Abraham Jacobi 1830 1919: Father of Modern Pediatrics

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Abraham Jacobi (1830 1919)Father of Modern
Pediatrics

• Recognised the interrelatedness of public
  policy, institutions, the vulnerability of the
  developing child, nutrition and psychological
  growth.
• Child health needed to include far more than
  the study and treatment of disease in children

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What is Pediatrics?

• Holt (1923)conceived the hierarchy of
  pediatrics, with academic research oriented
  pediatrics at the top, followed by the
  clinicians, and then the public health
  pediatricians who extended these experiences to
  the general public
• Veeder (1923) worried that pediatrics was
  losing the child angle. Pediatricians knew much
  about disease, but not enough about normal growth
  and development of children.
• Griffith (1929)pediatrics placed too much
  reliance on the laboratory, and the rare and
  unusual were awarded recognition over the
  prominent and common.

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The Development of Pediatrics

• Subspecialties
• - By organ (cardiology, pulmonology,allergy)
• - By age (neonatology, adolescence)
• Prevention
• -Vaccines
• - Prevention of adult disease
• Child development
• Development of a scientific basis and clinical
  skills

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New Morbidity ???? ?? ?- " Haggerty (1975)
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3. ?????
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?????? ICD ??? ??????
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New Morbidity 0.9 of all Diagnoses
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Under Representation of New Morbidity

• 3000 Children(4.8) with 5000 New Morbidity (NM)
  Diagnoses little follow up?
• 25 cases of child abuse in 500,000 diagnoses
• Developmental Reading Disorder 5 children
• Autism 1 child!
• ADHD- 28 of NM Diagnoses

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• ?? 60 ???????? ?-54 ???????? ?????? ????????
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Residents Reporting No Exposure or only
lectures on New Morbidity (n88)

• Gynecology 72
• Learning problems 71
• School age behavior 66
• ADHD 64
• Health promotion 59
• Drug abuse 48
• Preventive medicine 46
• Common orthop probs 43

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Department Heads

• 9/14 department heads said their residents had no
  community exposure during training
• 9/14 said there should be a rotation of 6 months
  in the community
• Exposure to New Morbidity less than 2.5 on a
  scale of 5
• Most (10/14) work in the community in primary
  care or consultation

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• The four low scoring questions
• To what degree does your physician discuss health
  maintenance?
• To what degree does he discuss child safety?
• To what degree does he discuss developmental
  issues?
• To what degree does he discuss behavioral issues?

• 1 2 3 4 5
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????? 1

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????? 2

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• ???? ?????? ????? ????? ??????? ?? ????????
• ???? ?? ????? ????? ?????? ??????
• ???? ?????? ????? ??????, ????? "???????",
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• The Pediatric Home
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  ???????

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• ??????? ?-Beersheva experiment
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• COPC ????? ??????? ???????
• ????? ?????? ????? "???"

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OFAKIM 1976 MY PERSONAL EXPERIENCE

• 60-100 patients/day
• Clinic controlled by Mazkir and cleaning lady
• Attempted integration of preventive and curative
  nursing (Tea crisis)
• No real agreement between KH-Misrad Habriut-and
  academic dept
• Dismantling of change when I left

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My New Morbidity Experience

• Genetic counselling-Tay-Sachs, necrotising
  alveolitis
• Management of chronic asthma
• Child abuse
• Behavioral disturbances
• Informal contacts with mental health, social
  welfare, education services
• Dental caries
• Cultural pediatrics shigella during shmita
• Health services ER study

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Every Child MattersChange for Children (UK)

• Every Child Matters Change for Children is a new
  approach to the well-being of children and young
  people from birth to age 19.
• The Government's aim is for every child, whatever
  their background or their circumstances, to have
  the support they need to
• Be healthy
• Stay safe
• Enjoy and achieve
• Make a positive contribution
• Achieve economic well-being

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Every Child Matters Change for Children An
Overview of Cross Government Guidance

• Inter-Agency Co-operation to Improve the
  Wellbeing of Children Childrens Trusts
• Sets out the broad strategic direction for
  the development and operation of childrens
  services.
• It does so through describing the
  arrangements that constitute a childrens trust
  and how, through childrens trusts, local
  authorities and other key partners should
  discharge their duty to co-operate to improve
  the wellbeing of children and young people

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Every Child Matters (ctd)

• The focus will be on prevention, early
  intervention and enabling children, young people
  and their families to make healthy choices. The
  key indicators on which progress towards the
  vision will be monitored are
• Increasing breastfeeding at 68 weeks
• Promoting the take-up of school lunches
• Reducing childhood obesity
• Improving emotional health and wellbeing, and
  child and adolescent mental health services
  (CAMHS(
• Improving services for disabled children

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Every Child Counts (Public Service Agreements)-
The Secretary of State for Children, Schools
and Families is the lead minister for this PSA
and will receive progress reports from the Child
Health and Wellbeing Board, which is co-chaired
by the Director-General for Children and
Families (DCSF) and the Chief Nursing Officer
(Department of Health(
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AUSTRALIA Stronger Families and Communities
Strategy (SFCS) 2004-2009

• Early ChildhoodInvest to Grow provides funding
  for early childhood programs and resources. Its
  aim is to contribute to improved outcomes for
  young children through prevention and early
  intervention and to build the Australian evidence
  base about what works in prevention and early
  intervention in early childhood.

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Choice and Flexibility in Child Care125 million
over four years

• What is it?
• Choice and Flexibility in Child Care provides
  Australian parents with flexible and innovative
  child care solutions.
• In Home Care
• In Home Care (IHC) provides child care in the
  child's home by an approved carer and is only
  available to families that have no other child
  care options, including
• families in rural and remote Australia
• families working non-standard hours such as
  police, firefighters, nurses, doctors, musicians
  and security personnel
• families with multiple children under school age
• families where either the parent or child has a
  chronic or terminal illness

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Linking Research and Service DeliveryThe
Victoria,Australia Model

• Minister for Children
• Office for Children (responsible for policy
  direction and early child services)
• Advisory group of experts in early childhood to
  advise re policy to Minister

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Framework for Change
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????.............................
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• In all areas, the common answer gave a high rating

• How well does your pediatrician know your childs
  health history?
• 1 2 3 4 5
• ????? ???? ????? ???
• ???? ????

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• Implications for Pediatric Residency Training

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The Need for Child-Directed Services in the USA

• 1912-Establishment of the Childrens Bureau
  (within the Dept of Commerce and Labor) to
  investigate..infant mortality, birth rate and
  other factors affecting the health of the child
• 1921 Sheppard-Towner act authorised grants to
  states to promote welfare and hygiene of
  maternity and infancy
• 1929- Failure of Renewal of act due to oppisition
  of physicians, the church and the Public Health
  Service