes. Neurologic development of vision occurs up until the age of 12 years. Misalignment of the eyes (strabismus), uncorrected refractive error (myopia, hyperopia, and astigmatism), and asymmetry of refractive error (anisometropia) between the 2 eyes can negatively affect this development and cause amblyopia (“lazy eye”). If these conditions are diagnosed and treated early, good vision can develop and may be maintained. Certain diseases elsewhere within the body, like diabetes, can affect the eyes, and therefore the pediatric ophthalmologist addresses.

Pediatric endocrinology is a specialty concerned with the endocrine systems of infants, children, adolescents, and young adults.  Because of the complexity of the endocrine system, a number of diseases and conditions can be traced to problems in this system. Pediatric endocrinology provides diagnostic and therapeutic services for infants and young adolescents with Diabetes mellitus, Type 1 and Type 2, hypoglycemia and disorders of physical growth, disorders of puberty (including precocious puberty and delayed puberty) and sexual maturation Hyperthyroidism and Hypothyroidism, short stature, pituitary function, Congenital Adrenal Hyperplasia (CAH), Turner Syndrome, and calcium and phosphorous metabolism- calcium disorders hyperkalemia and juvenile osteoporosis).

pediatric neurology or child neurology deals with the diagnosis and management of neurological conditions in neonates, infants, children and adolescents. The discipline of child neurology encompasses diseases and disorders of the spinal cord, brain, peripheral nervous system, autonomic nervous system, muscles and blood vessels that affect individuals in these age groups. A pediatric neurologist has the specialist training and knowledge to assess, diagnose and treat a child with problems that involve the nervous system. The conditions that pediatric neurologists deal with, vary considerably, from relatively simple disorders such as migraine or cerebral palsy through to more complex and rare conditions such as metabolic diseasor neurodegenerative disorders.

Pediatric orthopedics is a specialty that deals with the evaluation and management of musculoskeletal problems including the growing bones, joints, or muscles in children (newborns to young adolescents). Musculoskeletal problems and their evaluation/treatment in children differ from those of an adult. In children, musculoskeletal problems arise due to growth which does not occur in adults. The complex musculoskeletal disorders in children are best treated by a medical-surgical approach by a pediatric orthopaedic doctor. Some of the common conditions treated by pediatric orthopaedic doctors include deformities of the limb and spine, present at birth or later, such as limb length discrepancy, scoliosis and club foot; abnormalities in gait/limping; fractures; infections or tumors in the bone or joint. Depending on the condition, pediatric orthopaedists provide appropriate non-surgical or surgical treatments to address the problems.

Pediatric dermatology focuses on the treatment and management of children’s skin, hair and nail conditions. These conditions can develop as children grow, or they can be present from birth. Pediatric dermatology focuses on children from infancy through adolescence. Pediatric dermatology deals with the skin problems, which may or may not require treatment, like acne, birthmarks, cysts, hives, lesions, moles and warts. Conditions in children where treatment is necessary include albinism, alopecia, atopic and contact dermatitis, eczema, epidermolysis bullosa, ichthyosis, hemangiomas, psoriasis, neurofibromatosis and vitiligo  

A medical home is an idea in which a primary care provider is the eventual basis of all health care for a child. This would include acute care visits for illnesses and injuries, anticipatory guidance, immunizations and vaccinations, growth and development monitoring and nursing, preventive health maintenance, and for children with special health care needs, especially; a coordinated management of care among other medical and nonmedical specialists (speech therapy, audiology, child development and school programs, and so on). Pediatrics is committed to improving the physical, emotional, and social health of infants, children, and adolescents through novel and innovative medical care, research, education, training, and advocacy.

Neonatology is a division of pediatrics that specifically deals with medical care of newborn infants, especially the premature or preterm or ill. Neonatology is a specialized sub-discipline of pediatrics since neonatologists have to be trained specifically to handle the most complex and high-risk complications. Perinatology is concerned with the medical care of the mother as well as the fetus at higher-than-normal risk for complications. A high-risk infant might be cared for by a primatologist before birth and by a neonatologist after birth.