Pediatry

History of pediatry in France

Until the Century of the lights, specificities and the person of the child will be practically ignored. Even the large philosophers ignore the child. Only Saint Augustin will tell his childhood. The child is only one miniature adult with precarious survival. From the 18th century, the child gradually will be perceived like a being in growth and maturation, somatic and psychic, at the same time as a subject of education and training requiring an early intervention. However, the newborn will be regarded a long time as a simple “digestive tract”, a being reflex, without any competence, stripped of feelings and feelings; a hardly moderate consideration when this being becomes crawling then peddler. Moreover, strong the Infant mortality is regarded as a usual fate, almost normal and the Infanticide of malformés, as well as the Eugénisme, will have established among a long time. In fact, few doctors are interested in medicine of the child before the two world wars of the XX° century, even if one can however evoke certain precursors like the Nile Rosén von Rosenstein in Sweden with the XVIII° century, like much later, Armand Trousseau and Antoine Marfan in France at the dawn of the XX° century. The concerns, taken of load and discovered on the matter are, indeed, recent and followed the slow and progressive emergence of pediatry under the effect of the hecatomb of the two world Great Wars (need for replacing the sacrificed generations), of the revolutions Pasteurian and freudienne, the Hospitalisme and the birth of the Obstétrique. The XIX° century constitutes however the transition period as regards hospitalization of the children and promotion of preventive actions and social.

about 1620: Peter Chamberlen the elder one invents the Forceps
about 1800: Jean-Louis Baudelocque, and others like the professor Joseph Récamier his true precursor, takes part in the creation of modern obstetrics. It founds in Paris a maternity and a school of midwives which always bear its name. A little later, Abraham Jacobi opens the first private clinic for children in USA
1872: creation of the word pédiatrie
1874: law of December 23rd, 1874, known as law Roussel (monitoring of the children placed in Nourrice, organization of districts responsible for the health of the children which lives there and compilation of statistics on this population at risk).
1875: Madeleine Brès can be regarded as the first pediatrist française
1878: the teaching of pediatry is officialized in France
1877: rest of the woman enceinte
1896: the Mairie of Paris sets up a Commission of study of the food by the Lait. Gaston Variot, Paul Strauss and Pierre Budin found the League against infant mortality”.
1891: lumbar Puncture
1892: first consultation for Infant S in France, under the responsibility of Pierre Burdin
1894: the hospital-dispensary of Belleville rested by Gaston Variot becomes the " Drip of lait" (benefits of a strictly controlled infantile food).
1895: Radiography
1901: discovered blood groups
1906: the cuti-reaction (Pirquet test) discovered by the Austrian pediatrist Clemens von Pirquet
1907: appearance of the word pediatrist (Larousse)
1911: creation of the Institute of child welfare in Paris which includes/understands not only one formation intended for the doctors " puériculteurs" (qualifier of the time) but also a “school of the mothers” and cycles of conference intended for large the public
1917/1920: creation of the School of child welfare of the Medical college of Paris, as well as the Diploma of Visitor of maternal and infantile, future hygiene nurse péricultrice whose diploma of State will be created in 1947
1935: law of the 1935, known as law Strauss for the protection of the children of less than three years. It also sets up the notebook of growth with of which any child must be provided as of the naissance.
1945: schedule of November 2nd (protection of the children of less than 6 years, generalization of the health record delivered to the birth, obligation to create or develop the antenatal consultations or infants for all the departments). The professor Robert Debré created the first service of pediatry, with personnel specific male nurse and care, distinct from the assumption of responsibility of the adults. It is the beginning of modern pediatry and SME.
1948: official definition of prematurity by the Office world of Health (alive newborn with one period of gestation of less than 37 weeks). Preceded by work of Pierre Budin, it, in practice, will be refined and specified thereafter discoveries scientifiques.
1950: birth of pediatry néonatale, first under-speciality of the pédiatrie
1951: a precise law: the role of the consulting doctor and the elements of the examination of the child to be carried out, the role of the nursery nurse and extend the services of SME to the whole of the population. The decree of July 19th, 1962 will come to supplement and reform these dispositions
1960/1970: Francoise Dolto brings psychoanalytical dimension to pediatry. It is as at that time as affirm themselves or are born from many under-specialities of the pédiatrie
1970: monitoring of the new-born babies in maternity with an obligatory doctor visit in the first week (law of July 15th, 1970, followed by the decree of August 27th, 1971)
1975: the fetal echography finally makes it possible to observe the alive fetus in its amniotic bubble. Currently, the various techniques of the Medical imagery supplement these observations and, with the projections of the genetics, allow increasingly precise and early diagnoses…/…

to note which exists an International Company of the History of the Medicine (SIHM) of which one of its presidents, the Canadian pediatrist Of Broquerie Fortier (1976-1980) was strongly invested in the history of pediatry.

Pediatry is exerted by a specialist physician

If the interventions in margin are excluded or in supplement of pediatry, like that of the pédo-psychologists or that of the personnel of child welfare, in France, pediatry is in a strict sense a medical activity. So certain general doctors have a competence in pediatry, specialization in pediatry remains attached to the quality of pediatrist, i.e. with a Médecin specialist (10 years of formation, including 4 years of additional specialization at the conclusion of initial training).

Role of the pediatrist general practitioner

Except the pediatrists who are specialized in a particular discipline, the pediatrist general practitioner is responsible for the regular monitoring of the growth of the child and his awakening, as well as all interventions afférant there: Vaccination S, modes, Tracking and treatment of various pathologies…

In fact, its intervention recovers the four following principal functions: prevention, tracking, treatment and rehabilitation.

- the prevention becomes increasingly antenatal since one can prevent the complications obstétricales due to the blood incompatibilities. Novel methods as the amniotic puncture which makes it possible to analyze the fetal cells opened the way with many progress as regards antenatal prevention: detection of the chromosomal anomalies, for example. Without counting considerable advances of the genetics. Then, the attention is related to the food hygiene, vaccinations, the education of the parents, in particular on the accident risks (various ingestions), of sudden death, school overwork or on the contrary, the psychogenic adynamy of the teenager (weak activity), etc.
- the detection of the metabolic anomalies, like the Phénylcétonurie (or hyperalaninemy), the Hyperphénylalaninémie and the congenital Hypothyroïdie starts as of the birth. The interest of the early tracking of these diseases as of the birth is that they can profit from an effective cure either by the mode or by the contribution of drugs and thus avoid any encephalopathy which would become final. One also thinks of the detection of the anatomical anomalies like the Luxation congenital of the hip, the sensory anomalies like the Strabisme or the Surdité, or with the tracking of the Autisme. Then, it is in school where the child spends most clearly his time that it is advisable to make this tracking (role of the school doctors). Many techniques of trackings exist: test with sweat for the Mucoviscidose, the test of Guthrie for the phénylcétonurie, etc.

- the pediatric treatment made many progress. It poses especially the problem of the choice of the place of the treatment. The hospitalization is not always necessary but can prove to be essential if the guard and the monitoring of the newborn can be assured in residence. Ambulatory pediatry offers sometimes a solution satisfaisante.

- the Rééducation (or Rehabilitation) of the after-effects of an acute anomaly having been treated at the stage is a big part of pediatry. One thinks for example of the infantile diabetes, etc

The pediatrist must have qualities of listening, patience and observation with sometimes apprehensive, restive children or too young people to express themselves, and a relational good with parents whose testimony is essential (in particular for the children of less than 2 years) and that it can, in return, to reassure and advise (as regards health, of food, of hygiene, but also of education, even of psychology)

It should be noted that, marginally, certain pediatrists dispute overall this role of a pediatrist more turned towards pathologies than towards health of the child.

Studies of pediatry in France

All the doctors receive a teaching in pediatry which they can possibly supplement, among the obligatory training courses that they must achieve, of a training course directed towards pediatry. However, to become specialist (pediatrist), it is necessary to prepare and obtain one OF (Diploma of specialized studies) in pediatry. This teaching includes/understands 250 hours, without counting the practical training courses, distributed for the moment over 4 years.

Mainstream educations:

- Evaluation methodology of the practices of care and the clinical research and epidemiologic in pédiatrie
- Organization, management, ethics, right and medical responsibility in pédiatrie

specific Lesson:

- Development of the embryo and the fetus; prevalence of prematurity and the hypotrophie to the birth;
- Growth and development somatic, sensory and psychological normal and pathological of the infant and the child;
- Puberty and sexuality of the child and the teenager;
- Food and nutrition of the infant and the child;
- Pharmacology (metabolism, posology, action and toxicity) of the usual drugs in pediatry;
- Functional Explorations in pediatry;
- Morbidity and perinatal and infantile mortality in the world;
- Epidemiology, physiopathology, anatomopathology, diagnosis, forecast and treatment of the diseases of the fetus and the newborn, the infant, the child and the teenager;
- Infantile Maternal protection and, organization of the births and prevention of prematurity and the hypotrophie;
- Prevention and assumption of responsibility of malformations, the genetic diseases, the handicaps and the ill-treatment in the child; diagnosis anténatal and tracking néonatal;
- Program of vaccination;
- Organization and assumption of responsibility of the pain in the child and the pediatric urgencies médico-chirurgicales
;

Hands-on training in approved services:

- Five six-month periods in a service approved for OF pediatry, including at least four in the teaching hospital or officially agreed services and at least, in two different services or departments. The candidate must have validated at least a semi-annual training course in general pediatric unit, unit neonatology and with the urgencies (pediatric reanimation or emergency pediatry or six formative guards in a pediatric resuscitation unit)
- One six-month period in a service approved for OF pediatry, genetics, of medical gynecology-obstetrics and gynaecological or public health and social medicine;
- Two six-month periods in services approved for others As soon as those previously cités.

Income of the French pediatrists

The income of the pediatrists would be the least low of all the specialist physicians, according to a study of the Ministry for the health gone back to 1999, the observations of a member of Parliament in 2003 and those of a collective of liberal pediatrists made in 2007, for which the income of the pediatrists is of " 10 to 20% in lower part of the general practitioners and 50% in lower part of the average revenue of the specialists ". August 1st Some lawful measurements of the Ministry for Health aiming at the income of the pediatrists:
- Two decrees, one of December 27th, 2001, the other of May 31st, 2002 created an increase of particular subjection for the acts related to each childbirth carried out the night, Sunday and bank holidays, for the liberal pediatrists subjected to an obligation of astreinte
- Stopped of August 29th, 2002 modifying the general nomenclature of the professional acts the alignment of increases for the visits of night of the pediatrists allowed on those of the doctors généralistes
- Stopped of July 31st, 2002, published on August 2nd, 2002, relating to the national agreement of good practices and good use of the care concluded between the health insurance and the professionals created a contractual increase of 5,13 euros of the consultations and visits specific paid by the pediatrists for the children from 0 to 24 months inclus.

In this matter it is however advisable to take into account the various agreements made later on between CNAM and doctors' associations.

Demography of the French pediatrists

There are overall approximately 6000 pediatrists in France in 2007, from which approximately 60% women (of constant increase) to which are added various pediatric specialities. Liberal medicine would represent in 2007 approximately 40% of manpower of the pediatrists (will infra). According to a study of 2004 carried out under the aegis of the National council about the Doctors, the number of the pediatrists has been in constant increase for 20 years. They accounted for 3,1% of the total of the doctors and 6,3% of the French specialists. Nearly 95% a regular activity whereas they were hardly 3,1% not installed and 2,1% temporarily without activité.
exerted

Without distinguishing by type of exercise, the Order of the doctors, for the pediatrists having a regular activity, currently gives on its site the following figures between 2002 and 2005:

Pediatry

- 2002: 6163 (2536 H/3627 F)
- 2003: 5948 (2461 H/3487 F)
- 2004: 6049 (2453 H/3596 F)
- 2005: 6151 (2451 H/3700 F)

pediatric Surgery

- 2002: 73 (36 H/37 F)
- 2003: 77 (39 H/38 F)
- 2004: 166 (112 H/54 F)
- 2005: 174 (113 H/61 F)

Psychiatry option children and teenagers

- 2002: 1287 (631 H/656 F)
- 2003: 1253 (609 H/644 F)
- 2004: 347 (141 H/206 F)
- 2005: 1234 (599 H/635 F)
For its part, the study of 2004 gave the following precise details:

pediatric Density:

Although the progression is weaker than in other specialities, the medical density passed from 6,8% per 100.000 ha in 1983 (3708 pediatrists) to 10,5% in 2003 (6281 pediatrists). The distribution geography remains however very unequal: weak in the center of the country (5,8); strong in Ile de France (17,3), in Aquitaine, Indre-et-Loire, in frontage is and north-eastern and certain departments of the sud.
In spite of these figures, a demographic crisis is profiled in this speciality of the fact mainly of these two factors:
- increase in demand (downtown, in neonatality, urgency, SME and maternity because of the new constraints of these last, new assumptions of responsibility: handicaps, pain, cancer, genetics, crisis of youth). This is however to put in parallel with the fact that specialization in pediatry like the nutrition, the endocrinology, the study of allergies, etc, develops with the detriment of the general pediatry which is the prerogative of the liberal pediatry of city. However, only 20% of the children would have a pediatric follow-up.
- raises uninsured (population pyramid of the pediatrists compared to the stations of interns offered which is in fall). Thus the Middle Age of the pediatrists was 48,2 years (respectively 50,9 years for the men and 46,4 years for the women) and manpower of less than 45 years was already lower than that of more than 55 years. Moreover, it is advanced that the government policy would like that there are no more pediatrists downtown, as in certain countries (Great Britain, Spain). The stations of interns especially would thus have been fixed according to the needs hospitaliers.

Type for exercise for the pediatrists:

The study counted, on 5948 pediatrists (95% of the total) having a declared regular activity:
- 1712 pediatrists as a liberal (of which 53,6% women) are 27,3% of the total déclaré
- 902 pediatrists in mixed exercise (of which 47% women) are 14,4% of the total déclaré
- 3294 paid pediatrists (of which 64,3% women) are 52,4% of the total déclaré

The organization of the occupation of pediatrist in France

Installation of a liberal pediatrist.

It is subjected to the requirements for the installation of any doctor, namely, mainly the inscription in the table of the Ordre of the doctors which is worth authorization to exert, subject to the recording of the diploma for the occupation of doctor and the recognition of the qualification of pediatrist (automatically with one OF pediatry), and the various affiliations, in particular with the Social security (officially agreed in sector 1 or 2, or not officially agreed). There is thus no professional quota, nor geographical, in spite of imbalances répartitifs observed (supra). The methods of installation are varied: individual cabinet, grouping medical, clinical, etc Moreover, part of the liberal pediatrists have a mixed activity (liberal and paid and/or hospital) that is to say a little more of the third of them.

Recruitment and career of the pediatrists hospital practitioners within the public corporations of santé.

Recruitment answers the general terms necessary for the other medical disciplines, in particular with the requirement of a contest organized under the responsibility of the DHOS (direction of the hospitalization and the organization of the care) of the ministry for Health. The latter is also charged, to organize the access by contest to the third cycles of the medical studies, and the procedures of choice of station and assignment of the interns.

- The hospital practitioners in pediatry, who must have validated a third cycle in the discipline (OF pediatry or equivalent), are recruited by contest (after an oral test, the examination of the " titles and travaux" and " services rendus" and a maintenance). The full-time experts are named by the Minister for Health, after opinion of the national statutory commission (by the regional prefect for part times). It will be noted that the hospital practitioners can take place several of exercise. Moreover, those which are full-time can carry on a liberal activity within their (S) establishment (S) but not outside. It is rigorously the opposite for those which are part-time

- For the teaching hospital ones in pediatry it is necessary to note the eminent role of the National council of the universities (CNU) for the nomination of the Professors - hospital practitioners (pH) and University lecturer - hospital practitioners (MCU-PH) in pediatry. Pediatry belongs to section 54 (Development and pathology of the child, gynecology-obstetrics, endocrinology and reproduction) of the CNU, of which it constitutes a sub-section (sub-section 54-01). Its operation answers the specific rules applicable to the medical disciplines. The election of the members takes place to the majority uninominal system with two turns for a 6 years mandate, renewable by half every 3 years. See its current composition. In fact the CNU registers the candidates on the short list for the functions considered and opens to them the doors of the contests in the recruiters establishments. It should be noted that the future professors must hold a Accreditation to supervise research (H.D.R.), and generally a thesis of University. After success, the Professors and University lecturers, are named respectively by the president of the Republic and the Minister for Health. One their characteristics is the Bi-membership, they are indeed engaged and employed at the same time by the ministry for Health and that of State education. There exist also the teaching hospital temporary ones (teaching hospital expert or senior registrars assistants of the hospitals, more rarely,), which is a transitory situation generally making it possible to prepare aggregation professorale

Professional organizations of the pediatrists:

Like any doctor, the pediatrists are subjected to the Order of the doctors, in particular for the respect of the Code of conduct, their inscription in the table (except for the pediatrists of the public office), the process of qualification of the specialists and the monitoring in the conditions in exercise in the profession (with the jurisdictional and disciplinary capacities available to the Order). However, the pediatrists are not represented there as such. On the other hand, pediatry is more visible within the organization of reflection than is the Académie of medicine. It belongs to the first division of its board of directors " Medicine and specialities médicales" , the object of the commission " Maternity - Childhood - Adolescence" and of some work groups, of which those devoted to l" Installation of time scolaire" and with the " Nutrition of the nourrisson".

The pediatrists are gathered in various learned societies (professional associations or colleges):
- French company of pediatry (will infra)
- French Association of ambulatory pediatry (will infra)
- Association of the juniors in pediatry (AJP)
- College of the pediatrists of general hospitals (COLPEHGE)
- College of the professors of pédiatrie
- Association of the pediatrists of language française
- French company of medicine périnatale
- French company of surgery pédiatrique
- French-speaking Company of pediatric imagery (SFIP)
- Pediatric French company of dermatology (SFDP), etc.

Various types of exercises of pediatry in France

pediatry as a liberal: current care, periodic checkups or intercurrent consultations for acute problems. In France, there would be less than 2500 liberals on a total of approximately 6000 pediatrists (supra). The profession considers that insufficient to ensure a total cover of the care the children. An analysis, very local, permanence of the care ensured by the liberal pediatrists in the department of the Coasts of Armor gone back to 2004 reveals that the pediatrists are especially women, of an average age 49 years, installed in group, in majority exerting in sector 1, within a cabinet located downtown. They receive only on go, although in general accepting the urgent not programmed catches of loads (approximately 20% of their activity). This assumption of responsibility causes a disturbance in their work for a third of them. The true or only felt urgencies account for 34% of their activities of consultation. Half of them ensure the follow-up of in-patients. Some take part in the guards jointly with the hospital ones.

pediatry in hospital: care with the hospitalized children and assumption of responsibility of the newborn, consultations external generally relating to pathologies specific in cardio-pediatry, néphro-pediatry, renal, digestive, etc the specialized hospitals have the technical plate and necessary competences with the complementary explorations justified by these specific problems.

Hospital having a service of pediatry in Paris region : Antoine-Béclère (Clamart), Ambroise-Avoided (Boulogne), Bicêtre (the Kremlin-Bicêtre), Jean-Verdier (Bondy), Louis-Mourier (Doves), Necker-child-Patients (Paris 15°), Robert-Debré (Paris 19°), Saint-Vincent-of-Paul (Paris 14°), Trousseau (Paris 12°), Pity-Salpêtrière (Paris 13°).

pediatry in maternity: the pediatrist ensures (in dialog with the obstetricians and the team of care) the medical assumption of responsibility of the newborn, as of the room of childbirth, until his return to the residence. He carries out the systematic examinations intended to make sure of the good health of this one. This intervention requires a great vigilance and a specialization in medicine néonatale, because of the situations urgently vital frequently met in this context. Many pediatrists are attached to maternity.

SME, school medicine: various trackings, school overwork, etc However, owing to the fact that it is especially of a preventive medical approach and Public health, like by shortage of the specialists, these stations are seldom occupied by pediatrists.

pediatry in specialized establishments, CAMSP, SESSAD,…: assumptions of responsibility individualized from the children presenting of the handicaps or the difficulties of development within a multi-field team (Psychiatrist S, doctors of functional rehabilitation, rééducateurs)

It should be noted that according to an investigation carried out in 2000 in the Rhone-Alps area, 63% of the pediatrists take place several of exercise. A third of them exerts on three places and more. The pediatrists make primarily consultations with the cabinet and obligations in private clinic. Less obligations at the hospital where it make especially clinical monitoring of in-patients. Lastly, the pediatrist devotes overall 6% of his time to management.

Various pediatric specializations

the pediatrist néonatal ensures, in dialog with the obstetricians and the team of maternity, the medical assumption of responsibility of the newborn as of the room of childbirth until its return to the residence. It carries out the systematic examinations intended to make sure of the good health of this one. This exercise requires a great availability and specific competences in medicine néonatale, because of the situations urgently vital frequently met in this context.

Other pediatrists specialized (or specialists only directed towards pediatry) like pediatrists rheumatologists, cardiologists, surgeons, neurologists, nephrologists, endoctrinologists, dermatologists, nutritionists, hematologists, lung specialists, the pédopsychiatres, etc

August 1st

Parallel medicines in pediatry

The recourse to parallel medicine (or nonconventional Medicine) also exists in pediatry:

the holistic medicines, for example for the treatment of the children reached of disorder of deficit of the attention with hyperactivity, or being the homeopathic remedies for the treatment of asthma in the child or the remedies known as natural to look after the child in general and.
the Osteopathy. One will thus note, with reserve, that according to a study of association known as " Academy of Ostéopathie" , 46% of the infants (270 000) (age bracket going from the birth to 9 months) born in France in 2005 would have profited from a consultation by an osteopath. Always according to this study, testimonys of the teams in perinatal pediatry would be in this particularly evocative direction of the utility of this profession, as well in term of comfort as of savings in health which results from this.
the traditional medicine. One thinks in particular of the relationship between pediatry and Chinese medicine (will infra), and even of the African practices which, sometimes, are ercercent on the children in a suppletive way, even concurencielle, on our territory within certain communities.

Future of pediatry in France

Liberal pediatry: a threatened speciality?

Here what its singularity said a liberal pediatrist in 2002 of it to defend:

" Directly located in competition with other types of medical exercise, pediatry is threatened in its existence even, in particular in its liberal practice.

Certain followers of a trade unionism medical little confraternel and especially anxious to defend their interests suitable for the contempt of the freedom of choice of the patients, would wish to see limiting the access of the children to our cabinets (as with that of the other specialists) by instituting the principle of a " filtrage" who would allow the patients to come to consult us only with their agreement.

This situation is worsened by the unfavorable medical demography, which with it only makes difficult the access to the pediatrist for all the children, the retirements exceeding the new installations. " …/…

…/… " Its long formation (...), its daily experiment, its preoccupation with an continuing education to this demanding discipline make the doctor ready of it to manage all the aspects of the development of the children, of the birth at the end of the growth.

Indeed, the very particular and specific character of the paediatrics (...) requires a specific approach (...). It should be known that, the training courses of pediatry not being obligatory lasting the not specialized medical studies, a doctor can settle without never to have examined a child!

the pediatrist, by his knowledge of the operation of the organization of the child, very often can dédramatiser of the benign situations but distressing for the parents and to propose simple means of treatment, not very expensive for the community, by avoiding the medicamentous climbing. In addition, its knowledge of pathologies rare and important to recognize allows him not " to pass to côté" those and to propose the most adapted catch of load. Lastly, its preoccupation with a globality in the approach of health enables him to be interested in the broadest aspects of this field, which they are the problems of a psychological nature, school, of the tracking of the sensory disorders (hearing, vision), etc…

It occupies pediatric urgencies also particularly, while frequently taking part in the organized turns of duty as soon as local manpower is sufficient, or while assisting in its hospital services. Its contribution is also essential in the care suggested with the handicapped children or reached chronic diseases "

Of other pediatrists also launched at the same time a more aggressive cry of alarm:

S.O.S. WE RUN! such is well the impression of the majority among us owe the current location: a deaf bureaucracy and blind man with the field realities methodically apply its plans of destruction of liberal pediatry. All the methods are good for them: financial strangulation of sector 1, by blocking of the fees since 7 years and racket in the form of increase authoritative of the URSSAF (1000 Euros on average), threats and intimidations against those which do not télétransmettent, moral harassing and unjustified sanctions for minor reasons (...), press campaigns for advising to make look after the children by general practitioners, if possible referents,… ".

See also the claims of the collective of the liberal pediatrists (above mentioned) at the time of the presidential campaign of 2007.

The Sommelet report/ratio of 2007

The claims of the liberals are, into different, to put in prospect with a report/ratio entitled " The child and the teenager; a stake of company, a priority of the system of santé" , result of a two years work on French pediatry, that Professor Danièle Sommelet gave to the Minister for Health in March 2007.

According to the report/ratio Sommelet, the exercise of the pediatry of tomorrow is directed towards:

- a recasting of liberal pediatry towards an excellence in the fields of the prevention and the education, dealt with of chronic pathologies under development network, of the pediatric specialities (in the big cities);
- the essential presence of the pediatrists in all the sectors of Community medicine and the public health concerning the child;
- the organization of pediatry in CHU around emergency pediatry, specialities pediatric, of the neonatology, and all the care of recourse, while preserving a general pediatry of quality for the services of proximity;
- reinforcement of the pediatric teams of the general hospital CHG to bring autonomy necessary to management of the urgencies, the neonatology and general pediatry and by developing work in network for the pediatric specialists;
- the implication strong of the pediatrists in research, the technological innovation and the développement.

In all the cases of figure, according to the report/ratio, the rise of pediatry is possible only under certain conditions:

- unit without fault of all the modes of exercise of the medicine of the enfant
- equal share of the care with the doctors généralistes
- alliance with the pédopsychiatrie, the public health, the specialists in the sensory world, etc

more generally, the report/ratio makes eleven recommendations to optimize pediatry and the assumption of responsibility of the health of the children:

1 - To work out with HAS and the whole of the actors a national plan of organization of the professional practices concerning all the fields of the health (physical, mental, social) of the child and the teenager.
2 - To rationalize the protection and prevention policy: missions, actors, tools, use of the data.
3 - To ensure the collection of the reliable epidemiologic data (recall: the health record evaluated forever):

- follow-up of indicators of health

- health monitoring

- quality of the actors and dies of assumption of responsibility

4 - To organize a dialog of the population (parents and teenagers from twelve to eighteen years) to know their needs and their waitings, their vision of the respective roles of the health professionals and associative movements.
5 - To contribute to the promotion of health by ensuring the partnership enters the institutions of the State, the territorial collectivities, and the actors of ground and by adopting a communication strategy adapted to the needs and the means.
6 - To evaluate the real demographic needs for the whole of the actors while taking into account:

- hospital retirements, stations, the inequality geographical

- the organization of the professional practices (cf 1)

- the evaluation of the activity and the rendered services

- the organization of new conditions of exercise: private hospital, divides or delegation of the tasks (nurses nursery nurses, psychologists…)

7 - To ensure excellence and immediate continuity and log term of the care and the total assumption of responsibility of the children and the teenagers reached of chronic diseases (+ role of associations of parents)
8 - Professionnaliser research in pediatry
9 - to gather the actors necessary to the reflection on the needs and the methods of support and/or the care of the teenager.
10 - to incite els actors of health and in particular pediatrists with the best taken into account of the interculturality and with a greater implication in the fight against the consequences of precariousness.
11 - To revise the training of the actors.

Pediatry with the international plan

The training of the pediatrists is ensured with a certain uniformity in many countries, in particular by a teaching and practical training courses in teaching hospital medium sanctioned by a diploma of end of specialized studies; OF in France (supra), Board off Spéciality in the Anglo-Saxon world. There exists a European association for the teaching of pediatry.

UNICEF and more particularly the Funds international of help to childhood, coordinate the programmes of assistance to childhood in the world. One of the emanations of these organizations is the CIDEF (international Center of childhood and the family) which is a national center and international of expertise and reference on the questions touching to the children and the families, in the fields medical and social. The interdisciplinary problems of connections are dealt with by organizations of this type, but are also often in the middle of international meetings, such as for example, the International symposium of Health and Périnatalité (Montreal April 2005), the International Congress “Child, prenatology and company” (Moscow May 2007) , etc

It is at the time of one of these international demonstrations that, addressing to the participants of XXIIe Congrès international of Pediatry joined together in Amsterdam on August 10th, 1998, after having urgently invited the participants to remain vigilant vis-a-vis the aggressive marketing of the substitutes of the mother's milk which harms the breast-feeding, the director of WHO, Doctor Brundtland declared:

" As pediatrists, you are not only doctors who prescribe a treatment. It is towards you that we turn ourselves to obtain councils on the growth and the harmonious development of our children, it is in you that we have confidence. This confidence makes that you play a particular part of Community person in charge. You clearly made hear your voice on behalf of the children who have such an amount of sorrow to make hear theirs in far too much country. "

Pediatry in the world

According to the areas of the world, pediatry is different in particular by its organization, its practices, its pathologies and its problems.

In Europe

Tchéquie : The pediatrists put themselves in grêve in March 2007. They wanted especially that the general Company of health insurance (VZP), the equivalent of our Social security, makes known to them how much they will touch for the care exempted in 2006, pours to them what it returns to them and which it cancels certain measurements of regulation which penalize them.

August 1st

In Canada and the United States

August 1st

In Africa

Pediatry is developed in a very unequal way according to the areas; very occidentalized in north (the Maghreb in particular) and in the south, very erratic in the sub-Saharan Africa where it is the subject of a particular strain of the international community because of two particular dangers (nutritional and infectious) which, with the weak obstetric assumption of responsibility in rural area (role of the matrons), remain one of the causes of a strong infant mortality (a child on four dies before 5 years and in certain zones, it is a child on two). This, without counting the cultural obstacles, in particular the persistence and the fatalism of African traditional medicine concerning the children.

At the nutritional level, one indeed notes pathology specific in this part of the world African:

- the protéïno-heating Syndrome of Malnutrition of the Weaning, with the case known as of the " children rouges" and its two states with the committed vital prognosis: " the Stagnation (an extreme thinness, the Atrophy of the Muscle S, the flask and folded Skin giving to the one year old child a mask of Old man) and the Kwashiorkor (with the Edema S of the body and the Face, the skin cracked, faded, falling in scraps, the Hair russet-red and breakable, a Apathy and the refusal to feed). This is at the origin of programs of Alimentation supplemented by Aliment S nouveau riches in local products and formulas of weaning which are produced on an industrial scale in several countries by agencies of the the United Nations, and, in particular, by the UNICEF. These products are distributed by the centers of SME to the children of the cribs, of the kindergartens, the schools. One of the major hurdles to this policy results from the family traditions, with the need (and the difficulty) for educating the Mère s.

- The Anemia nutritional, due to simultaneous deficiencies: deficit in protid S, Iron and vitamins necessary to the maturation of the red globules (Vitamin B12 and Folic acid). This type of anemia is often associated with anemias of parasitic origin.

- The Diarrhea of farinaceous foods, due to the strongly or exclusively glucidic mode (pulps of Millet, Rice, Manioc, etc…). This pathology little to be amplified in a catastrophic way by a microbial, viral or parasitic infection of the fact, in particular, water pollution. It can lead to a Gastro-entérite with vomiting which accentuates the salt and water loss. However an important dehydration leads to the Toxicose, which constitutes a big part of infant mortality.

At the infectious level:

One notes many digestive and respiratory infections, to which are added large the tropical Endémie S (endemic Tréponématose, measles, Paludisme), Tuberculose, Bilharziose (vesical or intestinal) and the Lèpre. The appearance of effective drugs and the programs of Vaccination S of mass initiated by WHO and the ONG make it possible to dam up these affections in particular in the rural areas where the services of SME are not very efficient. Nevertheless, taking into account the lacks of hygiene and Asepsis, the parasitic infections are numerous, with a particular place for the intestinal Ver S (Ascaris and the Ankylostome S). The Tétanos is also frequent there for this reason: néo-native tetanus (often because of the binding of the cord by a soiled bond), tetanus of the child (starting from the chronic wounds, otitises, Scarification S ritual or simple fixing of a jewel). The lung diseases are also supported by the nudity of the child.

A page documented well on pediatry in the countries in the process of development

In Asia

pediatry in Chinese China (: 儿童病房 er tóng bìng fáng):

The Chinese traditional Médecine (MTC) remains in spite of the development of the Western pediatric techniques. Even in China the credibility of this historical medicine is sometimes called into question but, while modern technologies are seen like a medicine of the detail, traditional medicine considers the globality of the child, in a way considered to be less aggressive by a majority of the population.

Thus, the MTC is not unaware of pediatry. The Massage (or Tui Na) is one of the pillars of the pediatric traditional practices. Inter alia, it is prescribed in the treatment of the internal affections in pediatry and for the sensory awakening of the child. As of the first month, the infant is thus massed to stimulate his internal bodies, as well as his driving bodies and the neck. The traditional pediatrist knows also the treatment of principal infantile pathologies by the Acupuncture, the Moxibustion and the Auriculothérapie and uses a particular Pharmacopée, with minimalist use, containing grass, of oils and various macerations. It will be noted, finally, that the use of the Scorpion S for the specific treatment of the Convulsion S epilepsy of the children is clearly documented in the Chinese old literature (literature of the Fangshu of the dynasties Song. For example, the Treaty of pediatry Xiaoer Weisheng Zong Wei Lun Fang, on the formulas for the health care of the children).

pediatry in India:

August 1st

pediatry in Japan

August 1st

Famous precursors or pediatrists

Edwige Antier, French pediatrist (XXI°s)
Jenny Aubry, French pédopsychiatre (XX°s)
Thomas Berry Brazelton, American pediatrist (XX°s)
Madeleine Brès, French pediatrist (XIX°s)
Pierre Budin, French pediatrist (XIX°s)
Robert Debré, French pediatrist (XX°s)
Francoise Dolto, pédopsychiatre French (XX°s)
Guido Fanconi, Swiss pediatrist (XX°s)
Harald Hirschsprung, Danish pediatrist (XIX°s)
Abraham Jacobi, American pediatrist (XIX°s)
Frank Chambliss Johnson, American pediatrist (XX°s)
Jerome Lejeune, French pediatrist (XX°s)
Paul Lemoine, French pediatrist (XX°s)
Antoine Marfan, French pediatrist (XX°s)
Aldo Naouri, French pediatrist (XXI°s)

András Pető, Hungarian pediatrist (XX°s)
Emil Pfeiffer, German pediatrist (XIX°s)
Clemens von Pirquet, French pediatrist (XX°s)
Beat Richner, Swiss pediatrist (XXI°s)
Paul Rohmer, French pediatrist (XX°s)
Theophilus Roussel, doctor and politician (XIX°s)
the Nile Rosén von Rosenstein, Swedish pediatrist (XVIII°s)
Marcel Rufo, French pédopsychiatre (XXI° S)
Albert Mason Stevens, American pediatrist (XX°s)
James Mourilyan To tan, English pediatrist (XXI°s)
Armand Trousseau, French pediatrist (XIX°s)
Anne Tursz, French pediatrist (XXI°s)
Gaston Variot, French pediatrist (XX°s)
Donald Winnicott, English pédopsychiatre (XX°s)

Curiosities

the frêre of the President of the French Republic Sarkozy, Francois, was enquiring pediatrist before dêtre in biology.
the professor Mattei is one of the only pediatrists to have been Minister for Health (2002)
the five Bulgarian nurses imprisoned in Libya of 1999 to 2007 had come to work in pediatry.
With the Burkina Faso, in 2007, a homonym of the Minister for the Health of the country, Alain Yoda, was made pass for his/her cousin and said pediatrist.
the vice-president of the third work group of the " Grenelle of the environment " organized by the French government in 2007 is a pediatrist, professor Alain Grimfeld * The American actor George Clooney made known himself for his role of Doctor Ross, pediatrist, in the series " Urgencies ".
Since October 16th, 2007, the 6 month old babies to three years have from now on their television channel: Baby First TV (CanalSat), which does not enchant the world of pediatry

Current events

September 2007 - ministerial Investigation into the recourse to the specialist in city medicine * 12° Meetings of practical pediatry, February 1st, th and 2nd 2008, Paris

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