World Pediatric Bone and Joint (PB&J) Day takes place annually on October 19th. Pediatrics (also spelled paediatrics or pædiatrics) is the branch of medicine that involves the medical care of infants, children, and adolescents. The American Academy of Pediatrics recommends people be under pediatric care up to the age of 21.A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean “healer of children”; they derive from two Greek words: παῖς (pais “child”) and ἰατρός (iatros “doctor, healer”). Pediatricians work both in hospitals, particularly those working in its subspecialties such as neonatology, and as primary care physicians.
The root of Pediatric medicine can be traced back to ancient Greece where Hippocrates, Aristotle, Celsus, Soranus, and Galen understood the differences in growing and maturing organisms that necessitated different treatment Celsus stated: Ex toto non sic pueri ut viri curari debent ( “In general, boys should not be treated in the same way as men.”). Some of the oldest traces of pediatrics exist in Ancient India where children’s doctors were called kumara bhrtya. Sushruta Samhita an ayurvedic text, composed during the sixth century BC contains the text about pediatrics. Another ayurvedic text from this period is Kashyapa Samhita. A second century AD manuscript by the Greek physician and gynecologist Soranus of Ephesus dealt with neonatal pediatrics. Byzantine physicians Oribasius, Aëtius of Amida, Alexander Trallianus, and Paulus Aegineta contributed to the field. The Byzantines also built brephotrophia (crêches). Islamic writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own, especially Haly Abbas, Serapion, Avicenna, and Averroes. The Persian philosopher and physician al-Razi (865–925) published a monograph on pediatrics titled Diseases in Children as well as the first definite description of smallpox as a clinical entity. Among the first books about pediatrics was Libellus [Opusculum] de aegritudinibus et remediis infantium 1472 (“Little Book on Children Diseases and Treatment”), by the Italian pediatrician Paolo Bagellardo. In sequence came Bartholomäus Metlinger’s Ein Regiment der Jungerkinder 1473, Cornelius Roelans (1450–1525) no title Buchlein, or Latin compendium, 1483, and Heinrich von Louffenburg (1391–1460) Versehung des Leibs written in 1429 (published 1491), together form the Pediatric Incunabula, four great medical treatises on children’s physiology and pathology.
The Swedish physician Nils Rosén von Rosenstein (1706–1773) is considered to be the founder of modern pediatrics as a medical specialty, his book The diseases of children, and their remedies (1764) is considered to be “the first modern textbook on the subject”. Pediatrics as a specialized field of medicine continued to develop in the mid-19th century; German physician Abraham Jacobi (1830–1919) is known as the father of American pediatrics because of his many contributions to the field. He received his medical training in Germany and later practiced in New York City.
The first generally accepted pediatric hospital is the Hôpital 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 merging with the physically contiguous Necker Hospital, founded in 1778. In other European countries, the Charité (a hospital founded in 1710) in Berlin established a separate Pediatric Pavilion in 1830, followed by similar institutions at Sankt Petersburg in 1834, and at Vienna and Breslau (now Wrocław), both in 1837. In 1852 Britain’s first pediatric hospital, the Hospital for Sick Children, Great Ormond Street was founded by Charles West. The first Children’s hospital in Scotland opened in 1860 in Edinburgh. In the US, the first similar institutions were the Children’s Hospital of Philadelphia, which opened in 1855, and then Boston Children’s Hospital (1869). Subspecialties in pediatrics were created at the Harriet Lane Home at Johns Hopkins by Edwards A. Park.
The purpose of World Pediatric and Joint day is to increase awareness concerning certain bone and joint related conditions in growing children and young adults, and highlight the measures which can be taken to prevent these conditions. The most common muscoskeletal injuries are fractures, growth plate injuries, overuse, apophyseal pain and infections.
Growth plates are the weakest seams in a child’s skeleton and are the most susceptible to injury. All growing children have growth plates in their bones and are at risk for growth plate injuries until the soft tissue is eventually replaced with solid bone. Growth plate injuries “can have devastating effects on the overall growth of children.” Any injury or impact, such as twisting an ankle or knee, can cause harm to the growth plate. The Ligaments surrounding a child’s joint are not very strong and may not be able to fully stabilize a fracture. Treatment for growth plate injuries depends on several factors such as which bone is injured, the type of fracture, the age of the child, and other associated injuries and circumstances. Injured growth plates should be casted, immobilized, and then rested. If the injury is severe enough, surgical intervention may be needed.
Overuse is a pediatric musculoskeletal injury and is caused by too much participation in sports. Little league elbow is an example of overuse syndrome that affects the growth plate on the inside elbow of the throwing arm in a baseball player. It can do serious damage to the growth plate in the arm due to repetitive use and excessive throwing. This is the reason for strict limits on how many pitches or innings a young pitcher is allowed to throw. Physicians recommend rest coupled with rehabilitation to allow the bones to heal but sometimes surgery is necessary to reattach the growth plate to the bone.
Apophyseal pain is common in the pediatric population, especially during periods of rapid growth and while youth are very active. The apophysis is the site of tendon attachment prior to skeletal maturity. Dr. Spellmon recommends rest, ice, anti-inflammatories, and rehab to treat apophyseal overuse injuries, and immobilization, rest, and rehab for an avulsion injury. However, with an avulsion fracture, depending on the severity, surgical intervention may be necessary.
Several different types of bacteria live on the skin and are considered normal skin flora. If skin is broken it allows bacteria to enter the bloodstream.” While children are still growing there is an abundant supply of blood to the bone and sometimes bacteria seed in the bone and cause an infection. This bone infection is called osteomyelitis and typically requires a hospital stay with IV antibiotics followed by oral antibiotics. In addition, labs, radiographs, and a clinical exam are typically followed until all are normalized.
Pediatric musculoskeletal injuries, May also be exacerbated by obesity developed during childhood. World Pediatric Bone and Joint Day highlights obesity, screening, and prevention. The day also looks at symptoms, treatment and economic impact. When not diagnosed early and managed appropriately, Pediatric muscoskeletal injuries can result in long-term disabling conditions, chronic pain and disability later in life. Many of these conditions can be prevented by measures taken to lessen the chance of occurrence. Raising awareness of these conditions in young people may allow them to live healthier lives, free from pain and conditions such as osteoporosis and arthritis that may surface later in life.
