Children are not simply miniature versions of adults, and their differences from adults extend far beyond physical size. The most prominent distinction is the developmental nature of childhood. The process of growth and maturation from birth to adulthood is continuous but occurs in distinct stages. During this process, not only do the size and weight of various systems, organs, and tissues increase, but their functions also develop and mature progressively. The differences in children's developmental stages are primarily reflected in six areas:
- Functional capacities of various organs.
- Immunity to diseases.
- Responses to illnesses.
- Drug dosages and tolerance to medications.
- Cognitive development and motor skills.
- Types and modes of emotional responses.
Based on these differences, children exhibit unique anatomical, physiological, immunological, and pathological characteristics at each stage of development. Moreover, significant variations exist in the onset, causes, and clinical manifestations of diseases, as well as in health and wellness priorities across different developmental periods. The younger the child, the greater the disparities from adults. For example, during the first week after birth, the newborn’s right ventricle weighs more than the left, with the two weights becoming similar by the second week of life. Thereafter, the left ventricle gradually overtakes the right in weight, continuing into adulthood. Newborns also have the fastest heart rate, which decreases over time to adult levels. Due to the dominance of the right ventricle at birth, electrocardiograms of neonates show a right-axis deviation.
Other examples of neonatal physiology include higher proportions of leukocytes and neutrophils in peripheral blood, as well as elevated hemoglobin levels compared to adults. The infant's heart is horizontally oriented, and the heart-to-thorax ratio is larger than in adults. The thymus remains prominent during infancy, producing a visible thymic opacity on chest X-rays—features that differ markedly from those of adults. Neurological development also varies by age. For example, neonates may exhibit positive abdominal wall reflexes and hyperactive tendon reflexes, with the Kernig sign being positive for the first two to three months of life. The Babinski sign may remain positive until the age of two. The infant brain is immature, and magnetic resonance imaging (MRI) may reveal widened extracerebral spaces and shallower gyri and sulci compared to adults.
Children are more prone to bronchopneumonia, whereas adults are more likely to develop lobar pneumonia. Similarly, congenital heart diseases are common in pediatric populations, whereas coronary artery disease is more prevalent in adults. Congenital malformations are also more frequently observed in children than in adults.
Because of these distinctive characteristics, pediatric medicine requires pediatricians to give heightened attention to these specificities in the diagnosis and treatment of illnesses.
Children are among the most vulnerable groups in society, and their health holds profound implications for families and communities. Throughout the growth and development of children, from birth to adolescence, numerous adverse factors from the family, society, and environment can affect their health. Pediatricians, as vital guardians of children's well-being, must not only monitor physical health but also work collaboratively with family members, schoolteachers, and community workers to provide appropriate conditions, environments, and services that promote children’s development, ensuring their physical and mental health. It is, therefore, crucial for pediatricians to address not only pediatric diseases but also these external adverse factors.
In their practice, pediatricians need to embody three essential qualities:
- The ability to apply the latest evidence-based knowledge and information to diagnose and treat diseases. This includes utilizing clinical experience and conducting literature searches to analyze the pathophysiological mechanisms of a child's condition and develop individualized care plans.
- Strong communication and practical skills. Pediatricians should effectively obtain medical histories considering children's unique characteristics, perform accurate physical examinations, follow standard procedures during routine operations, and correctly assess and respond to critically ill children.
- A spirit of selfless dedication. Pediatricians are expected to act in the best interests of their patients and families, maximizing professional knowledge and skills while remaining empathetic and sensitive to the emotions of children and their caregivers. This entails offering compassion, understanding, and reassurance throughout the diagnostic and treatment process.