PEDIATRICS Paper XVIII

Course description

The course in pediatrics is developed with an awareness of different aspects of child health applicable both in the developing and the developed countries. It is inclusive of the important issues pertaining to perinatal period, infancy, early childhood, middle childhood, puberty and adolescence.

The graduates are expected to acquire certain cognitive, psychomotor and communication skills. It is expected that these skills will prepare the graduates for necessary competences in history taking, clinical examination and interpretation of symptoms and signs, formulation and testing of diagnostic hypotheses, planning for the management and institution of the necessary treatment. The attitudes of compassion and caring are other desirable outcomes expected after going through the teaching learning activities offered during the pediatric course.

The course is organized in such a way that the students should have ample opportunities to acquire knowledge and skills during their posting for three months in the pediatric wards in their third year and during the junior internship posting during the final year of MBBS class. The teaching learning methods have been organized into theory classes, group discussions, problem solving seminars and bedside clinical classes.

These teaching learning activities are expected to help the students to acquire necessary skills and attitudes to: look after the health needs of the children in different settings, participate as a member of the child health care team, supervise the junior members of the team and participate in the planning and implementation of community child health programmes.

General Objectives:

At the end of the course the students will be able to manage common pediatric problems, save lives by instituting initial treatment in emergency situations and identify and refer patients who are beyond the graduates’ competence or level of health facility he or she is working at.

Specific objectives:

General pediatrics:

Students will be able to

define pediatrics and describe its scope
describe the normal growth and development during fetal life, neonatal period, childhood and adolescence and outline deviations thereof.
enumerate behavioral disorders and outline principles of their management.
describe the common paediatric disorders and emergencies in term of epidemiology, etiopathogenesis, clinical manifestations, diagnosis, rational therapy and rehabilitation.
distinguish between normal newborn babies and those requiring special care and institute early care to all newborn babies including care of preterm and low birth weight babies, provide correct guidance and counseling in breastfeeding and infant feeding.
state age related requirement of calories, nutrients, fluids, drugs etc. in health and disease.
state the principles of infant and young child feeding (including complementary feeding)
describe preventive strategies for common infectious disorders, malnutrition, genetic and metabolic disorders, poisonings, accidents and child abuse.
outline national program relating to child health including immunization program and Integrated Management of Childhood Illnesses (IMCI)
take a detailed paediatric history, conduct an appropriate physical examination of children including neonate, make clinical diagnosis, interpret common laboratory investigation and plan and institute therapy.
take anthropometric measurements, resuscitate newborn infants with bag and mask at birth, prepare oral rehydration solution, perform Tuberculin test, administer vaccine available under current national program, start an intravenous line and provide nasogartic feeding, observe vene-section and intra osseous infusion if possible.
conduct diagnostic procedure such as lumber puncture, pleural tap and ascitic tap, observe bone marrow aspiration
provide ambulatory care to sick children, identify indications for specialized/inpatient care and ensure timely referral of those who require hospitalization.
define impairment, disability and handicap and state measures to prevent them.
list the different types of childhood disabilities prevalent in Nepal and services available for their rehabilitation in the country.
identify the potential sources of ethical dilemmas in pediatric practice and mechanisms to resolve them.
state the principles of rational drug therapy in pediatric practice.
communicate skillfully during interaction with patients and their caregivers.
conduct physical examination of children including neonate
perform anthropometry and interpret growth of the child assess the developmental of a child
distinguish between normal newborn babies and those requiring special care
(including low birth weight and pre-term)
provide care of the newborn at birth and in the ward
advice on breast feeding, counsel for breast feeding & infant and young child feeding
make clinical diagnosis, conduct common bed side procedure, interpret common laboratory investigation and plan and institute therapy
recognize emergencies including the need for neonatal resuscitation and CPR
and care to be instituted and relevant procedure performed
observe diagnostic and therapeutic procedures such as intravenous access, nasogastric feeding, venesection, pleural tap, ascitic tap, lumber puncture if possible bone marrow aspiration, liver & kidney biopsy.

Neonatalogy

Students will be able to

define common terms used in neonatology such as neonate. Preterm, Small for gestational age (SGA) baby, post-term baby, Low Birth weight,
explain the mechanism of temperature regulation in newborn
describe management of feeding in the newborn including breast feeding and management of lactation.
explain normal fluid and electrolyte balance in neonate
define neonatal respiratory distress
describe the mechanisms of jaundice in newborn and its management
identify infection in a neonate and take appropriate action
define neonatal convulsions, list their types and describe their management.
enumerate birth injuries and their management
enumerate common congenital anomalies and their management
identify common danger signs in a neonate in order to recognize a sick neonate and take corrective steps

Pediatric emergencies

Students will be able to

diagnose and manage the following medial emergencies:
Poisoning- common childhood poisoning e.g. Kerosene oil,
organophospharus etc.
Shock — Hypovoiumic, Anaphylactic, Electric
Drowning
diagnose and refer following surgical emergencies:
Tracheo-oesophageal fistula,
Diaphragmatic hernia
Intestinal obstruction
Imperforate anus

Chromosomal Diseases

Students will be able to

diagnose and refer Down syndrome

Collagen Diseases

Students will be able to diagnose and manage

Acute Rheumatic Fever
Juvenile Rheumatoid Arthritis
Systemic Lupus Erythemetosus
Henoch Schonlein purpura

Cardiac Diseases

Students will be able to diagnose and manage.

Congestive heart failure
Acyanotic heart diseases: Atrial septal defect, ventricular septal defect, Patent Ductus Arteriosus
Cyanotic Heart Diseases — Tetralogy of Fallot, Transposition of Great Arteriosus
Rheumatic Heart Diseases
Infective endocarditis
Pericardial effusion
Hypertension in children

Renal Diseases

Students should be able to diagnose and manage

Acute glomerulonephritis & hematuria
Nephrotic syndrome
Urinary tract infection
Acute and Chronic Renal Failure
Haemolyatic ureamic syndrome
Vesicoureteric reflex (obstructive uropathy)

Endocrine Diseases