Children are unable to communicate or are not effective and accurate in communicating their condition, which makes it the responsibility of those who are taking care of the children to achieve an appropriate diagnosis and thus begin appropriate treatment of diseases. Every newborn and child needs customization of care, handling and treatment with appropriate dosages based on age and weight and that judgment and understanding on the part of the clinician make this the speciality of Pediatric Medicine and Pediatric Surgery very exciting as well as demanding.
A child is not a miniature adult. The health status of children is constantly changing as they are in a growing phase and their related issues are completely different from those in adults. Routine care of children of all age groups in itself is a tedious task as each and every age group has its own need and requirement in terms of understanding and caring for the child.
When we talk of diseases and a sick newborn or child, each age group has a different set of diseases that occur. Also, the behaviour of the newborn or a child affected by the same disease is different as each child’s health and nutrition’s status is different. Speaking of newborn babies, healthy full-term babies delivered of normal delivery are also not of the same weight and not of similar health conditions both internally as well as externally (environmental factors), these differences completely change the management of these babies including the dosages of the medicines and responses to treatment.
Pediatric Medicine and Pediatric Surgery
Pediatric Medicine and Pediatric Surgery are the two main branches of the medical profession that deal with diseases of children from birth (in fact even from the antenatal period (if any birth defect is detected) till 18 years of age.
Specialisation and categorisation
With the advancement of medical science and technology, there is sub-specialisation in both the main branches and categorisation of doctors dealing with children in two ways-
Based on the age of the child such as neonatologist (looking after only the newborn babies) or General Pediatricians (looking after children after the newborn period) or Adolescent paediatricians (looking after the needs of teenage children) and for surgical diseases of children General Pediatric Surgeons look after the common as well as advanced surgical conditions.
Based on the disease system/organ in Pediatric medicine such as Pediatric nephrologist (for kidney), Pediatric cardiologist (for the heart), Pediatric hepatologist (for liver), Pediatric neurologist (for the brain), Pediatric endocrinologist for endocrine glands), Pediatric pulmonologist (for lungs), Pediatric gastroenterologist (for intestines), haematologist (for blood diseases) oncologist (for cancer in children), etc.
The subspecialties in Pediatric Surgery based on system/organ similarly are Pediatric Anaesthesia, Pediatric Neonatal surgery (for newborn babies), Pediatric Hepatobiliary Surgeon (for liver surgeries), Pediatric Gastrointestinal surgeon (for intestinal surgical) diseases, Pediatric Urologist (for kidney surgeries), Pediatric Onco-surgeon (for childhood cancers), Pediatric orthopaedics (for bone and related disease), Pediatric ENT surgeon, Pediatric Ophthalmologist (for eyes), Pediatric plastic surgery and Burns, Pediatric Neurosurgery (for brain surgeries), Pediatric cardiothoracic surgery (for heart surgery), Pediatric endocrine surgery (for endocrine organ diseases), Pediatric Reconstructive Surgery, Pediatric Maxillofacial surgery, etc.
The allied branches also specialised for children are Pediatric Radiology, Pediatric Physiotherapy, Pediatric Occupational therapy, Pediatric Dietetics, Pediatric Nursing which is highly specialised as well as an integral part of the care of the child.
The need of the hour
First and foremost adequate and appropriate methods of caring and handling newborns and children have to be laid down. Deficiency in knowledge, understanding and caring on the part of all those who handle children right from parents and relatives to the medical and nursing team is a big challenge that India is facing even in the metro cities. Ignorance leads to a delay in diagnosis and treatment which is detrimental to the health of the child as children deteriorate very rapidly as compared to the adults and succumb to their illnesses if prompt action is not taken.
Skilled medical and nursing professionals’ availability is also lacking in our country. Where an estimated 50-60% of healthcare is offered by private clinicians and nursing home sectors in our country, skill development in specific areas of neonatal and pediatric care are lacking and thus even those primarily trained in adult diseases are treating and managing many conditions in children including performing operations. This certainly affects the outcome of both the medical and surgical conditions some of which become irreparable or uncorrectable, thus eventually leading to unhealthy adult society.
Innovations and Pediatric care
Apart from technological innovations, the basic concept of “Humanised Pediatric Care” has evolved which gives priority to the emotional care of the suffering child, to reduce the adverse psychological impact of disease, procedures, treatment and surgeries in children. The broad areas under which innovations in pediatric healthcare can be categorized are :
- Family-centred care.
- High technology care – advanced ventilators, precision scopes for newborns and children, minimally invasive surgical procedures, robotic surgeries, etc.
- Evidence-based practice – clinical trials for invasive versus non-invasive or minimally invasive care.
- Humanized Pediatric care – wherein every child is prepared psychologically for the treatment and procedures.
- Atraumatic care – such as skin probes, skin patches for drug delivery, etc.
- Preventive Pediatric care – by mandatory, regular, universal vaccination programs.
- Health promotion – awareness of health and disease, care of nutrition, growth monitoring of each and every child in India.
About the author
Prof (Dr) Sushmita N Bhatnagar is Head, Department of Pediatric Surgery, BJ Wadia Hospital for Children, Parel, Mumbai