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1、Introduction曹勵(lì)之 Physical and emotional health of infants、children、and adolescents；their growth and development；their disease prevention; and treatment. Development、Prevention、Clinic pediatrics Perinatology(圍生醫(yī)學(xué)) 、Neonatology(新生兒學(xué))、Adolescent medicine(青春期醫(yī)學(xué)) Principles: protect childrens health, impr
2、ove the life qualityThree differences: individual, age and sexGood recovery ability Weak self protectionvPediatrics is not the miniature of internal medicinevDifferent development regulations in different agesvDifferent normal data about physiology and biochemistry in different agesvImmune system is
3、 not as perfect as adultsvBigger water and nutrition requirementvDifferent pathological changes between adult and childrenvSingle child policy (China)Clinical Manifestation and DiagnosisInfective DiseasesChildrenSevereCant be limitedmultisystem involvementNeonateNot specificLosing definite locationv
4、Dose being connected with different agesvTreating the primary and the complications vNursing and supporting vChanging quicklyvGood capacity of restore vLess sequelae(后遺癥) than that of adult except nervous systemvEmphasize guarding of younger, weakness and critically illv Monitoring of perinatal peri
5、od v Planned immunization v Four of the most ordinary disease( malnutrition, anemia, diarrhea and pneumonia)v Preventing the adult disease( obesity, hypertension, diabetes or coronary heart disease)GOBI Growth, Oral rehydration, Breastfeeding, ImmunizationIMCI (integrated management of childhood ill
6、ness) Pneumonia(19%) Diarrhea(18%) Malaria(8%) Measles(4%) HIV/AIDS(3%) Neonatal diseases(37%): preterm, asphyxia, infection Infectious diseasesMental problems in childrenPrevention of adult diseases in childrenAccidental injury in childrenEnvironmental pollutionAdolescent medicine and other subject
7、s immersion into the Pediatrics Genetic diagnosis and prevention of childrens diseasesq Fetal period From fertilization to the birth of the babyStages of Development (Second)q Newborn period From umbilical cord ligation to 28th day (Early newborn period is younger than 7 days)vBad ability of adjusti
8、ng and adapting vHigh morbidity and mortality vImportance of health protection, nursing and planned immunization vPerinatal period :from 28 weeks of pregnancy to 7th day after birthvPerinatal mortality(死亡率) is an important guide line of judging developing degree of one country.MouthSkinApgar scoreMo
9、ther/infant binding(rooming in)Rule out congenital genetic and metabolic diseases Function analysis Immunization should be postponed if the child has an acute febrile illness.Premature babies can be immunized following the recommended schedule according to chronological age,i.e. immunization should
10、not be postponed.Being treated with chemotherapy or radiotherapy for malignant diseaseOn immunosuppressive treatment after organ or bone marrow transplant.On high-dose systemic steroids.With impaired cell-mediated immunity, e.g. severe combined immunodeficiency syndrome or Di George syndrome.Stages
11、of Development (Third)q Infancy period After delivery to 1 year old v Rapidest period of growthv Larger requirement of nutrition and energy Too much: obesity, diarrhea Deficiency: anemia, malnutrition v Breast milk v Planned immunization v Susceptive to the infectious disease in the latter 6 monthsv
12、 Physical examination: age 6 months: every 2-3 monthsStages of Development (Fourth)q Toddlers age From 1 year to 3 years v Faster intelligence development Elementary educationv Poorer ability of identifying danger Thunderbolt injury v Changing of food Malnutrition, disorders of digestion v Immune de
13、ficiency Being apt to infective diseasev Physical examination: every 6 months Stages of Development (Fifth)q Preschool age From 3 years to 6-7 years vSlower growth vMore mature development of intelligence plasticity culture(可塑性培養(yǎng))vTraining of good habit and independent ability (sleeping, eating, sto
14、ol, health habit)vPrevention of infectious diseases and accidents (learn self protection 119,110,120) vMore immune disease Stages of Development (Sixth)q School age From 6-7 years to 12- 14 years v Physical growth being similar as adults Except genital system v Comprehensive development of the moral
15、s, intelligence and bodiesv Lower morbidity v Cultivation of the sanitation habitStages of Development (Seventh)q Adolescence Girl：11-12y17-18y Boy：13-14y18-20y v The second peak of development and growth. v The peak development of the genital system- health carev The instability of neuroendocrine s
16、ystem- psychology ; behavior ; spiritScientific breeding: newborns and infantsSuitable breeding: later stagesEarly education: infants and toddlersInjury prevention: toddlers, pre-schools and school ages Psychiatric education: pre-schools, school ages and pubertySex education: school ages and puberty
17、Growth and DevelopmentGrowth Morphological growth of organs and systems Quantitative changeDevelopment Differentiation and mature function of cells , organizations and organs Qualitative change DefinitionContinued process and segmental Unbalance development of systems and organsInfluencing FactorsIn
18、heritanceSexNutritionDiseasePregnancyEnvironmentWeight Total weight of all organs, systems and liquid in body Reflecting conditions of growth and nutrition Calculating the dose of drug and transfusion Weight of birth Boy : 3.3 0.4 kg Girl : 3.2 0.4 kg Normal weight loss Weight loss during the first
19、10 days (3 to 9 percent ) Two peaks From birth to 6 months 3m: 700 800g/m 46m: 500 600g/m 712m: 300 400g/m Adolescence 45 kg/y 23y AgesAgesWeight(Weight(kg) )Increased Increased weightweight（kg） 112y Ages283m m612m m924m m12BirthBirth33/(/(03月月) )13/(/(312月月) )233/(/(12歲歲) )Growth on weight6m W：W at
20、 birth（Kg）+m0.7（Kg） 712m W：6 （Kg）+m0.25（Kg） 2ypre-puberty： age2（Kg）+7(or8)（Kg）or312m： age（m）+9 / 2(Kg) 16y： age（y）2+8（Kg） 712y： age（y）7-5 / 2(Kg)W=weight; m=months; y=yearsStanding HeightLength from the top of head to the bottom of foot Pars Inferior (0.40) (上部量) (下部量) 12 years old Pars Superior = P
21、ars InferiorSitting Height Height from the top of head to hucklebone tuber Representing the development of skull and spine 3y : Crown-rump length when lying on backFinger Distance Distance between two middle fingers when two arms lying at level Representing the development of long bone of the upper
22、limbsNormal: height 1 2cmHead CircumferenceAt birth：3334cm 1 y：46 cm (the first 3m=latermcm) 2 y：48 cm 5 y：50 cm 15y：5458cmChest Circumference At birth ： 32cm head circumference 12cm 1y： Head Circumference y： Head Circumference Chest circumference At birth 32 1y HC+（age-1） （age-1） CC= chest circumfe
23、rence, HC= head circumferenceUpper Arm Circumference y : Reflecting childrens nutrition conditions 13.5cm：Fine 12.513.5cm：Medium 12.5cm：Malnutrition Proportion of Body Proportion of the head and height: infants(1/4)-adults (1/8) Weight by Stature （體形勻稱）（體形勻稱） Weight-For-Height （身高的體重） Chest Circumfe
24、rence/Height （身高胸圍指數(shù)） EMI/age （年齡的體塊指數(shù)） Trunk-Leg Ration （身材勻稱（身材勻稱) Sitting Height/Standing Height . At birth:0.6714 years :0.53 Span and Standing Height常用的統(tǒng)計(jì)學(xué)表示方法常用的統(tǒng)計(jì)學(xué)表示方法 +2SD-2SDX均值離差法均值離差法P3rd P50thP97th百分位法百分位法（1）均值離差法：）均值離差法： 2SD（2）百分位法：）百分位法： P3rd P97thX X生生長(zhǎng)長(zhǎng)曲曲線線評(píng)價(jià)結(jié)果表示評(píng)價(jià)結(jié)果表示均值離差法：均值離差法：百分位
25、法：百分位法：等級(jí)法等級(jí)法三分法三分法下下（異常）（異常） 中中上上( (異常）異常）五分法五分法下下（異常）（異常）中下中下 中中中上中上上上（異常）（異常）p3rd p25th p50th p75th p97th -2SD -1SD 1SD 2SDXGrowth and Development of SystemsfontanellesAreaAt birthClosed age1.52cm18m0.5cm1 2mPalpable3 4mBone gap Posterior FontanelleFrontal Fontanelle AgeActivityMusclesSpinal curv
26、e3mLift head頸后肌頸后肌頸曲頸曲（頸部脊柱前凸）（頸部脊柱前凸）6mSit腰肌腰肌胸曲胸曲（胸部脊柱后凸）（胸部脊柱后凸） 12mWalk下肢肌下肢肌腰曲腰曲（腰部脊柱前凸）（腰部脊柱前凸）78m : Primary Teeth appears 2y : Deciduous Teeth = moons age (46) It is unusual if no teeth at 1 year. 2.5y : Completed The first molar at 6y ， the second at 12y，the third after 18y. Sensory and Perc
27、eptual, Behavioral DevelopmentBrain weightBrain weightweightweight%Adult brain Adult brain weightweight%Birth Birth 350g10%12%25%6m m 600700g50%12m m60%23y y75%45y y80%90%Adult Adult 1500g2%3%Development of brain function：Get closed to the adults level: 3yrs oldObtain adults full functions: 8yrs old
28、Congenital unconditioned reflexCongenital unconditioned reflex緊張性頸反射緊張性頸反射握持反射握持反射爬行反射爬行反射踏步反射踏步反射擁抱反射擁抱反射Summary Development of morphology is earlier than the function in the cerebral cortex； Lower excitement in cerebral cortex and higher in subcortical center ； Unconditioned reflex； Incomplete mye
29、linization of nerve fibers Sensory and Perceptual Development Ability of obtaining information from environment through sensor organs and is essential to other areas development.NewbornsNewborns The best focus distance is 20cm.Eyes and The best focus distance is 20cm.Eyes and heads are capable of fo
30、llowing the focused heads are capable of following the focused objects. Distinction of size and shape is objects. Distinction of size and shape is also possible.also possible.聽(tīng)感知的發(fā)育聽(tīng)感知的發(fā)育皮膚感覺(jué)的發(fā)育皮膚感覺(jué)的發(fā)育 Skin sensationSense Perception Development Sense of Taste（味覺(jué)）（味覺(jué)） At birth : Rather mature of tast
31、e 4 5 months: Key period of development Sense Perception Development Sense of Smell（嗅覺(jué)）（嗅覺(jué)） v At birth: Looking for nipples when smelling milks tastev 3 4m: Differentiation odor v 7 8m: Response to sweet-smellSense Perception Development Tactile Sensation （觸覺(jué)）（觸覺(jué)） Newborns are very sensitive in mult
32、iple areas 23y Distinct property56y Distinct objects of different size and weight Sense of painNewborns are not sensitive to the pain because of incomplete myelinization of nerve fibers which will be improved after 2 months. Motor Development Lift head2m Lift head3m Stable4m Very stable, freely rota
33、tion Roll over12m 側(cè)臥至側(cè)臥至 仰臥仰臥45月月 仰臥至仰臥至 側(cè)臥側(cè)臥68月月 仰臥至仰臥至 俯臥俯臥12mNewborn68mWalk、Run、Jump6月月 扶站扶站912月月 扶物走扶物走1歲歲 獨(dú)走幾步獨(dú)走幾步1.52歲歲 跑跑2歲歲 雙足跳雙足跳34.5歲歲 獨(dú)足跳獨(dú)足跳 大運(yùn)動(dòng)發(fā)育大運(yùn)動(dòng)發(fā)育 二抬二抬 lifts head 十站十站 stands alone 四翻四翻 rolls over 周歲走周歲走 walks alone 六坐六坐 sits 二歲跑二歲跑 runs well 八爬八爬 creeps 三歲獨(dú)足跳三歲獨(dú)足跳 hopsFine Motor Dev
34、elopment三玩手三玩手 plays hands 一歲亂畫一歲亂畫 scribbles 五抓五抓 grasps object 二歲折紙二歲折紙 folds paper七換手七換手passes object 三歲搭橋三歲搭橋 builds bridge九月對(duì)指九月對(duì)指 picks up with thumb-index fingerSpeech and Language Development Conditions of lingual developmentHearing CNS Pronouncing organs | | |Acceptance Understanding and ex
35、pression pronunciationAdvanced conditions：Adequate language Environmental irritation16m Pronounce single syllable711m Pronounce repeated syllables1013m Say:“mom”13y Say vocabularies, simple sentences and sing short songs45y Say compound sentences and sing nursery rhyme724m lingual interpret23y lingu
36、al expression Suspicious delayed14m problems with single word24m problems of combining 2 words30m difficulties of speaking simple sentencesScreening standard24m Vocabulary 30 Disability Vocabulary50 Suspicious個(gè)人個(gè)人- 社會(huì)能力的發(fā)育社會(huì)能力的發(fā)育（Personal Social Skill） personal social skill 二笑二笑 smile responsively 六
37、認(rèn)生六認(rèn)生 shy with strangers 九月做再見(jiàn)九月做再見(jiàn) wave bye-bye 一歲示需要一歲示需要 indicate wants 二歲做游戲二歲做游戲 play interactive games 三歲會(huì)穿衣三歲會(huì)穿衣 put on T-shirtAge Age Developmental signDevelopmental sign6-8weeks Asymmetrical Moro Excess head lagNo visual fixation/following No startle or quietening to soundNo responsive smil
38、ing8 months Persisting primitive reflexesNot weight bearing on legs Not reaching out for toysNot fixing on small objectsNot vocalizing10 monthsUnable to sit unsupported1 yearShowing a hand preferenceNot responding to own name18 monthsNot walkingNo pincer gripPersistence of casting3 yearsInaccurate u
39、se of a spoonNot speaking in sentences Unable to understand simple commandsUnable to use the toilet aloneNot interacting with other childrenNever Reflex Development () Appears at birth and never disappears Corneal reflex (角膜反射) Conjunctival reflex (結(jié)膜反射) Papillary reflex (瞳孔反射) Pharyngeal reflex (吞咽
40、反射)Never Reflex Development ()Appears at birth but disappears at 3 4 months Rooting reflex （覓食反射） Sucking reflex （吸吮反射） Grasping reflex （握持反射） Embrace reflex （擁抱反射）Never Reflex Development () Not exist at birth but appears gradually and be stable at 1 year Abdominal reflex（腹壁反射） Cremasteric reflex（提
41、睪反射） Tendon jerk（腱反射）Pathologic Reflex 4 months Kernig sign (+)3 years old: unconscious imaginationpreschool period: conscious and creative imagination Objective expressions and subjective reflections to scenes or sensePositive mood Negative moodExperiences of the relation between humans and objects
42、 on the basis of moodEmotion of trust, safety, friendship and honorPsychological actions to the environmentThinking ways Mood response Action styleInteresting Ability Character TemperamentStable, frequent personality and psychology characteristic Formed in post natal periodComparative stability Firs
43、t formed character after birth, which is always evident and stableVery important to infants in their mood and sociability improvementEasy child Difficult child Slow warm-up child( 啟動(dòng)緩慢） Intermediate type Psychological process of conquering difficulties and reaching expected aimsPositive will: consci
44、ous, perseverance, consciously resolute, good continenceNegative will: reliance, bigotry, impulseDemocrat- Independent, Brave, Intelligent, sociableStrictCruel, Stubborn, Lack of confidenceSpoilCocky, Selfish, Headstrong, Lack of ability in living aloneDifferent education patternsTry to please both
45、sides, Opportunistic, Lying Psychological DisordersDevelopmentalBehavioral Problems ( (發(fā)育行為問(wèn)題）發(fā)育行為問(wèn)題）vBreath holding（屏氣發(fā)作） vBiting thumb （咬指甲癖）vEnuresis（遺尿）vChildren wipe legs syndrome（兒童擦腿綜合征）vDefiance（違抗）、 Temper tantrums（發(fā)脾氣） vLying（說(shuō)謊）vSleep disorders（睡眠障礙）vAttention-deficit hyperactivity disorder (ADHA) (注意力缺陷多動(dòng)癥）
301395013501 緒論 生長(zhǎng)發(fā)育 兒童保健
