Раздел 2. Из истории педиатрии. Современные проблемы педиатрии overview of pediatrics

Pediatrics in concerned with the health of infants, children, and adolescents, their growth and development, and their opportunity to achieve full potential as adults. As physicians who assume a responsibility for children’s physical, mental, and emotional progress from conception to maturity, pediatricians must be concerned with social or environmental influences, which have a major impact on the health and wellbeing of children and their families, as well as with particular organ systems and biologic processes. The young are often among the most vulnerable or disadvantaged in society, and thus their needs require special attention.

Scope and history of pediatrics

Over a century ago, pediatrics emerged as a medical specialty in response to an increasing awareness that the health problems of children differ from those of adults and that the child’s response to illness and stress varies with age. The emphasis and scope of pediatrics continue to change, but this basic observation remains valid.

The health problems of children vary widely among the nations of the world depending on a number of factors, which are often interrelated. These factors include: (1) the prevalence and ecology of infectious agents and their hosts; (2) climate and geography; (3) agricultural resources and practices; (4) educational, economic, social, and cultural considerations; (5) stage of industrialization; and (6), in many instances, the gene frequencies for some disorders.

Pediatrics

Pediatrics is a medical speciality dealing with the development and care of children and with the diagnosis and treatment of childhood diseases. The first important review of childhood illness, anonymous European work called ”The Children’s Practice ”, dates from the 12^th century. The specialized focus of pediatrics did not to emerge in Europe until the 18^th century. The first specialized children’s hospitals, such as the London Founding Hospital, established in 1745, were opened at this time. These hospitals later became major centers for training in pediatrics, which began to be taught as a separate discipline in medical schools by the middle of the 19^th century.

The major focus of early pediatrics was the treatment of infectious diseases that affected children. Thomas Sydenham in Britain had led the way with the first accurate descriptions of measles, scarlet fever, and other diseases in the 17^th century. Clinical studies of childhood diseases proliferated throughout the 18^th and the 19^th centuries, culminating in one of the first modern textbooks of pediatrics, published by Frederic Rillet and Anttoine Barthez in France in 1838-1843. But there was little that could be done to cure these diseases until the end of the 19^th century. In the 20^th century the first well-child clinics were established to monitor and study the normal growth and development of children. By the mid-20th century , the use of antibiotics and vaccines had all but eliminated most serios infectious diseases of childhood in the developed world, and infant and child mortality had fallen to the lowest levels ever. In the last half of the century, pediatrics again expanded its boundaries to incorporate the study of behavioral and social as well as specifically medical aspects of child health. Not only do problems differ in various parts of the world, but priorities do also, because they must reflect local concerns, resources, and needs. The assessment of the state of health of any community must begin with a description of the incidence of illness and must continue with studies that show the changes that occur with time and response to programs of prevention, case finding, therapy. New problems become the foci of the attention and efforts of pediatric clinicians and research workers. Accordingly, with time, there may be major changes in the relative importance of the various causes of childhood morbidity and mortality.