Pediatrics as a specialty. Periods of childhood. Teratogen Factors

1. Subject of the lecture
Pediatrics as a specialty.
Periods of childhood, their characteristic features. Stages of
fetal development.
Teratogen factors, their effects at different stages of
pregnancy, "critical periods".
Functional activity of the endocrine glands and the
pathology features in different periods of childhood.

2. • The child - this is not a miniature adult, her body has its anatomical -
physiological peculiarity, which are constantly changing during the
whole period of childhood;
Can not talk about "rules" for children in general, without their
differentiation in the age aspect.
The principals of adult medicine cannot be directly adopted to
children.
Clinical manifestations of childhood diseases may be different from
adults.
Drug dosages in children are specific and not a mathematical
derivation of adult doses.
Nutrition is a critical necessity for children not only to sustain life, but
to ensure their growth and de-nt.

3. PEDIATRICS
• The branch of medicine that deals with the
care of children and adolescent is
pediatrics.
• A physician who specializes in the health
care of children and adolescents is a
pediatrician.
• Pediatrics covers the age group less than
18 year of age.

4. • The success of the doctor - pediatrician
depends on the knowledge of the dynamics of
the anatomical and physiological peculiarities of
the child, its reactivity needs to basic food
ingredients (proteins, fats, carbohydrates,
minerals, vitamins).
• Primary prevention, identification of early
markers and timely treatment they are the
emerging imperatives in pediatrics.

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6. Periods of childhood
• Prenatal period (duration 270 - 280 days):
Ovum phase 0 to14 days.
• Phase of embryonic development (up to 2 months.)
• phase of placental development (from 3 month to the
birthday).
• Newborn period, lasts 28 days.
• Infants period, lasts 1 year.
• Toddler 1 to 3 years.
• Preschool child/
• School age child 6 to 10 years (girls), 12y.(boys)
• Adolescence (prepubescent, pubescent, postpubescent)

7. - Postnatal stage (from birth to 17 - 18 years)
- 1 neonatal period (neonatal):
- early neonatal period (from birth to 7 days);
- late neonatal period (8 to 28 days);
- 2 Period infants (1 to 12 months).
- 3 Period of baby teeth (from 1 to 7 years):
- preschool period (from 1 to 3 years);
- Preschool (3 to 6 - 7 years).
- 4 Primary school age (6 - 7 to 11 - 12 years).
- 5 high school age or puberty (12 to 17 - 18
years).

8. Utero:
• From the moment of fertilization until birth;
• Duration 270 - 280 days.
• Phases: a) embryonic development (the first 1.5 - 2 months.)
• b) placental development (3 th to 10 th month.)
• Characterized by:
• rapid growth of the fetus (fetal length is increased by 5 000
times)
• weight gain (6 • 10¹² times)
• Dining by maternal (hemotrophic): development of the
embryo and fetus depends on the nature of maternal nutrition,
her health condition.

9. Newborn period:
Lasts 28 days after birth;
- It takes adaptation to new conditions of existence;
- Availability boundary (transient state):
- - Erythema;
- - Generic tumor;
- weight loss (up to 7 - 8%)
- violation of thermal balance (transient hypo - and
hyperthermia);

10. - hormonal management;
- urate heart attack;
- physiological hyperbilirubinemia;
- physiological jaundice;
- transient metabolic disorders;
- transient dyspepsia;
- transient overgrowth.

11. • The first breath (lung smoothing);
• Fits newborn circulation;
• Stops operation of the umbilical cord, oval
window, and arantsiyevoyi botalovoyi ducts;
• Hemotrophe nutrition changes to laktotrophe;
• Increases basal metabolic rate;
• All the basic functions of newborn are in a
state of unstable balanse;
In the cortex of the brain dominated processes
of inhibition over excitation processes;
(sleep 20 - 22 hours a day)

12. Pathology of neonatal period:
• Embrio- and fetopatiyi;
• Maternity injury;
• Congenital lesions (intrauterine infections, especially
TORSH - infection, congenital anomalies of
development).
• Rare acute children's infectious diseases (measles,
scarlet fever, rubella, chicken pox, etc.).
• High susceptibility to E. coli coccal and (staph) flora.

13. Features of Infant period (from 1 to 12
months)
• 1 Intensive growth and increase of mass child.
• Up to 4 - 5 months of life there is a doubling of
the mass, which was at birth, and the child's
weight was tripled at year.
• Height of the child during the first year of life
increased by 50% compared with baseline at
birth;

14. • 2 high intensity metabolic predominance of
anabolic processes required for rapid
growth and weight gain;
• 3 The predominance of the functional
activity of the thyroid gland, which provides
a high basal metabolic and anabolic
processes, and thymus. This hormonal
alteration (increased basal metabolic rate)
and immunological background leads to
the abnormalities of Constitution: such as
lymphatic - hypoplastic diathesis, exudative
abnormality of constitution etc.;

15. • 4 increased growth and differentiation
of brain tissue, morphologically and
functionally its imperfections, increased
blood-brain barrier. This is the reason
for the child's susceptibility to cramps
functional nature, frequent meningism
observed frequently in respiratory viral
diseases in this age;

16. • 5 functional weakness of the digestive
system, low activity of enzymes in saliva,
gastric juice, which contributes to frequent
indigestion, often a cause of malnutrition;
• 6 intensive growth muscle - skeletal
system, which may contribute to rickets.
Thus there is a delay teething, broken
parity and consistency of teething;

17. • 7 underdevelopment of the paranasal sinuses
(maxillary sinus, etc.), so infant practically does
not occur antritis and sinusitis;
• 8 weakening of passive immunity and
development on 2 - 4 th month of life the so-
called transient or physiological
hypoimmuneglobulinamie, accompanied by a
decrease in the concentration of Ig G in serum
and characterized by delayed maturation of
cellular and humoral immune factors. It
predisposes to different infections, promotes
frequent otitis media, pneumonia, etc.;

18. Period of baby teeth:
• preschool subperiods (1 - 3 years)
• preschool sub-periods (4 - 7 years)
• Characterized by:
• gradual improvement of the functional
capacity of the organism;
• remains heightened vulnerability;
• extraordinary plasticity;
• emotional lability;

19. • rapidly developing intelligence: fluent,
enriched stock of ideas;
• improved analyzer - synthetic function
of the cerebral cortex;
• reduced susceptibility to diffuse
reactions;
• more common childhood infections;
• increases the frequency of TB infection.

20. Preschool period (nursery age):
• The child is very mobile, curious;
• The basic form of development is a
game;
• Through the game gets the first child
labor skills, rapidly growing vocabulary;
• After 2 - 3 years sentences are wordy;
• The child imitates adult around;

21. • After 1.5 years of age naps is 3 hours.,
night - 11 hours.
• Possible overload experiences and
negative environmental impacts.
• Increases extending acute childhood
infections.

22. Preschool period (4 - 7 years):
• There is a growing need to communicate with
other children;
• In terms of intellectual development of a child
is ready for admission to the school;
• Slightly slows down the process of growth;
• Actively improving the functionality of the
organs and systems;
• In 5 - 6 years starts changing baby teeth to
permanent;

23. • The child goes to the diet of the adult;
• Duration daily sleep is 2 - 2.5 hours., night
- 10 - 11 h .;
• Developing fine motor skills: the ability to
ride a bicycle, skating, dance, sew, knit;
• Very good memory: easy to memorize
poems, retell stories, learn a foreign
language;

24. • Especially important is the precise
organization of educational work at home and
children's groups;
• Markedly reduced tendency to generalization
process and toxicity;
• Manifest allergic disease (asthma, rheumatic
fever, glomerulonephritis, etc.).

25. Characteristics of primary school age
(adolescence period 7 - 12 years)
• 1 ends morphological differentiation of cells of
the cerebral cortex, especially the motor areas
and peripheral innervation ends forming
apparatus;
• 2 is a characteristic equilibrium of excitation and
inhibition with some predominance of excitation
and dominance of the cerebral cortex over
subcortical area, its autonomic functions;

26. • 3 Significantly increases muscle mass
movement developing such qualities as
speed, agility, strength and endurance;
• 4 It is noted predominant hormones
thyroid and gonads, are possible
because endokrine dysfunction;
• 5 Baby teeth completely change
permanent.
• 6 develops perseverance necessary
employment skills;

27. • 7 Forming ability, the ability to long
purposeful activity (mental and
physical);
• 8 This period is a maximum of play;
• 9 An increasing amount of attention and
its stability;
• 10 It should strictly follow the posture,
correct position at a desk or table,
physical activity and its uniform effect
on both limbs.

28. The period of high school age
(12 - 17.18 g.)
• This is puberty;
• Characterized by severe restructuring of the
endocrine system, increased growth;
• Girls secondary sexual characteristics develop
faster than boys 1 - 1.5 years;
• Most common functional disorders of the cardio -
vascular system, nervous system, due to the
rapid growth disproportionate to the whole body
and individual organs and autonomic instability -
the endocrine system;

29. • There is a violation of physical and
sexual development, thermoregulation
instability, susceptibility to malnutrition,
digestive system diseases;
• The most difficult period of
psychological development, the
formation of liberty, conscience,
morality;
• The high level of activity subcortex;
• Mostly generalized activation of the
emotional nature.

30. Stages of development of the
endocrine glands:
Prenatal period:
• formation intrarenal system;
• is laying insular apparatus;
• Newborn period:
• effects of hormones mother through breast
milk;

31. • Infansy period:
• more intensive functioning of the
thyroid and thymus glands, reverse
development intrarenal system.
• Period of baby teeth:
• high impact pineal and thymus
glands; towards the end of enhanced
activity of the anterior pituitary: isolation
of growth hormone

32. • Adolescence :
Begin to show activity gonads, pituitary function is
enhanced;
Puberty:
- Reduced inhibitory effect on hypothalamic
area pineal body,
- Increased secretion of gonadotropin,
- An increase in the synthesis of sex hormones,
- Enhanced function of gonads,
- In the cortex of the adrenal androgens are
produced intensively,

33. Physiological variants of the onset of
puberty
• 1 Missing;
• 2 Constitutional type of early puberty;
• 3 Constitutional differences in the growth
and distribution of subcutaneous fat basis;
• 4 premature development of secondary
body hair;
• 5 Premature breast development;

34. • 6 Variations of the characteristic
features of male and female;
• 7 Differences in the external shape and
mental characteristics;
• 8 Hirsutism in women;
• 9 Gynecomastia in boys;
• 10 Disorders of menstruation;
• 11 Cryptorchidism.

35. Critical periods of growth and development
age limit
Peculiarity of
critical periods
Prenatal
period: the
first
trimester
(20 - 70
days after
conceptio
n)
Last
trimester
of
pregnancy
The maximum
intensity of cell
proliferation,
differentiation,
tissue
formation
organs. The
risk of
congenital
defects rise.
The
accelerated
increase in
body weight.

36. The second
half of the
year - the
second year
of life
Early
childhood
and pre-
school stage
(2 - 7 years)
Puberty
period
The transition
to
independence
nutrition from
the mother.
Intensive
growth and
energy
metabolism.
The relative
stabilization of
the growth rate
(homeorezys),
first extract the
end of this
period.
Completion of
myelination
major afferent
pathways of
the nervous

37. Teratohenez
• The emergence of fetal malformations under
the influence of endogenous and exogenous
factors :
a) genetic (mutant genes, chromosomal
aberrations);
b) physical (ionizing radiation);
c) Chemicals (occupational hazard, poison,
alcohol, smoking, some medications);
d) infectious agents (virus rubella, influenza,
cytomegalovirus, etc.).

38. Teratogenic factors contribute:
• a) anatomical defects;
• b) genetic disorders;
• c) cytogenetic changes

39. The effects of teratogenic factors, depending on
the phase of fetal development.
• 1 phase of embryonic development:
a) chromosomal abnormalities;
b) mutations;
c) congenital malformations incompatible
with life (abortion, stillbirth, etc.);

40. • Phase 2 placental development:
a) delay of growth and differentiation
(hypoplasia);
b) violation of tissue differentiation
(dysplasia);
c) proliferative responses of connective
tissue with infectious agents (cirrhosis,
fibrosis);
d) intrauterine malnutrition