儿科绪论（英文版）

PEDIATRICSOVERVIEWCHAPTER1TheScopeofPediatricsPediatricsisconcernedwiththehealthofinfants,children,andadolescents;theirgrowthanddevelopment;andtheiropportunitytoachievefullpotentialasadults.Itisthescienceandartofprevention,diagnosis,andtreatmentofthediseasesofchildrenfrombirththroughadolescence,whetherthesedisturbancesbephysical,mental,oremotional.儿科学是一门关于从出生到青春期儿童疾病预防、诊断与治疗的科学和艺术，这些儿童期的疾病可以是肉体的，也可以是精神方面的。TheScopeofPediatricsThemostcharacteristicfeatureofpediatricsisthatitdealswiththegrowthanddevelopmentofthechild,comprisingallthosechangesinsizeandformandincomplexityoffunctionthatconstitutegrowingup.儿科学最主要的特征是要研究儿童的生长发育，儿童的生长发育造成了其形体方面的变化，也是其功能复杂性的基础。SubspecialtyofPediatricsSubgroupedbytheemphasisofhealthcare：DevelopmentalPediatrics（发育儿科学）PreventivePediatrics（预防儿科学）ClinicalPediatrics（临床儿科学）RehabilitationinPediatrics（儿童康复医学）,etcSubgroupedbyage：Perinatology（围生医学）Neonatology（新生儿学）AdolescenceMedicine（青春医学）,etcTheGoalOfPediatricsTobecertainofthehealthofchildren.Topromotethelifequalityofchildren.DifferencebetweenChildandAdultAchildisincontinuousgrowthanddevelopment.“ACHILDISNOTALITTLEMAN”Functionsofvariousorgansystems各系统功能差异Degreeofimmunitytodisease机体免疫反应程度Responsetotheeffectsofdisease对疾病的应激反应Dosageofdrugsandtolerancetodrugs对药物剂量及耐受性Mentalandmotorability精神运动的能力Pattenofemotionalresponse心理反应DisparityinOccurrenceandProgressionofDiseasebetweenChildrenandAdultDisparityinanatomy,physiology,andimmunologicfunctionbetweenchildrenandadultTheyounger,themoredifferentDisparityinoccurrenceandprogressionofdiseasebetweenchildrenandadultDisparityinspectrumofdisease不同的疾病谱Congenitalanomalies、inbornerrorsofmetabolism(morecommoninchildren)先天畸形、先天代谢性疾病多见

Newbornsandinfantsisvulnerabletoinfection

新生儿、婴儿易发生感染Sinusitisisrareininfancy鼻窦炎在婴儿相对少见Infantsandyoungchildrenarevulnerabletoobstructioninrespiratorytract婴幼儿易发生气道阻塞DisparityinOccurrenceandProgressionofDiseasebetweenChildrenandAdultDisparityintypeofdiseasePneumoniaChildren:bronchialpneumonia支气管肺泡炎症Adult:lobarpneumonia大叶性肺炎

VitDDeficiencyChildren:rickets(佝偻病)Adult:malacosteon(骨软化)DisparityinoccurrenceandprogressionofdiseasebetweenchildrenandadultDisparityinmanifestationofdiseasediarrheadehydration；feverseizureDisparityinoccurrenceandprogressionofdiseasebetweenchildrenandadultStagesOfAChildByAgeEmbryoperiod（胚胎期）:thefirst8weeksofgestation,theformationoftissuesandorgans怀孕~8周Fetusperiod:fromthe9thweekofgestationtothedeliveryoftheneonatalinfant,thegrowthanddevelopmentofthefetus第9周~分娩出生Fetus（胎儿期）:fromconceptiontothebirthoftheneonate,40weeks.从受精卵形成~出生为止，40周。Earlyneonates:thefirstweekafterbirthPerinatalperiod（围产期）:fromthe28thweek’sofgestationtothe7thdayoftheneonateafterbirth.Neonates（新生儿期）:fromdeliveryandcuttingofftheumbilicalcordofthenewborntothe28thdayafterbirth从胎儿娩出脐带结扎时开始~28天Birthinjury,apnea,infections,hemorrhage,hyperbilirubinemia,etcarecommonmedicalproblemsinthisstage.Carefullytakingcareoftheneonatalinfantisofgreatimportance.Infants（婴儿期）:the1styearafterbirthInfectiousdiseases,malnutrition,andindigestionarecommoninthisperiod感染、营养不良、消化不良多见Healthcare:Properfeeding合理喂养Vaccinationintime

按时预防接种Youngchild(toddler’sage，幼儿期):from1yearoldto3yearsoldBegintowalk,quicklinguisticandintelligencedevelopment,strongcuriosity学习行走，语言、动作、思维发育迅速，强烈的好奇心

Healthcare:Preventionofaccidentsandinfectiousdiseases防意外、感染Propernutrition合理营养Preschool（学龄前期）:from3yearsoldto6～7yearsoldGrowthrateslowsdownbutlanguageandemotion,asindicatorsforintelligence,continuetodevelopquickly.Healthcare:EncouraginggoodbehaviorSuitabletimingtobeginearlyeducationDiseaseprevention:rheumaticfever,acuteglomerulonephritis,etc.Schoolage（学龄期）:aged6~7topre-adolescenceSystemandorgansdevelopmenthavebeenalmostreachedtothelevelofadults(exceptforsexualorgans).Self-esteemplaysveryimportantroleinthepsychologicaldevelopment.Healthcare:Encouraginggoodattitudeandhabitsforstudyandbehaviors.Preventionofnearsightedness（近视）,decayedteeth（龋齿）,etc.Adolescence(earlyyouth，青春期):from10yrsoldto20yrsold.

Theadolescenceofagirlmaybeginandendabout2yrsearlierthanthatofaboy.女孩青春期的开始与结束时间均比男孩的早2年左右。Childreninthisperiodundergorapidchangesinbodysize,shape,physiology,andpsychologicalandsocialfunctioning.ThesecondpeakofphysicalgrowthrateafterbirthHealthcare:nutrition,exercisesandnormalpsychologicaldevelopment.DEVELOPMENTANDFUTUREOFCHILDREN<18yrintotalpopulation developedcountries22.4% developingcountries35.7% china30%(UNCF1999)

<18yr400million(china)InfantMortalityinChinaandDevelopedCountry~1949199920002003City15%1.18%0.55%Ruralarea20%3.7%DevelopedCountries0.4~0.7%yearareaMortalityofChildrenunderAge5inChinaandDevelopedCountry~1949199920002003city2.1%1.4%

0.7%

Ruralarea7.1%4.6%DevelopedCountries0.4~0.8%yearareaTheChangeofMortalityofChildreninChina

MortalityComparisonofChinawithOtherCountriesChildrenaccountforahighpercentageinthetotalpopulation.Inourcountry,thehealthcareofchildrenhasbeeningreatprogression.AnalysisofDeathunderAge5

inChina（2000）Death<5yrs:93%inruralInfantdeath:accountingto80％newborndeath65％oftotalinfantdeath

Leadingdeathcause:Pneumonia（肺炎）、asphyxia（窒息）、prematurity（早产儿）、diarrhea（腹泻）、congenitalanomalies（先天畸形）TheWorldSummitforChildrenin1990“TheWorldDeclarationontheSurvival,ProtectionandDevelopmentofChildreninthe1990s”PlanofActionforImplementingofthedeclaration中国政府制定“九十年代中国儿童发展规划纲要”“（2001～2010）中国儿童发展纲要”“（2011～2020）中国儿童发展纲要”TheChildrenAreOftenAmongtheMostVulnerableorDisadvant-agedinSocietyandTheirNeedsRequireSpecialAttention.PrinciplesandObjectives

《AWorldFitForChildren》-2002PutchildrenfirstEradicatepovertyLeavenochildbehindCareforeverychildEducateeverychildProtectchildrenfromharmandexploitationProtectchildrenfromwarCombatHIV/AIDSListentochildrenandensuretheirparticipationProtecttheEarthforchildrenControlofinfectivediseaseFocusonpsycho-behaviorproblemManagementofAccidenceandinjuryPreventionandtreatmentofcongenitalanomaliesPreventivemeasuresinchildhoodforadultdiseaseTasksofpediatricianin21CenturyReferences:References:KEYPOINTS

INTHISCHAPTERCharacteristicfeaturesofpediatrics

StageofchildrenbyageQuestionAninfantcanmovehisheadfromsidetosidewhilefollowingamovingobject,canlifthisheadfromaproneposition45degreesofftheexaminingtable,smilewhenencouraged,andmakescooingsounds.Hecannotmaintainaseatedposition.Themostlikelyageoftheinfantis1month3months6months9months12monthsThankYouforYourAttention!PEDIATRICSChenDehui(1030412)PediatricDepartmentThefirstAffiliatedHospitalofGuangzhouMedicalUniversityGROWTH

AND

DEVELOPMENTCHAPTER2Assessmentindicatorsforgrowthanddevelopmentaswellastheirmeasure-mentsKeymotorsindicatingforagesofinfantdevelopmentKEYPOINTS

INTHISCHAPTERGrowthAndDevelopmentGrowth

Thechangesofformandincreasesinsizeofthebodyandorgansofachild

儿童各器官、系统的长大DevelopmentMaturationofcells,tissuesandorgans

组织、器官、功能的分化成熟PatternsofGrowthandDevelopmentGrowthanddevelopmentisacontinuousandstagedprocessDifferentrateofdevelopmentinvarioussystemsIndividualvariationingrowthanddevelopmentGrowthanddevelopmentshowCephalocaudalpatternFactorsInfluencing

GrowthAndDevelopmentGenetics基因遗传Nutrition营养状况Healthstatusduringpregnancy母体怀孕时的健康状况Livingenvironments生活环境Effectsofdiseases疾病影响IndicatorsForAssessmentofGrowthAndDevelopmentBodyWeight体重Height身高SittingHeight坐高HeadCircumference头围

ChestCircumferenc

胸围UpperArmCircumference上臂围SubcutaneousFat

皮下脂肪BodyWeightAsensitiveindicatorforgrowthandnutritionalstatus评估生长及营养状况Animportantvariableforcalculationofdrugdosage,energyandfluidsupplement

用于计算儿童用药剂量、能量及液体治疗Examination

Babybalanceforinfants(accuracyin50g），weighingscaleforchildren（accuracyin100g）

婴儿测体重精确：50g；儿童:100gInfantsandchildrenshouldbeweighedwithouttheirclotheson.需要去掉衣服的重量NormalWeightGain

Age NormalBW（kg）Newborn

Male 3.3±0.4 Female 3.2±0.43～4months

Doublebodyweightafterbirth ofbirth1yearold

10 2yearold

12Averagebodyweightforchildrenof1～12old：

BW（kg）＝Age(years)×2＋8PhysicalWeightLossAnewborn’sweightmaydecrease10%belowbirthweightinthe1stweekasaresultofexcretionofexcessextravascularfluidandpossiblypoorintake.生后1周生理性体重下降，水分丢失、胎粪排出、摄入不足有关，下降约3%~9%Intakeimprovesascolostrumisreplacedbyhigh-fatmilkandtheamountofmilkinfantsuckincrease,Infantshouldregainorexceedbirthweightby7～10daysofageandshouldgrowatapproximately30g/day.

及时喂养，生后7~10天体重恢复出生时体重，后体重增长约30g/天Height

Thelengthfromthetopoftheheadtotheplantapedis测量方法：头顶~平足底部Anparameterforbodygrowthandgrowthvelocity,anassessmentforskeletongrowth

评估儿童生长、生长速度骨骼生长Measurement＜3yearsold

Measuringinrecumbentposition

(Bodylength)3岁以下卧位测量＞3yearsold

Measuringinstandingposition（Height)BodyLengthScaleBodyLengthScaleNormalHeightGainAgeNormalHeight（cm）GainingHeight(Length)byAgeNewborn503monthsafterbirth11～13cmareincreased

and12～13cmduringthefollowing9

months,soin

the1styeartheheight

willincrease25cm.10～12cminthe2ndyear.Fromage2～10,5～7cm/yearwillbegained.1yearold752yearsold85SomeConceptsAboutHeight

SettingHeight（坐高）：Thelengthfromthetopofheadtoischialtuberositywhichmeansthelengthoftheheadandspinalcolumn头顶部~坐骨结节的距离UpperLength（上部量）：Thelengthfromthetopofheadtotheupperedgeofsymphysispubis头顶部~耻骨联合上缘的距离，评估扁骨的生长LowerLength（下部量）：Thelengthfromtheupperedgeofsymphysispubistodorsaldecubitus.耻骨联合上缘~脚底，评估长骨的生长。UpperLength&LowerLength新生儿的上部量占身长的60%，下部量占身长的40%，12岁以前各年龄期有一定的比例。对矮小症患儿，除测量身长外，尚需测量上、下部量，如下部量过短表示长骨发育障碍，见于克汀病（甲状腺功能低下）及软骨营养障碍。

Head/Trunk+legUpperlengthinbodylengthMidpointLowerlengthinbodylengthNewborn1/460%Abovenavel40%Age2BelownavelAge6Betweennaveland

theupperedgeofsymphysispubisAge1250%theupperedgeofsymphysispubis50%Adult1/8Lowerlength＞UpperlengthHeadCircumference&

ChestCircumferenceHeadCircumference（头围）：Indicatorforgrowthanddevelopmentofbrainandcranium

评估脑与颅骨的发育。出生时约33~34cm，1岁时46cm，2岁时48cm。ChestCircumference（胸围）：Indicatorforgrowthanddevelopmentofthoraxandlung.评估肺与胸廓的生长。出生胸围约32cm，1岁时约等于头围。1岁~青春前期胸围=头围+年龄-1cmHeadCircumferenceMeasurementMeasuringthegrea-testoccipitofrontalcircumference眉弓上缘、枕骨结节环绕一周的长度Reflectingthevolumeofintracranialcon-tentsaswellasthethicknessoftheskullandscalpChestCircumferenceExaminationMeasuringthethoraciccirclearoundnipplesandinferiorangleofscapulaandtakingtheaveragevaluebetweeninspirationandexpiration平乳头下缘经肩胛骨下缘平绕胸一周NormalValuesofHeadCircumference&

ChestCircumferenceAge

HC（cm）

CC（cm）

HC－CC（cm）

Newborn 32～34 32 ＜1～21yearold 46 46

01yearlater 48（age2） HC+（age-1）

＞（age-1）HC:Duringthe1st3monthsoflifeHCwillincreaseabout6cmwhichwilltheamountofincreaseduringthefollowing9.HCgrowsabout6～7cmfromage2to15.GrowthCurveofHeadCircumference

&

ChestCircumference（cm）年龄AgeHCCCAssessmentofGrowthASSESSMENTOFGROWTH均值（Mean）＆标准差Standard（SD）正常分布±1SD+2SD+3SD68.3%95.4%99.7%ASSESSMENTOFGROWTH百分位数（Percentile）P3～P9795%表格与生长曲线（Growthchart）多参数指标年龄别体重（Weightforage）年龄别身高（Heightforage）体重别身高（Weightforheight）Developments

ofSkeletonandTeethCranialBonesThematureofcranialbones（颅骨）canbereflectedby:Headcircumference头围Fontanel囟门Closingofsuture骨缝闭合Bone,Fontanels,SuturesOfCranialFrontalboneOccipitalboneParietalboneNormalFusionofCranialBonesPosteriorfontanel（后囟门）:6～8wksafterbirth出生时很小或已闭合，6~8周闭合Suturesofcranialbones（颅骨缝）:3～4monthsafterbirthAnteriorfontanel（前囟门）:1～2cminnewborn,Theanteriorfontanelusuallytendstoenlargeduringthefirstfewmonthsoflife,lessenafter6monthsold.Itclosescompletelyin1～1.5yearsold.出生时1~2cm，1~1.5岁闭合SpinalColumn正常情况Duringthefirstyearoflife,spinalgrowupfasterthanextremities.Lateron,thesituationisreversed.新生儿的脊柱弯曲不明显，呈轻度后凸，3个月的婴儿能抬头时出现凸向前的颈曲，6个月后会坐时，出现凸向后的胸曲，1岁开始走路时，出现凸向前的腰曲。OssificationCenter

骨化中心Theappearanceofossificationcenter(endochondralossification)isoneofthemarksforskeletal.长骨的生长主要由长骨干骺端的软骨骨化，骨膜下成骨，使长骨长长、增粗，当骨骺与骨干融合时，标志长骨停止生长。骨化中心的出现评估长骨的生长成熟程度。BoneAge骨龄Boneageisthemeasurementofskeletalmatura-tion.AradiographofthelefthandandwristisobtainedandcomparedwiththepublishedstandardsofGreulichandPyle.Kneefilmsaresometimesaddedforyoungerchildren.

用X线检查测定不同年龄儿童长骨干骺端骨化中心的出现时间、数目、形态的变化，并标准化，为骨龄。BoneAge骨龄Referencestandardsforbonematurationfacilitateestimationofboneage.

骨龄反映长骨的生长成熟程度

Theboneageislowandiscomparabletotheheightage:Constitutionalgrowthdelay,Endocrinologicshortstature,Undernutrition.

骨龄延迟：生长发育迟缓，生长激素缺乏症，营养不良等Theboneageisnormal(comparedtochronologicalage):Familialshortstature.

骨龄正常：家族性身材矮小DevelopmentofOssificationCenters腕骨骨化中心的出现时间

年龄 骨化中心

3M

头骨、钩骨1岁下桡骨

2～3岁 三角骨

3岁 月骨3.5～5岁

大、小多角骨

5～6岁 舟状骨

7～9岁

豆状骨骨龄测定在临床上有重要意义，骨龄落后见于生长激素缺乏症、呆小病、肾小管酸中毒等；骨龄超前见于中枢性性早熟、先天性肾上腺皮质增生症等。3月头、钩骨；1岁下桡骨（够）；加了2与3（三角骨）等约（月骨）多少？答案：大小多（骨）3-5岁周（舟）5舟6下尺骨（6-7岁）；逗9豆10全都齐DentitionPrimarydentition（乳牙）Timeoferuptionofprimaryteeth:About6months(4~10months)

ofage,allprimaryteethshouldbeeruptedat2~2.5yearsoldNumberofprimaryteeth:20intotalCalculationoferuptionofprimaryteeth:Numberofprimaryteeth=Age(month)-6TimeAndOrderofDentitionDentitionPermanentteethTimeofgrowingpermanentteethBeginning:at6~7yearsoldFinish:at20~30yearsoldNum