PAEDIATRICS

Pediatrics (or paediatrics) is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean healer children; they derive from two Greek words: (pais = child) and (iatros = doctor or healer). In the United States, a pediatrician (US spelling) is often a primary care physician who specializes in children, whereas in theCommonwealth a paediatrician (British spelling) generally is a medical specialist not in primary general practice

SYMBOL OF PAEDIATRICS

FIRST PAEDIATRIC HOSPITAL IN THE WORLDGREAT

ORMOND STREET HOSPITAL IN LONDON, UNITED KINGDOM

HISTORICAL DEVELOPMENT OF PAEDIATRICS

IN WORLD

Pediatrics is a relatively new medical specialty. A 2nd century AD manuscript by the Greek physician and gynecologist Soranus of Ephesus dealt with neonatal pediatrics; the Persian scholar and doctor al-Razi (865925) published a short treatise on diseases among children.The first printed book on pediatrics was in Italian (1472) Bagallarder's Little Book on Disease in Children. Pediatrics as a specialized field of medicine developed in the mid-19th century; Abraham Jacobi (18301919) is known as the father of pediatrics because of his many contributions to the field. He was born in Germany, where he received his medical training, but later practiced in New York City. In the Western world, the first generally accepted pediatric hospital is the Hpital des Enfants Malades (French: Hospital for Sick Children), which opened in Paris in June 1802 on the site of a previous orphanage. From its beginning, this famous hospital accepted patients up to the age of fifteen years, and it continues to this day as the pediatric division of the Necker-Enfants Malades Hospital, created in 1920 by merger with the physically contiguous Necker Hospital, founded in 1778.

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This example was only gradually followed in other European countries. The Charit (a hospital founded in 1710) in Berlin established a separate Paediatric Pavilion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (nowWrocaw), both in 1837. The English-speaking world waited until 1852 for its first paediatric hospital, the Hospital for Sick Children, Great Ormond Street, some fifty years after the founding of its namesake in Paris.In the USA, the first similar institutions were theChildren's Hospital of Philadelphia, which opened in 1855, and then Boston Children's Hospital (1869).

PAEDIATRICS INDIAN PIONEERS

A synopsis on Paediatrics in India is incomplete without a mention of the individuals responsible for its development. Some of the pioneers and their contributions are mentioned here. Dr. George Coelho, the Father of Paediatrics in India, was the superintendent of the first independent childrens hospital, the B. J. Hospital for children. He started the Association of Pediatricians of India (API) in 1950 and edited its official organ the Indian Journal of Child Health from 1952 to 1959. He was of the opinion that the policies regarding teaching, service and research in Paediatrics should be decided by Paediatricians only. While Paediatrics was being established in the western part of the country by Dr. Coelho, the credit of its development in the east goes to Dr. K. C. Chaudhuri. Dr. Chaudhuri founded the first independent Paediatric journal The Indian Journal of Pediatrics in Calcutta in 1933 and started the Indian Pediatric Society (IPS) in 1948. He was instrumental in establishing a private Institute of Child Health in Calcutta of which he was the first director. In the South, Professor S.T. Achar was the pioneer who planned the Institute of Child Health at Egmore, Madras. He was the first Professor of Paediatrics in India (at the Madras Medical College, 1948) and first Indian to have a FRCP in Paediatrics from Canada.

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Dr. Raghunandan V. Sanzgiri, along with Dr. Coelho, started the DCH course at the CPS (1944) and later MD in Paediatrics at the University of Bombay.To generate and keep up the interest in Paediatrics, he started the programme of rotating clinical meetings in various hospitals in 1946 and these are being held to this day. He was the main force behind the Indian Journal of Child Health. In 1963, Dr. Sanzgiri along with others was a part of the team that guided the amalgamation of the API and the IPS to form the Indian Academy of Pediatrics (IAP). Professor Harish Chandra organised the national conference which helped in the amalgamation of the two independent associations of Paediatricians mentioned above. He started the MD degree course at the Osmania University at Institute of Paediatrics, Niloufer Hospital, Hyderabad which was followed by postgraduate courses in Paediatric Surgery (1977)

HISTORY OF PAEDIATRICS IN INDIA

Our rich heritage of Ayurveda has detailed description of maternal and child health care. Sushruta in his Sushruta Samhita, had devoted a chapter toKaumarabrita (service to children). This was perhaps the first record of Paediatrics in ancient India. Paediatrics was called Kaumarbhritya tantra. TheAtharva Veda (1500 BC) describes childrens diseases and Kaushika Sutra included Paediatrics. Kashyapa and Jeevaka (400 BC) were well known Paediatricians of ancient India. Kashyapa Samhita deals exclusively with Paediatrics. Charaka wrote in details about the care and management of newborn in Sarira Sthana and Ashtanga-Hridaya. The Charaka Samhita in fact mentions an international conference of scholars. Kaumarbhritya andPrasuti tantra talk of prenatal care, and also lay emphasis on neonatal care, care of the baby including feeding and management of illnesses of children.This includes - maternal care (with respect to food, drink, leisure, restricted work, sleep, etc.), neonatal care (cleaning, dressing, bath, procedure akin to cardiac compression), care of the umbilical cord, breast feeding (including concept of a wet nurse), annaprasana (initial eating of solid food), daily care of eyes and skin, and common symptomatology in childhood illnesses

HISTORICAL DEVELOPMENT OF PAEDIATRICS IN INDIA

Indian Academy of Pediatrics

The Indian Academy of Pediatrics was established in 1962, in Patna, Bihar, with less than 100 pediatricians as its members. As of 2007 there are over 16,500 members across the country. It has State, District, and City level branches. The Academy has promoted different specialties in the field of pediatrics through it various Chapters. The IAP is the unique association of pediatricians in India; other organizations of medical specialties are often more segmented. The association has been able to maintain unity among its members. One of the major activities undertaken by the IAP since its inception has been to organize Continuing Medical Education (CME) programs by holding conferences, symposia, lectures and other meets all over the country. IAP head office is in Mumbai while Delhi is the seat of its official publication - Indian Pediatrics, an indexed journal. A more recent journal - Practical Pediatrics - - is published fromChennai and is fast becoming a popular source of scientific information.

HISTORY IN INDIA

The Indian Academy of Pediatrics has been closely linked with the development of Pediatrics at some centers in India. In the 40's there were only 12-15 pediatricians in India - 6 in Mumbai, 2 in Delhi, 2 in Madras and about 4 to 5 in Calcutta. Pediatrics made a beginning in Mumbai in 1928, when Dr George Coelho, rightly called the Father of Indian Pediatrics, became the Superintendent of the BJ Hospital for Children - the first children's hospital in India. He remained the head of the department of Pediatrics till 1953. In 1929, Bai Jerbai Wadia Hospital for Children became a separate independent children's hospital. Dr George Coelho started independent research and services in 1928. The postgraduate course for diploma in child health was started at BJ Hospital and Bai Jeerbai Wadia hospital for children in 1944 and the University of Bombay in 1946. Many of the senior pediatricians of today in the country worked at the BJ Hospital for children under the leadership of Dr George Coelho. He edited the Indian Journal of Child Health from 1952 to 1959 A separate department of pediatrics was created in Government General Hospital, Chennai, in 1946 with Professor ST Achar. He was later responsible for the creation of a separate Institute of Pediatrics and Children's Hospital in Egmore, Chennai.

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In 1948, the department of Pediatrics was started at the Nair hospital and Topiwala National Medical College with Dr Shatilal C Sheth as the head of the department. At around the same time, the department of Pediatrics was started in Patna with Dr Lala Suraj Nandan Prasad as its chief. In the early 50's, Dr PN Taneja, the senior-most pediatrician in Delhi, became the first chief of Pediatrics at Irwin hospital; and later full-time professor of Pediatrics at the All India Institute of Medical Sciences in New Delhi. Simultaneously, Dr JN Pohowalla, became the professor and head of the department in Indore. In 1933, Dr K. C. Chaudhuri founded the first independent pediatric journal namely, the Indian Journal of Pediatrics, in Calcutta. Dr Chaudhuri also started the Indian Pediatric Society in 1948. By 1958, the Indian Pediatric Society had organized nine National Pediatric Conferences in different cities in India. The Association of Pediatrics of India started in 1950 in Bombay by Dr George Coelho listed only pediatricians as "Ordinary members", and those interested in pediatrics as "Associate Members". The Indian Pediatric Society, however, had a number of non-pediatricians as "Ordinary members". Dr Coelho was of the opinion that the policies regarding teaching, service and the research in pediatrics should be decided by pediatricians only. Dr Chaudhuri on the other hand was of the opinion that all medial personnel including general practitioners who were interested in pediatrics, should be made "Ordinary" members of the Indian Pediatric Society. Dr ST Achar along with the second generation of pediatricians in Mumbai, Delhi, Calcutta, Patna and Indore acted as the catalytic force for the merger of the two national pediatric bodies.

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Another important difference of opinion between Dr George Coelho and Dr KC Chaudhuri was regarding the organization of independent and separate conferences for pediatricians. Dr Coelho decided to establish the Annual Conference of Association of Pediatricians of India in collaboration with various specialty organizations like Cardiologists, Neurologists, Hematologists and other internal medical disciplines. He felt that this would help influence the status of pediatrics as a separate discipline with senior medical professional of the country, who were the decision makers in the field of medical education. However, Dr KC Chaudhuri thought that the pediatricians of India should have a separate independent annual conference of their own. He felt that conducting a separate annual meeting of pediatricians would help establish pediatrics as an independent discipline. Considering the difference of ideas and approach of the two senior pediatric pioneers, the younger generation of pediatricians decided that it was necessary to unite the voice of all pediatricians across India by the common bond of a National Pediatric body. The Indian Pediatric Society at its annual conference at Jaipur in December 1961, adopted a resolution proposing the constitution of a single All India Organization, representative of Indian Pediatricians, instead of two. The Association of Pediatricians of India at its annual conference in Indore in February 1962 responded with a similar proposal.

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A joint committee was set up to formulate proposals to achieve this end. The members of the committee were Dr Sisir K Bose, Dr Harish Chandra, Dr SP Ghosal, Dr SS Manchanda, Dr BD Patel, Dr P Tirumala Rao, Dr Shantilal C Seth, Dr PN Taneja, Dr PM Udani and Dr JKG Webb. The committee held its first meeting at Hyderabad in March 1962. Dr Sisir K Bose was elected its Convenor. The committee laid down the principles on which the new body to be called the "Indian Academy of Pediatrics" would be constituted. The Secretaries of the two existing bodies, Dr SP Ghosal and Dr BD Patel were called upon to draw detailed proposals regarding the constitution of the proposed "Indian Academy of Pediatrics". The joint committee held its second meeting on the eve of the joint Hyderabad conference of the two bodies in 1963. At this meeting the draft constitution together with the recommendation of the joint committee was approved and forwarded to the Indian Pediatric Society and the Association of Pediatricians of India for consideration and acceptance. The Indian Pediatric Society and the Association of Pediatricians of India then jointly decided to form the Indian Academy of Pediatrics as the single representative body of Pediatricians of India and the first National Conference of the Indian Academy of Pediatrics was held in Pune in 1964. The official journal of the IAP - Indian Pediatrics, incorporated the Indian Journal of Child Health and the Journal of the Indian Pediatric Society; commenced publication in January 1964 from Calcutta. The central office of the Indian Academy of Pediatrics was established in Mumbai.

PAST PRESIDENTS OF INDIAN ACADEMY OF PAEDIATRICS

Dr. L.S.A. Prasad = 1964 Dr. P.N. Taneja = 1965 Late Dr. Shantilal C. Seth = 1966 Late Dr.S.S.Manchanda = 1967 Dr. P.M. Udani = 1968 Late Dr. Harish Chandra = 1969 Dr.J.N. Pohowalla = 1970 Late Dr.S.M. Merchant = 1971 Late Dr.N.S. Tibrewala = 1972 Late Dr.R.S. Dayal = 1973

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Dr.B.D. Patel = 1974 Late Dr.V.Balagopal Raju = 1975 Dr.Shanti Ghosh = 1976 Dr.Piloo E Bharucha = 1977 Dr.O.P Ghai = 1978 Dr. R.K. Gandhi = 1979 Dr. Satya Gupta = 1980 Dr.S.P Ghosal = 1981 Dr. K. Indirabai = 1982 Dr. B.N.S. Walia = 1983

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Dr.K.K. Kaul = 1984 Dr.S.K. Bhargava = 1985 Dr. N. Sunderavalli = 1986 Dr. (Mrs) A.B. Desai = 1988 Dr. D.G. Benkappa = 1989 Dr. N.R. Bhandari = 1990 Dr. Subash C. Arya = 1991 Dr. N.B. Kumta = 1992 Dr. R.D. Potdar = 1993 Dr. Meharban Singh = 1993

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Dr. Uday Bodhankar = 1994 Dr. Y.K. Amdekar = 1995 Dr.R.N.Srivastava = 1996 Dr. A. Parthasarathy = 1997 Dr. M.R. Lokeshwar = 1998 Dr. T. Jacob John = 1999 Dr. Swati y Bhave = 2000 Dr YC Mathur = 2001 Dr.Dilip Mukherjee = 2002 Dr.H.P.S.Sachdev = 2003 Dr.M.K.C.Nair = 2004

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Dr.Raju C Shah = 2005 Dr.Nitin Shah = 2006 Dr Naveen Thachker = 2007 Dr R.K.Agrawal = 2008 Dr Panna Chaoudury = 2009 Dr Deepak Ugra = 2010 Dr T.U.Sukumaran = 2011 Dr Rohit Agrawal = 2012

TRAINING OF PEDIATRICIANS

The training of pediatricians varies considerably across the world. Depending on jurisdiction and university, a medical degree course may be either undergraduate-entry or graduate-entry. The former commonly takes five or six years, and has been usual in theCommonwealth. Entrants to graduate-entry courses (as in the USA), usually lasting four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Medical graduates hold a degree specific to the country and university in and from which they graduated. This degree qualifies that medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for "internship" or "conditional registration". Pediatricians must undertake further training in their chosen field. This may take from four to eight or more years, (depending on jurisdiction and the degree of specialization). The post-graduate training for a primary care physician, including primary care pediatricians, is generally not as lengthy as for a hospital-based medical specialist. In most jurisdictions, entry-level degrees are common to all branches of the medical profession, but in some jurisdictions, specialization in pediatrics may begin before completion of this degree. In some jurisdictions, pediatric training is begun immediately following completion of entry-level training. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing pediatric (or any other) specialization. Specialist training is often largely under the control of pediatric organizations (see below) rather than universities,and depending on jurisdiction.

AT PRESENT PAEDIATRICS

Fifty years of independence and health care development provided through the various five-year plans have resulted in an improvement in the health status of the population of our country as a whole. This is true more so in the areas where medical facilities, both preventive and curative have reached. The vaccine preventable diseases, Indian childhood cirrhosis, tuberculous meningitis, etc. have shown a decreasing trend over this interim but have not still been totally eliminated. The spectrum of infectious diseases has also changed. While we still see diarrhoea, pneumonia, and other infections, the threat of an epidemic of the human immunodeficiency virus, which is affecting children who are innocent bystanders of the disease, cannot be overemphasised.

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Technology has progressed in leaps and bounds over the past two decades. Fortunately, this advantage has become available to us in the form of newer radio-imaging techniques, serological tests, and other sophisticated metabolic tests. It has now become possible to study body function at a sub-cellular and molecular level. This has resulted in our ability to diagnose and manage a number of inherited disorders amongst others. The benefit of antenatal diagnosis for some disorders has now become possible. The advantage of advanced technology has affected therapeutic modalities also. A vast array of drugs has been developed for many diseases. In this era of quick communication and fast travel, the benefits of a newly discovered drug has started reaching our country within few years rather than decades. Sharing of information benefits both the doctors and the patients. The medical fraternity attempts to do this by forming various societies and branches under the auspices of the national academies. For the benefit of patients of a specific disease, support groups have been formed by the interested Paediatricians and the parents of the patients along with some NGOs. These include Thalassaemia society, WISDOM, Spastic society, etc.