Pediatrician’s guide

Pediatricians examine and treat children of all ages. The pediatrician has a special responsibility in preventive care and early detection.

Abstract

• The pediatrician not only treats acute illnesses, but also carries out check-ups and vaccinations.
• Not only the young patients, but also their parents are supported and advised by the pediatrician.
• In addition to their professional qualifications, a pediatrician must have a high degree of empathy and communication skills.

The responsibilities and activities of the pediatrician

As a neonatologist, the pediatrician deals with neonatal medicine and is also a doctor of pediatric and adolescent medicine. His activities include the detection, treatment and rehabilitation of physical illnesses in young people from infancy to adolescence. This includes

• Disorders of physical and/or mental development
• Disabilities
• Psychosomatic and mental illnesses

Specializations in paediatrics include the detection and treatment of prenatal diseases, as well as neonatal medicine. Social paediatrics is also a possible specialization for paediatricians – and last but not least the very demanding field of paediatric oncology.

Examination methods and diagnoses at the pediatrician

Just as with adult patients, the examination by a pediatrician begins with a medical history. However, as the patients themselves, depending on their age, are often either unable to describe their symptoms at all or cannot do so clearly, the pediatrician is also dependent on the parents for the diagnosis. From their point of view, they describe the symptoms that prompted them to take the child to the doctor.

The physical examination is based on the complaints expressed or the symptoms present.

• It usually involves listening to the heart sounds, bronchi and lungs with a stethoscope.
• By visually examining the throat and nasal concha, the pediatrician can quickly identify whether inflammatory diseases of the mucous membranes, the tonsils or adenoids are present.
• If children complain of abdominal pain, palpation of the abdomen provides the pediatrician with initial information about the possible causes.
• A pediatrician can also perform vision and hearing tests.

Vaccination program and early detection with the paediatrician

The pediatrician is the contact person for the complete vaccination program – this includes the vaccination consultation and the execution of the vaccinations in the scheduled periods. Comprehensive vaccination protection is an essential part of the preventive measures that a pediatrician should carry out. This is because vaccinations protect against diseases in childhood and beyond. The pediatrician also carries out a total of ten early childhood screening examinations from birth until the child reaches school age. The free examinations serve to check the state of health and allow developmental disorders to be diagnosed in good time.

The most important recommended vaccinations

The Standing Committee on Vaccination (STIKO) recommends the following vaccinations. The costs for these vaccinations are covered by statutory health insurance.

Diseases that the pediatrician often treats

Sore throat: Sore throats in children can have various causes – they can affect the throat and larynx, but also the tonsils. In the case of recurrent tonsillitis, which can be accompanied by a rapid onset of high fever, removal of the tonsils is recommended as a last resort.

Infectious diseases: Children, especially toddlers, contract bacterial or viral infections more frequently than adults – up to once a month, partly due to close contact with playmates at nursery, kindergarten or school. Coughs, colds and fever are the most common symptoms, and the pediatrician initially prescribes soothing medication and home remedies such as inhalations or fennel honey for coughs. In this way, the use of antibiotics can be reduced or avoided.

Whooping cough: Whooping cough is typically characterized by a choppy cough that often lasts until exhaustion sets in. The coughing fits are preceded by an early phase that resembles a normal cold. Pertussis is a highly contagious and therefore notifiable bacterial disease. Parents can prevent whooping cough through vaccinations as part of the regular vaccination program. The pediatrician will advise on this. If a child has whooping cough, the course of the disease can be alleviated with antibiotics. However, the recovery phase can take up to ten weeks.

Mumps: When young patients suffer from “goat fever”, they initially feel weak and exhausted. Within three days, they also develop a fever and swelling of the parotid glands, which cause the “hamster cheek effect”. The disease is caused by viruses and is harmless in children, but can damage their hearing. Mumps can also be vaccinated as a preventative measure. Sick children are treated with antipyretic and pain-relieving medication until the illness subsides.

Scarlet fever: Scarlet fever is caused by streptococci and is highly contagious. There is no vaccination. Scarlet fever begins with a cough and sore throat, characterized by a bright red tongue. The bacteria are spread by droplet infection when coughing and sneezing. The first symptoms are accompanied by fatigue, often fever, chills, aching limbs and vomiting. Skin rashes – all over the body – can accompany the illness. The symptoms also include whitish papules on the oral mucosa. Scarlet fever is treated with antibiotics. If treatment is not started in time, purulent tonsillitis can develop. Pneumonia or purulent middle ear infections as a result of protracted scarlet fever infections are also not uncommon. Late effects such as hearing loss cannot be ruled out.

Measles: The measles virus initially causes symptoms that resemble a flu-like infection, followed by a phase in which the typical reddish skin rash appears. Each phase is accompanied by a sharp rise in temperature. The disease can also be accompanied by fatigue, headaches and abdominal pain, colds and conjunctivitis, as well as whitish spots on the oral mucosa (Koplik spots). Measles is highly contagious and must be reported. There is no active substance against the virus. Treatments can only provide symptomatic relief until the disease subsides. Measles is not a “harmless” childhood disease; in individual cases it can lead to life-threatening complications. The measles vaccination as part of the early childhood vaccination program offers complete protection.

Chickenpox:Chickenpox is a reddish, itchy and weeping skin rash that is highly contagious and caused by viruses. The accompanying symptoms of this typical childhood illness include headaches, aching limbs, fever and tiredness. Scratching the rash should be prevented in order to avoid sepsis. In uncomplicated cases, lotions to relieve itching and possibly antipyretics are prescribed. As a preventive measure, small children should be immunized against varicella by being vaccinated twice. Once children have contracted chickenpox, they usually also have lifelong immunity.

Overweight: The profound change in lifestyle and eating habits means that pediatricians are increasingly diagnosing overweight or obesity in children and adolescents. Doctors recommend not only a change in diet, but also a targeted exercise program to achieve sustainable weight reduction and prevent subsequent damage.

Attention deficit hyperactivity disorder (ADHD): Attention deficit hyperactivity disorder, or ADHD for short, affects an estimated half a million children and adolescents in Germany. Two thirds of them carry the disorder into adulthood. The organic causes of ADHD are not exactly known, and a genetic predisposition is also assumed. Experts agree that those affected suffer from impaired transmission of the neurotransmitters serotonin, dopamine and noradrenaline. ADHD is very disruptive for the patient, but also for the family and the school or work environment. The illness is accompanied by therapy, parent training and, in extreme cases, medication (usually Ritalin). ADHD cannot be cured – therapy can only alleviate the symptoms.

ADHD – how does the pediatrician make the diagnosis?

The pediatrician usually makes an initial diagnosis of ADHD. However, a reliable diagnosis is only possible from the age of three. In addition to patient and parent interviews, physical and neurological examinations, intelligence and attention tests as well as behavioral assessments are part of the diagnosis. Other tests, such as brain wave measurements and blood tests, can also be carried out so that the pediatrician can get an idea of the child’s general development and behavior.

How do I prepare my child for a visit to the pediatrician?

Parents who bring their – usually already ill – child to the pediatrician are often worried and excited themselves. Especially if it is their first child. However, the little patient is also excited and anxious. Strangers instill fear, especially during the stranger phase. However, parents can prepare their child for a visit to the doctor. For example, a favorite stuffed animal or a cuddly blanket can be taken along. It is also a good idea to examine the teddy bear or doll first. As a general rule, if you are unable to calm your child, for example if they have a high temperature or a severe cough, keep calm yourself. This is because the excitement of the parents is projected onto the child.

What documents should I take with me to the pediatrician?

It doesn’t matter whether you are taking an infant for a check-up or taking an older child to the pediatrician for an acute illness: Take your child’s vaccination record with you, the booklet of early detection examinations and, of course, your health insurance card.

Sick child – now what? Sick leave for parents

A parent can be released from work to care for a sick child if the child is demonstrably too ill to attend a childcare facility.

• Employees are entitled to ten sick days per year to care for a child.
• With two children it is a total of 25 days.
• If you have more than two children, this figure can increase to up to 50 days per year.

The pediatrician will issue a corresponding certificate.

Child sicknessbenefit: If the paid leave period is not sufficient and a parent has to take unpaid leave to care for one or more children, child sickness benefit comes into effect. According to § 45 of the German Social Security Code, Fifth Book (SGB V), the health insurance pays 70 percent of the gross salary during this time, up to a maximum of 90 percent of the net salary.

Questions and answers

Sources

• https://www.aerzteblatt.de/treffer?mode=s&wo=17&typ=1&nid=101496&s=Kinderarzt
• https://de.statista.com/statistik/daten/studie/284044/umfrage/gesundheitsprobleme-von-kindern-haeufigkeit-in-deutschland-nach-alter-2013/
• https://www.impfen-info.de/wissenswertes/wie-impfempfehlungen-zustande-kommen/