Dr Seema Verma
MBBS, DCH (LKO) MIAP
Department of Pediatrics
Differences between adult and pediatric medicine
The body size differences are paralleled by maturation changes. The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Congenital defects, genetic variance, and developmental issues are of greater concern to pediatricians than they often are to adult physicians. A common adage is that children are not simply “little adults”. The clinician must take into account the immature physiology of the infant or child when considering symptoms, prescribing medications, and diagnosing illnesses.
A major difference between the practice of pediatric and adult medicine is that children, in most jurisdictions and with certain exceptions, cannot make decisions for themselves. The issues of guardianship, privacy, legal responsibility and informed consent must always be considered in every pediatric procedure. Pediatricians often have to treat the parents and sometimes, the family, rather than just the child. Adolescents are in their own legal class, having rights to their own health care decisions in certain circumstances. The concept of legal consent combined with the non-legal consent (assent) of the child when considering treatment options, especially in the face of conditions with poor prognosis or complicated and painful procedures/surgeries, means the pediatrician must take in to account the desires of many people, in addition to those of the patient.
Aspiring medical students will need 4 years of undergraduate courses at a college or university, which will get them a BS, BA, or other bachelor’s degree. After completing college future pediatricians will need to attend 4 years of medical school and later do 3 more years of residency training, the first year of residency is formerly called “Internship.” When completing the 3 years of residency, medical students are eligible to become certified in pediatrics by passing a rigorous test that deals with medical conditions related to infants and children.
In high school, future pediatricians are required to take basic science classes, such as, biology, chemistry, physics, algebra, geometry, and calculus and also foreign language class, preferably Spanish, and get involved in high school organizations and extracurricular activities. After high school, college students simply need to fulfill the basic science course requirements that most medical schools recommend and will need to prepare to take the MCAT (Medical College Admission Test) their junior or early senior year in college. Once attending medical school, students courses will focus on basic medical sciences, like human anatomy, physiology, chemistry, etc., for the first two years. The second two years is when medical students start to get “hands-on” experience with patients
Training of pediatricians
The training of pediatricians varies considerably across the world. Depending on jurisdiction and university, a medical degree course may be either undergraduate-entry or graduate-entry. The former commonly takes five or six years, and has been usual in the Commonwealth. Entrants to graduate-entry courses (as in the US), usually lasting four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Medical graduates hold a degree specific to the country and university in and from which they graduated. This degree qualifies that medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for “internship” or “conditional registration”.
Pediatricians must undertake further training in their chosen field. This may take from four to eleven or more years, (depending on jurisdiction and the degree of specialization). The post-graduate training for a primary care physician, including primary care pediatricians, is generally not as lengthy as for a hospital-based medical specialist.
In the United States, a medical school graduate wishing to specialize in pediatrics must undergo a three-year residency composed of outpatient, inpatient, surgical, and critical care rotations. Specialties within pediatrics require further training in the form of 3-year fellowships. Specialties include critical care, gastroenterology, neurology, infectious disease, hematology/oncology, rheumatology, pulmonology, child abuse, emergency medicine, endocrinology, neonatology, and others.
In most jurisdictions, entry-level degrees are common to all branches of the medical profession, but in some jurisdictions, specialization in pediatrics may begin before completion of this degree. In some jurisdictions, pediatric training is begun immediately following completion of entry-level training. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing pediatric (or any other) specialization. Specialist training is often largely under the control of pediatric organizations (see below) rather than universities, and depend on jurisdiction.
Common procedures include:
• Inguinal Hernia Repair – Total laparoscopic needle-assisted or open technique
• Umbilical Hernia repair
• Epigastric Hernia Repair
• Undescended Testicle – Laparoscopic or open technique
• Lumps and Bumps
• Branchial Cysts/Sinuses
• Lymph Node biopsy
• Central Venous Line/Port Removal
• Breast Mass Excision/Biopsy
• Labial Adhesions
• Percutaneous Liver Biopsy
Common inpatient laparoscopic and open procedures include:
• Nissen Fundoplication – management of gastroesphageal reflux disease
• Cholecystectomy – gallstones
• Appendectomy – appendicitis
• Splenectomy – splenomegaly
• Pectus Excavatum Repair – pectus excavatum or caved in chest
• Surgery for inflammatory bowel disease – Crohn’s or Ulcerative colitis
• Colostomy closure/reversal
• Ovarian masses – tumors or cysts
• Tumor Biopsy
• Thoracotomy/Thoracoscopy – chest tumors, lung cysts
• Laparoscopy/Laparotomy – abdominal
• Pyloromyotomy – pyloric stenosis
• Gastrostomy/PEG placement – failure to thrive or feeding intolerance
• Skin Grafting – burns
• Colonic Pull-through – Hirschsprung’s Disease
Common neonatal surgeries include, but are not limited to:
• Repair of Esophageal Atresia/Tracheoesophageal Fistula
• Repair of Gastroschisis
• Repair of Omphalocele
• Repair of Congenital Diaphragmatic Hernia
• Abdominal Masses/Cysts
• Colostomy – Imperforate Anus, bowel obstruction, etc.