兒科學(xué)（英文版）

PEDIATRICSOVERVIEWCHAPTER1TheScopeofPediatricsPediatricsisconcernedwiththehealthofinfants,children,andadolescents;theirgrowthanddevelopment;andtheiropportunitytoachievefullpotentialasadults.Itisthescienceandartofprevention,diagnosis,andtreatmentofthediseasesofchildrenfrombirththroughadolescence,whetherthesedisturbancesbephysical,mental,oremotional.兒科學(xué)是一門關(guān)于從出生到青春期兒童疾病預(yù)防、診斷與治療的科學(xué)和藝術(shù)，這些兒童期的疾病可以是肉體的，也可以是精神方面的。TheScopeofPediatricsThemostcharacteristicfeatureofpediatricsisthatitdealswiththegrowthanddevelopmentofthechild,comprisingallthosechangesinsizeandformandincomplexityoffunctionthatconstitutegrowingup.兒科學(xué)最主要的特征是要研究?jī)和纳L(zhǎng)發(fā)育，兒童的生長(zhǎng)發(fā)育造成了其形體方面的變化，也是其功能復(fù)雜性的基礎(chǔ)。SubspecialtyofPediatricsSubgroupedbytheemphasisofhealthcare：DevelopmentalPediatrics（發(fā)育兒科學(xué)）PreventivePediatrics（預(yù)防兒科學(xué)）ClinicalPediatrics（臨床兒科學(xué)）RehabilitationinPediatrics（兒童康復(fù)醫(yī)學(xué)）,etcSubgroupedbyage：Perinatology（圍生醫(yī)學(xué)）Neonatology（新生兒學(xué)）AdolescenceMedicine（青春醫(yī)學(xué)）,etcTheGoalOfPediatricsTobecertainofthehealthofchildren.Topromotethelifequalityofchildren.DifferencebetweenChildandAdultAchildisincontinuousgrowthanddevelopment.“ACHILDISNOTALITTLEMAN”Functionsofvariousorgansystems各系統(tǒng)功能差異Degreeofimmunitytodisease機(jī)體免疫反應(yīng)程度Responsetotheeffectsofdisease對(duì)疾病的應(yīng)激反應(yīng)Dosageofdrugsandtolerancetodrugs對(duì)藥物劑量及耐受性Mentalandmotorability精神運(yùn)動(dòng)的能力Pattenofemotionalresponse心理反應(yīng)DisparityinOccurrenceandProgressionofDiseasebetweenChildrenandAdultDisparityinanatomy,physiology,andimmunologicfunctionbetweenchildrenandadultTheyounger,themoredifferentDisparityinoccurrenceandprogressionofdiseasebetweenchildrenandadultDisparityinspectrumofdisease不同的疾病譜Congenitalanomalies、inbornerrorsofmetabolism(morecommoninchildren)先天畸形、先天代謝性疾病多見(jiàn)

Newbornsandinfantsisvulnerabletoinfection

新生兒、嬰兒易發(fā)生感染Sinusitisisrareininfancy鼻竇炎在嬰兒相對(duì)少見(jiàn)Infantsandyoungchildrenarevulnerabletoobstructioninrespiratorytract嬰幼兒易發(fā)生氣道阻塞DisparityinOccurrenceandProgressionofDiseasebetweenChildrenandAdultDisparityintypeofdiseasePneumoniaChildren:bronchialpneumonia支氣管肺泡炎癥Adult:lobarpneumonia大葉性肺炎

VitDDeficiencyChildren:rickets(佝僂病)Adult:malacosteon(骨軟化)DisparityinoccurrenceandprogressionofdiseasebetweenchildrenandadultDisparityinmanifestationofdiseasediarrheadehydration；feverseizureDisparityinoccurrenceandprogressionofdiseasebetweenchildrenandadultStagesOfAChildByAgeEmbryoperiod（胚胎期）:thefirst8weeksofgestation,theformationoftissuesandorgans懷孕~8周Fetusperiod:fromthe9thweekofgestationtothedeliveryoftheneonatalinfant,thegrowthanddevelopmentofthefetus第9周~分娩出生Fetus（胎兒期）:fromconceptiontothebirthoftheneonate,40weeks.從受精卵形成~出生為止，40周。Earlyneonates:thefirstweekafterbirthPerinatalperiod（圍產(chǎn)期）:fromthe28thweek’sofgestationtothe7thdayoftheneonateafterbirth.Neonates（新生兒期）:fromdeliveryandcuttingofftheumbilicalcordofthenewborntothe28thdayafterbirth從胎兒娩出臍帶結(jié)扎時(shí)開(kāi)始~28天Birthinjury,apnea,infections,hemorrhage,hyperbilirubinemia,etcarecommonmedicalproblemsinthisstage.Carefullytakingcareoftheneonatalinfantisofgreatimportance.Infants（嬰兒期）:the1styearafterbirthInfectiousdiseases,malnutrition,andindigestionarecommoninthisperiod感染、營(yíng)養(yǎng)不良、消化不良多見(jiàn)Healthcare:Properfeeding合理喂養(yǎng)Vaccinationintime

按時(shí)預(yù)防接種Youngchild(toddler’sage，幼兒期):from1yearoldto3yearsoldBegintowalk,quicklinguisticandintelligencedevelopment,strongcuriosity學(xué)習(xí)行走，語(yǔ)言、動(dòng)作、思維發(fā)育迅速，強(qiáng)烈的好奇心

Healthcare:Preventionofaccidentsandinfectiousdiseases防意外、感染Propernutrition合理營(yíng)養(yǎng)Preschool（學(xué)齡前期）:from3yearsoldto6～7yearsoldGrowthrateslowsdownbutlanguageandemotion,asindicatorsforintelligence,continuetodevelopquickly.Healthcare:EncouraginggoodbehaviorSuitabletimingtobeginearlyeducationDiseaseprevention:rheumaticfever,acuteglomerulonephritis,etc.Schoolage（學(xué)齡期）:aged6~7topre-adolescenceSystemandorgansdevelopmenthavebeenalmostreachedtothelevelofadults(exceptforsexualorgans).Self-esteemplaysveryimportantroleinthepsychologicaldevelopment.Healthcare:Encouraginggoodattitudeandhabitsforstudyandbehaviors.Preventionofnearsightedness（近視）,decayedteeth（齲齒）,etc.Adolescence(earlyyouth，青春期):from10yrsoldto20yrsold.

Theadolescenceofagirlmaybeginandendabout2yrsearlierthanthatofaboy.女孩青春期的開(kāi)始與結(jié)束時(shí)間均比男孩的早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（早產(chǎn)兒）、diarrhea（腹瀉）、congenitalanomalies（先天畸形）TheWorldSummitforChildrenin1990“TheWorldDeclarationontheSurvival,ProtectionandDevelopmentofChildreninthe1990s”PlanofActionforImplementingofthedeclaration中國(guó)政府制定“九十年代中國(guó)兒童發(fā)展規(guī)劃綱要”“（2001～2010）中國(guó)兒童發(fā)展綱要”“（2011～2020）中國(guó)兒童發(fā)展綱要”TheChildrenAreOftenAmongtheMostVulnerableorDisadvant-agedinSocietyandTheirNeedsRequireSpecialAttention.PrinciplesandObjectives

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

INTHISCHAPTERCharacteristicfeaturesofpediatrics

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

AND

DEVELOPMENTCHAPTER2AssessmentindicatorsforgrowthanddevelopmentaswellastheirmeasurementsKeymotorsindicatingforagesofinfantdevelopmentKEYPOINTS

INTHISCHAPTERGrowthAndDevelopmentGrowth

Thechangesofformandincreasesinsizeofthebodyandorgansofachild

兒童各器官、系統(tǒng)的長(zhǎng)大DevelopmentMaturationofcells,tissuesandorgans

組織、器官、功能的分化成熟Growthanddevelopmentisacontinuousandstagedprocess是一個(gè)連續(xù)的、分階段的過(guò)程PatternsofGrowthandDevelopmentPatternsofGrowthanddevelopmentDifferentrateofdevelopmentinvarioussystemsPatternsofGrowthandDevelopmentIndividualvariationingrowthanddevelopmentPatternsofGrowthandDevelopmentGrowthanddevelopmentshowCephalocaudal（從頭到尾）pattern生長(zhǎng)發(fā)育通常遵循由上到下、由近到遠(yuǎn)、由粗到細(xì)、由低級(jí)到高級(jí)、由簡(jiǎn)單到復(fù)雜的規(guī)律FactorsInfluencing

GrowthAndDevelopmentGenetics基因遺傳Nutrition營(yíng)養(yǎng)狀況Healthstatusduringpregnancy母體懷孕時(shí)的健康狀況Livingenvironments生活環(huán)境Effectsofdiseases疾病影響IndicatorsForAssessmentofGrowthAndDevelopmentBodyWeight體重Height身高SittingHeight坐高HeadCircumference頭圍

ChestCircumferenc

胸圍UpperArmCircumference上臂圍SubcutaneousFat

皮下脂肪BodyWeightAsensitiveindicatorforgrowthandnutritionalstatus評(píng)估生長(zhǎng)及營(yíng)養(yǎng)狀況Animportantvariableforcalculationofdrugdosage,energyandfluidsupplement

用于計(jì)算兒童用藥劑量、能量及液體治療Examination

Babybalanceforinfants(accuracyin50g），weighingscaleforchildren（accuracyin100g）

嬰兒測(cè)體重精確：50g；兒童: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 ofbirth(出生體重的2倍)1yearold

10(出生體重的3倍)

2yearold

12Averagebodyweightforchildrenof1～12old：

BW（kg）＝Age(years)×2＋8PhysicalWeightLoss

生理性體重下降A(chǔ)newborn’sweightmaydecrease10%belowbirthweightinthe1stweekasaresultofexcretionofexcessextravascularfluidandpossiblypoorintake.

生后1周生理性體重下降，水分丟失、胎糞排出、攝入不足有關(guān)，下降約3%~9%Intakeimprovesascolostrumisreplacedbyhigh-fatmilkandtheamountofmilkinfantsuckincrease,Infantshouldregainorexceedbirthweightby7～10daysofageandshouldgrowatapproximately30g/day.

及時(shí)喂養(yǎng)，生后7~10天體重恢復(fù)出生時(shí)體重，后體重增長(zhǎng)約30g/天WeightIsasensitiveindicatorforgrowthandnutritionalstatus

Height

Thelengthfromthetopoftheheadtotheplantapedis測(cè)量方法：頭頂~平足底部Anparameterforbodygrowthandgrowthvelocity,anassessmentforskeletongrowth

評(píng)估兒童生長(zhǎng)、生長(zhǎng)速度骨骼生長(zhǎng)Measurement＜3yearsoldMeasuringinrecumbentposition

(Bodylength)3歲以下臥位測(cè)量＞3yearsold

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

and12～13cmduringthefollowing9

months,sointhe1styeartheheightwillincrease25cm.10～12cminthe2ndyear.Fromage2～10,5～7cm/yearwillbegained.年齡（y）×7+751yearold752yearsoldAfter2yrsold85SomeConceptsAboutHeight

SettingHeight（坐高）：Thelengthfromthetopofheadtoischialtuberositywhichmeansthelengthoftheheadandspinalcolumn頭頂部~坐骨結(jié)節(jié)的距離UpperLength（上部量）：Thelengthfromthetopofheadtotheupperedgeofsymphysispubis頭頂部~恥骨聯(lián)合上緣的距離，評(píng)估扁骨的生長(zhǎng)LowerLength（下部量）：Thelengthfromtheupperedgeofsymphysispubistodorsaldecubitus.恥骨聯(lián)合上緣~腳底，評(píng)估長(zhǎng)骨的生長(zhǎng)。UpperLength&LowerLength新生兒的上部量占身長(zhǎng)的60%，下部量占身長(zhǎng)的40%，12歲以前各年齡期有一定的比例。對(duì)矮小癥患兒，除測(cè)量身長(zhǎng)外，尚需測(cè)量上、下部量，如下部量過(guò)短表示長(zhǎng)骨發(fā)育障礙，見(jiàn)于克汀病（甲狀腺功能低下）及軟骨營(yíng)養(yǎng)障礙。

Head/Trunk+legUpperlengthinbodylengthMidpointLowerlengthinbodylengthNewborn1/460%Abovenavel40%Age2BelownavelAge6BetweennavelandtheupperedgeofsymphysispubisAge1250%theupperedgeofsymphysispubis50%Adult1/8Lowerlength＞UpperlengthContinuousandStagedProcessinHeightGainofChildren出生~1歲，青春期是身高增長(zhǎng)的兩個(gè)高峰期HeadCircumference&

ChestCircumferenceHeadCircumference（頭圍）：Indicatorforgrowthanddevelopmentofbrainandcranium

評(píng)估腦與顱骨的發(fā)育。出生時(shí)約33~34cm，1歲時(shí)46cm，2歲時(shí)48cm。ChestCircumference（胸圍）：Indicatorforgrowthanddevelopmentofthoraxandlung.評(píng)估肺與胸廓的生長(zhǎng)。出生胸圍約32cm，1歲時(shí)約等于頭圍，2歲48cm，2~15歲僅增加6~7cm。1歲~青春前期胸圍=頭圍+年齡-1cmHeadCircumferenceMeasurementMeasuringthegreatestoccipitofrontalcircumference眉弓上緣、枕骨結(jié)節(jié)環(huán)繞一周的長(zhǎng)度ReflectingthevolumeofintracranialcontentsaswellasthethicknessoftheskullandscalpChestCircumferenceExaminationMeasuringthethoraciccirclearoundnipplesandinferiorangleofscapulaandtakingtheaveragevaluebetweeninspirationandexpiration平乳頭下緣經(jīng)肩胛骨下緣平繞胸一周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）年齡AgeHCCCAssessmentofGrowthASSESSMENTOFGROWTH均值（Mean）＆標(biāo)準(zhǔn)差Standard（SD）正常分布±1SD+2SD+3SD68.3%95.4%99.7%ASSESSMENTOFGROWTH百分位數(shù)（Percentile）P3～P9795%表格與生長(zhǎng)曲線（Growthchart）多參數(shù)指標(biāo)年齡別體重（Weightforage）年齡別身高（Heightforage）體重別身高（Weightforheight）Developments

ofSkeletonandTeethCranialBonesThematureofcranialbones（顱骨）canbereflectedby:Headcircumference頭圍Fontanel囟門Closingofsuture骨縫閉合Bone,Fontanels,SuturesOfCranialFrontalboneOccipitalboneParietalboneNormalFusionofCranialBonesPosteriorfontanel（后囟門）:6～8wksafterbirth出生時(shí)很小或已閉合，6~8周閉合Suturesofcranialbones（顱骨縫）:3～4monthsafterbirthAnteriorfontanel（前囟門）:1～2cminnewborn,Theanteriorfontanelusuallytendstoenlargeduringthefirstfewmonthsoflife,lessenafter6monthsold.Itclosescompletelyin1～1.5yearsold.出生時(shí)1~2cm，1~1.5歲閉合SpinalColumn正常情況Duringthefirstyearoflife,spinalgrowupfasterthanextremities.Lateron,thesituationisreversed.新生兒的脊柱彎曲不明顯，呈輕度后凸，3個(gè)月的嬰兒能抬頭時(shí)出現(xiàn)凸向前的頸曲，6個(gè)月后會(huì)坐時(shí)，出現(xiàn)凸向后的胸曲，1歲開(kāi)始走路時(shí)，出現(xiàn)凸向前的腰曲。OssificationCenter

骨化中心Theappearanceofossificationcenter(endochondralossification)isoneofthemarksforskeletal.長(zhǎng)骨的生長(zhǎng)主要由長(zhǎng)骨干骺端的軟骨骨化，骨膜下成骨，使長(zhǎng)骨長(zhǎng)長(zhǎng)、增粗，當(dāng)骨骺與骨干融合時(shí)，標(biāo)志長(zhǎng)骨停止生長(zhǎng)。骨化中心的出現(xiàn)評(píng)估長(zhǎng)骨的生長(zhǎng)成熟程度。BoneAge骨齡Boneageisthemeasurementofskeletalmatura-tion.AradiographofthelefthandandwristisobtainedandcomparedwiththepublishedstandardsofGreulichandPyle.Kneefilmsaresometimesaddedforyoungerchildren.

用X線檢查測(cè)定不同年齡兒童長(zhǎng)骨干骺端骨化中心的出現(xiàn)時(shí)間、數(shù)目、形態(tài)的變化，并標(biāo)準(zhǔn)化，為骨齡。BoneAge骨齡Referencestandardsforbonematurationfacilitateestimationofboneage.

骨齡反映長(zhǎng)骨的生長(zhǎng)成熟程度

Theboneageislowandiscomparabletotheheightage:Constitutionalgrowthdelay,Endocrinologicshortstature,Undernutrition.

骨齡延遲：生長(zhǎng)發(fā)育遲緩，生長(zhǎng)激素缺乏癥，營(yíng)養(yǎng)不良等Theboneageisnormal(comparedtochronologicalage):Familialshortstature.

骨齡正常：家族性身材矮小DevelopmentofOssificationCenters腕骨骨化中心的出現(xiàn)時(shí)間

年齡 骨化中心

3M 頭骨、鉤骨1歲下橈骨

2～3歲 三角骨

3歲 月骨3.5～5歲大、小多角骨

5～6歲 舟狀骨

7～9歲豆?fàn)罟枪驱g測(cè)定在臨床上有重要意義，骨齡落后見(jiàn)于生長(zhǎng)激素缺乏癥、呆小病、腎小管酸中毒等；骨齡超前見(jiàn)于中樞性性早熟、先天性腎上腺皮質(zhì)增生癥等。3月頭、鉤骨；1歲下橈骨（夠，骼）；加了2與3（三角骨）等約（月骨）多少？答案：大小多（骨）3-5歲周（舟）5舟6下尺骨（6-7歲）；逗狗（豆9）10全都齊舟、月、三角、豆，大小、頭、橈、鉤DentitionPrimarydentition（乳牙）Timeoferuptionofprimaryteeth:About6months(4~10months)

ofage,allprimaryteethshouldbeeruptedat2~2.5yearsoldNumberofprimaryteeth:20intotalCalculationoferuptionofprimaryteeth:Numberofprimaryteeth=Age(month)-6TimeAndOrderofDentitionDentitionPermanentteeth（恒齒）TimeofgrowingpermanentteethBeginning:at6~7yearsoldFinish:at20~30yearsoldNumberofpermanentteeth:28~32(dependingonwhetherthewisdomtoothareeruptedornotandhowmanytheyareerupted.NEURO-PSYCHOLOGICALDEVELOPMENTDevelopmentsOfBrainAndSpinalDevelopmen