What Is a Pediatrician?
Pediatrics is one of the four major branches of medicine along with surgery, internal medicine, and obstetrics and gynecology. The term itself is of Greek origin and derived from the words the first is “pais” which means child and the second is “iatros” which means healer or in the modern world, doctor. Pediatricians are healers of children.
The truth is that we’ve all been to a pediatrician in our lives. We’ve been there as patients and we’ve taken our siblings, children, or relatives to pediatricians too. Every family has one just like every family has a family doctor. These are two essential primary care specialties which we refer to whenever we complain of something. Just because a pediatrician is a primary care doctor that doesn’t mean he or she should be taken lightly. Would you trust anyone with your son or daughter? I doubt it. When it comes to our children we’re always looking for the best of the best. These are our children and there’s no room for error. That’s why pediatricians are extremely important members of the medical family. They have to be alert and prepared to deal with any emergency or condition presented to them. Children are more prone for complications as their fragile bodies can’t handle as much stress as adults. A child who loses 1 liter of blood will definitely suffer more than an adult who may just need minor fluid replacements.
Common Conditions They Deal With
Common cold and the flu: These are two conditions pediatricians and family doctors face throughout the year although the flu is definitely a lot more common during the colder months of the year. A child will suffer from a runny nose and a sore throat and that’ll be pretty much it with the common cold. With the flu it’s a little more severe. The child will likely have generalized bony and muscle aches as well as a high fever. The common cold usually only has a mild grade fever. The flu needs careful monitoring as it can be complicated by pneumonia which can be lethal in adults so imagine how much more stressful pneumonia is in children. A pediatrician will mostly prescribe anti-pyretics to bring down the fever as well as analgesics to ease the muscle and bone aches. Both are fairly common conditions and we’ve all certainly suffered from them at one point or the other in our lives.
Otitis media: Otitis media is an infection of the middle ear. This is another common condition in children. Otitis media is more dangerous in kids because of the risk of the infection spreading to the brain as the skull still hasn’t completely fused together (which is normal in children) so there are gaps for the infection to extending upward from the inner ear into the skull. The symptoms may not be apparent and pointing towards otitis media as the child depending on his or her age might not be able to describe what’s hurting him or where the pain is. Sometimes otitis media presents with abdominal pain resembling gastroenteritis so it’s important to examine the ear in cases of gastroenteritis in children.
Gastroenteritis: This is a common disease that affects both adults and children, but as we grow up our immunity is exposed to more pathogens and becomes more developed so as adults we’re a little more resistant to gastroenteritis and it takes something significantly virulent to affect us. The added risk when it comes to children is that with severe diarrhea and vomiting they can be prone to dehydration which their fragile bodies can’t handle for too long or if too severe. That’s why a pediatrician will mostly focus on rehydrating the child as most cases of gastroenteritis resolve on their own. The important thing is to avoid dehydration during the disease then the recovery process.
Rash: Children get all sorts of rashes. Some are mild and some can be nasty, but luckily despite making the child uncomfortable for a few days they confer lifelong immunity. That’s why we get rashes as children but don’t get them again as adults. Of course we have plenty of vaccines to thank for the decline in diseases that can cause a rash such as rubella and measles. We also have a chickenpox vaccine now. Besides dealing with children who have a rash, a pediatrician plays an extremely important role in prophylaxis. It’s the pediatrician’s job to make sure that his or her patients are up to date on their vaccinations and to make sure parents understand the importance of vaccines and not to neglect them. Some of the major vaccines now are the MMR (measles, mumps, rubella), polio, and the DPT (diphtheria, pertussis, and tetanus) vaccines
Congenital anomalies: Pediatricians are the ones who deal with children born with congenital anomalies. Some anomalies present since the first day of birth while others may take weeks to develop. Diseases such as Hirschsprung disease and VSD may take a few weeks to start developing symptoms. Others that present straightaway include esophageal atresia and transposition of the great vessels. Early detection of these is essential so that they can be treated adequately before the development of complications and before they start affecting the child’s growth. Some anomalies will present from the moment the child is born like a cleft lip or palate for example. Adequate steps should be taken in order to fully diagnose the extent of the defect and start planning the repair.
Malignancies: It’s terrible that people get cancer, but it’s definitely more terrible that children can get cancer too. Tumors like Wilms tumor, neuroblastoma, and leukemia all affect children. A good pediatrician will suspect and diagnose these malignancies as early as possible before they progress and become inoperable which would result in a poorer prognosis.
A pediatrician’s job isn’t an easy one and if you believe that all they do is treat sore throats and runny noses then you’re definitely wrong. Their job is far more complicated than that and they need to be on their toes in order to detect serious health problems.
History of Pediatrics
Being one of the major branches of medicine, pediatrics is definitely not a new science. It’s been around for thousands of years. The earliest findings relating to pediatrics are in 1552 BC where there are descriptions on papyrus of breastfeeding practices as well as cures of ocular diseases and worms. The next point in history where pediatrics pops up is around the year 400 BC where Hippocrates wrote about cephalohematoma, asthma, diarrhea, mumps, hydrocephalus, and worms. This is evidence that pediatrics has been around for an extremely long time as these diseases all present in childhood. Hydrocephalus, cephalohematoma, and mumps almost exclusively present during childhood and asthma also mostly starts during the childhood period. Soranus of Ephesus wrote in 100 AD about the fingernail test which can be used to acquire an idea about the quality and fat content of a woman’s breast milk. In the year 200 AD, Galen described pneumonia, intestinal prolapsed, and ear discharge (mostly otitis media).
Moving to recent times, the first hospital dedicated to pediatrics that we know of is the Hospital des Enfants Malades which opened in 1802 in Paris. The name translates to the Hospital of Sick Children. This hospital only hosts and treats patients younger than 15 years of age. Hospital des Enfants Malades was a pioneer as it was the first purely pediatric hospital in the world and led to the spread of the idea that there should be purely pediatric hospitals everywhere else. Soon other countries followed France and started opening their own hospitals dedicated to children. These countries include England, Germany, Russia, and Poland. 1855 witnessed the opening of the first pediatrics hospital in America, mainly in Philadelphia.
The father of pediatrics in the United States is Dr. Abraham Jacobi. He was a German pediatrician who moved to the United States in 1853. He started forming pediatric health societies as well as opening pediatric departments in multiple hospitals in New York.
Significant events in the history of pediatric medicine
One of the oldest of these events happened in 1796 when Edward Jenner started testing and discovered the first smallpox vaccine. Of course the smallpox vaccine is one of the greatest discoveries in all of medicine not just pediatric medicine as smallpox is a potentially lethal disease that has now been eradicated from the Earth thanks to the extensive use of the vaccine all over the world.
In 1825 the world witnessed two of its first ever pediatric medical textbooks. The first of these is called “Practical Observations on Diseases of Children” by Dr. George Logan and the other is called “Treatise on the Physical and Medical Treatment of Children” by Dr. William Potts Dewees.
In 1849 America witnessed the first woman to graduate from medical school in Dr. Elizabeth Blackwell. Dr. Elizabeth then went on to study pediatrics in prominent children’s hospitals in England, Scotland, and Paris. She then went back to New York and helped start an infirmary for women and children.
In 1862 Louis Pasteur invented pasteurization. It wasn’t until 1886 that Franz von Soxhlet used the technique to pasteurize milk which is a prominent event in history as we can all now drink milk safely without worrying about getting the stomach flu or worrying about our children getting infected especially considering how much more they consume milk compared to us adults.
The diphtheria and pertussis vaccines were discovered in the years 1923 and 1926. As we mentioned previously these two vaccines which are part of the DPT vaccine are mandatory in the United States. Diphtheria can cause suffocation and death as it forms membranes in the throat than can occlude the airways. Diphtheria also causes severe toxemia. Pertussis causes the whooping cough which consists of severe bouts of coughing that can last up to 4 weeks. The coughing is so severe and powerful that it can cause intracranial hemorrhage due to the increase in pressure associated with the act of coughing itself.
Dr. Hattie Elizabeth Alexander was a pediatrician at New York Presbyterian Morgan Stanley Children’s Hospital. She was also a microbiologist. Her combined knowledge of microbiology and pediatrics allowed her to discover a new and more potent treatment for meningitis caused by Haemophilus Influenzae B. She did this in 1940. The treatment she discovered was more effective than other treatments available at the time. She was also able to detect an antibiotic resistant strain of Haemophilus Influnzae which was a significant discovery at the time as well.
Moving on to more recent events in the world of pediatrics, in 1952 the APGAR score was made by Dr. Virginia Apgar. This score is used to assess a baby’s wellbeing immediately after their delivery to assess if the baby needs resuscitation or any form of intervention. It assesses a baby’s appearance (if cyanosed or pale), pulse, grimace, activity, and respiratory rate. By assessing these items you end up with a score out of 10. The lower the score the worse the baby’s overall general condition and the higher the need for resuscitation.
In the same year of 1952 the polio vaccine was discovered by Jonas Salk. Another live vaccine was discovered in 1962 by Albert Sabin. The vaccine currently used in the United States is the Salk vaccine, but many other countries worldwide use the live vaccine. The Salk vaccine relies on injective a killed virus. This creates immunity to the polio virus in the blood. The live vaccine is given orally through repeated doses, but since it is given orally it also gives immunity at the level of the gut. So that antibodies in the intestine can combat the virus as well and prevent it from entering the blood. The side effect of the live vaccine (which relies on giving a weakened virus) is that in immunocompromised patients it can actually give them the disease.
Dr. Frances Kelsy, in 1960, prohibited the use and sale of the drug thalidomide. Thalidomide was a popular drug at the time as it was given as a sleeping pill to pregnant females. Soon the drug was discovered to cause very serious birth defects such as absent limbs. Of course since then the drug has become obsolete as its production stopped as soon as it was discovered that it was the cause of these major birth defects.
One of my favorite pediatric milestones happened in the year 1962 when Dr. C. Henry Kempe published his paper called “The Battered Child Syndrome” which is about child abuse. This led to the creation of programs and organizations that fight child abuse and help treat and protect the children who are victims of the abuse.
In 1966 Dr. Dilip Mahalanabis created packs of oral rehydration solution therapy which are used to treat gastroenteritis and diarrhea in children. As we already mentioned previously the main thing doctors worry about in children with diarrhea or gastroenteritis is dehydration and so the most important step in treatment is to make sure these kids are rehydrated.
Autism was only recognized as a disease of its own in 1980 even though its clinical picture was described as early as 1911. In 2007 the CDC reported that the prevalence of autism is 1 in every 150 children.
How to become a pediatrician
Well it’s just like with every other specialty of medicine. 4 years of college followed by taking the MCATs, then you get accepted into medical school for 4 more years. After that during the match you apply to a pediatrics residency which is usually about 3 years in length. Once you’re done with all that you’re officially a general pediatrician. Of course, if you want to become more specialized in a particular field of pediatrics then you can apply to a fellowship in that field which is usually about 2-3 in duration.
Neonatology comes first because it’s the specialty that deals with infants the second they’re born. They’re usually present during the delivery of the child and do a quick and rapid assessment to make sure everything is fine. One of the things they do is the APGAR score which we previously discussed. One of the major jobs of neonatologists is to take care of premature infants which require special care.
Cardiology is another important branch as congenital heart diseases aren’t that uncommon. Diseases such as ASD, VSD, PDA, Fallot’s tetralogy, and TGA can be encountered. It’s important to diagnose and treat these conditions early before they cause irreversible damage to the heart. Other diseases cardiology pediatricians face are rheumatic heart disease and infective endocarditis, but these issues are very rare in a developed country like the United States and are mostly present in developing countries.
Hematology and Oncology is another specialty. We’ve already talked about childhood malignancies such as leukemia, CNS tumors, Wilms tumor, lymphoma, and others such as neuroblastoma. The incidence of these malignancies is slowly rising, unfortunately. So it’s these doctors’ job to diagnose these malignancies as early as possible and find the best treatment plan for each case according to the child and the tumor.
Infectious disease is a pediatric specialty as well. Children are running around all day unaware of the amount of germs in the world around them. They’re also curious which can make them put dirty things into their mouths. Children in general are not very aware of what’s clean and what isn’t. There are also infectious diseases such as rubella, measles, mumps, and chickenpox which can spread rapidly throughout a classroom affecting all the children in it. Luckily, however, we have vaccines for most of these conditions right now so we see them less than before.
There’s also pediatric surgery. Unlike adult surgeons who often specialize in a single system or a few organs, pediatric surgeons usually work anywhere in the entire body as they have knowledge to deal with any condition the child suffers from that needs surgical intervention. These conditions can be cardiac such as Fallot’s tetralogy or VSD, hepatobiliary such as a choledochal cyst or biliary atresia, or urinary pathologies. It could also be something cosmetic such as repairing a cleft lip or cleft palate. Each of these will need a specific treatment plan and not all of them have to be repaired straightaway. Some can be treated conservatively with surgical interference later on during a patient’s life. A cleft lip for example is treated at about 3 months and there’s no need to rush into treating it earlier than that.
Emergency medicine is present in both pediatrics and for adults. Children can need emergency medical attention too especially as they’re more active and less fragile. It’s not just limited to accidents though. For example a child with diabetes type 1 may suffer from diabetic ketoacidosis which is potentially lethal if not treated urgently and effectively. Another condition that may be encountered in the pediatric ER is a severe asthma attack. Prompt treatment using O2 and bronchodilators given via nebulizers in addition to IV corticosteroids can be life saving in children suffering from status asthmaticus.