MIL OSI Translation. Region: Russian Federation –
For children, special types of drugs and milder methods of treatment are being developed, and doctors are less and less frightening of little patients, trying to find an approach to everyone.
On November 20, all over the world celebrate Children’s Day, in Russia it is also a professional holiday of children’s doctors – pediatricians. Thousands of such specialists of different ages and qualifications work in Moscow clinics and hospitals.
On the eve of the holiday, we asked pediatricians – representatives of two generations, how they came to the profession and how they see today’s children’s medicine. The first expert – Svetlana Denisova, works in children’s city clinical hospital № 9 named after G.N. Speransky… She is a pediatrician of the highest qualification category with 30 years of experience, doctor of medical sciences, professor. Second expert – Igor Dmitriev, pediatrician of the gastroenterology department (pediatric) children’s city clinical hospital named after Z.A. Bashlyaeva… The young doctor not so long ago graduated from the university with honors, and today he is writing a dissertation on a topical pediatric topic closely related to the cardiological profile. In a pandemic, he was one of the first to be called up to work in the red zone and helped newborns in the neonatology department.
About the profession
Svetlana Denisova: Soviet schoolchildren dreamed of becoming teachers, doctors, cosmonauts, builders or engineers. I wanted to be a doctor or a teacher, and since a pediatrician combines these two professions, I entered the 2nd Moscow State Medical University named after N.I. Pirogov at the pediatric faculty. I love my profession and get satisfaction from the fact that I can heal children, help them, be happy when everything works out and the child recovers. Each pediatrician needs to constantly improve in the profession and study childhood diseases, so that, knowing the stages of development and symptoms of the disease, the doctor can help the little patient to recover.
Igor Dmitriev: When I was a student, pediatric departments left a stronger impression on me, which ultimately influenced the choice of my further professional path. In my opinion, such a broad specialty as pediatrics requires a deeper knowledge of various diseases. You need to know a lot – it helps to choose the right tactics for examination and treatment.
About childhood diseases
Svetlana Denisova: Children most often suffer from infectious diseases. In adults, on the contrary, the first place is occupied by cardiovascular pathology, oncology, diseases of the gastrointestinal tract. Since the child’s immunity is only developing in the first years of life and young children do not immediately receive all vaccinations, naturally, they are more susceptible to infections. The list of traditional childhood illnesses may change over time. For example, 10 years ago, we rarely met diphtheria and measles, because almost all children, with rare exceptions, were vaccinated against these infections. Now children are vaccinated at the request of their parents, many unvaccinated children. Therefore, there are diphtheria, whooping cough, and polio – diseases with which, it seemed, we said goodbye long ago.
Igor Dmitriev: Now a lot of problems are starting to shift to an earlier age. And understanding how all this happens allows us to choose certain tactical decisions. For example, diabetes mellitus – it was previously thought that it only occurs in adults. But children also get sick, and not only with diabetes of the first, but also of the second type. The development of diagnostics and examinations at the prescribed time allows us to record this at an earlier age. But it is also important that in our progressive age, diseases are progressing – therefore, adult diseases begin to occur more often in children.
The need to learn
Svetlana Denisova: People of any profession study. We learn new things about the mechanisms of disease development, new diagnostic methods are constantly emerging (now we generally diagnose and study diseases at the cell level), treatment methods are being improved. This is the first thing for which you need to learn all the time. Second, the viruses and bacteria around us are also changing, antibiotic-resistant species are emerging, new viruses – the same COVID-19.
Igor Dmitriev: Children’s diseases have been studied well enough, but approaches to their treatment and diagnosis are changing. Different ways of solving problems are emerging, and drugs are being developed that allow you to cope with the disease in a shorter time. The treatment options themselves are changing. For example, hemangiomas are vascular tumors. Previously, they were treated with surgical methods, which led to the formation of rough scars on the skin, but now it is possible to cope with the disease with medication, without cosmetic defects.
About approaches to the treatment of children
Svetlana Denisova: Today there are forms of medicines for children that are easier for a child to take than pills. It is difficult and inconvenient to give them to young children – they must be dosed correctly, ground into powder, they often taste bitter. Drops, suspensions or syrups make it much easier for parents to treat and care for a sick child. For example, special applications – adhesive plasters – have been created for children with oncological diseases as pain relievers. This greatly facilitates the treatment and life of the child, who is already receiving many medications.
Igor Dmitriev: If the doctor sees that it is possible to do with the pill form of drugs instead of an injection, of course, he will choose this option so as not to injure the child. But it happens that injection is a priority, because in a particular case it is more effective. I try to prescribe pills whenever possible, but, for example, in case of severe allergies, an injection will help faster, and the child will go home faster. Previously, for infectious diseases, intramuscular injections were often prescribed for a course of seven days, which was quite painful, but now we can supply the patient with a peripheral venous catheter – to give one injection instead of several. Daily administration of medication through such a catheter will not cause negative emotions in the child.
About the image of a doctor
Svetlana Denisova: It all depends on how the parents set up the child to meet with the doctor. In any case, a visit to a doctor should not cause negative emotions either in children or in their parents. With experience, a young doctor acquires the skills of communicating with little patients and the ability to win them over, remove negative reactions to examination. It is easier for a doctor who has found contact with the child and the parents to do his job.
Igor Dmitriev: Unfortunately, parents often intimidate children, they say that the doctor will give an injection if they are capricious. Then already the kind of doctor causes a negative in children. I believe that good people should work in pediatrics, albeit moderately strict, because parents need to be set up to comply with medical recommendations. It happens that they are misunderstood: they drank the medicine, after two days everything went away – the course of treatment is not finished. But this does not mean that the problem has been solved, and if the doctor has made an appointment that he has to take the medicine for two weeks, then it is necessary to do it.
About absolutely healthy children
Svetlana Denisova: A child’s health begins from the prenatal period: if mom and dad are healthy, then with a high degree of probability the child will be healthy. Therefore, it is necessary to start the prevention of diseases in future children with their parents. For children, I recommend playing sports, hardening procedures – the same walks. It is also important to try to protect the child from contact with sick people, especially if he is very small and has not yet been vaccinated.
Igor Dmitriev: Children’s health directly depends on the health of their parents – this is the foundation, the base. And there are also bricks that are laid in childhood and on which the general condition of the child depends in the future. An important role is played by the lifestyle, the mode of sufficient physical activity, sleep, limited time of work with gadgets, ecology. Of course, preventive examinations are also important, because doctors can detect the disease at an early stage, when there are no symptoms yet. The main thing is to start with yourself as parents.
About internet treatment
Svetlana Denisova: You can trust information on the Internet, but be careful. In Soviet times, they believed in television and newspapers, now they unconditionally believe in the Internet. One friend told me: “10 minutes on the Internet – and I’m a candidate of medical sciences!” In fact, the human body – and even more so, the body of a child – is more complex than the mechanism of any modern machine. When you read about a disease, you will find all its symptoms at home, therefore, medical information from the Internet should be taken carefully and be sure to discuss it with your doctor. Self-medication over the internet is dangerous. It is important to understand that on Internet resources they give protocol, non-personalized recommendations, and whether they can be applied in your particular case, you need to decide with a specialist.
Igor Dmitriev: The Internet is a huge source of information, including useful information. The only question is where to find it and how to use it correctly. The doctor has the necessary medical knowledge, it is easier for him: he knows what and where to look if necessary. There are scientific journals, articles, clinical recommendations, interesting cases from practice, which allows you to expand the horizons of a specialist. And what parents read often scares them and is not always reality, although the doctor can explain everything correctly.
About working in a pandemic
Svetlana Denisova: Many parents of young patients come to us without masks or with masks on their chins, so you have to patiently explain why you need to wear personal protective equipment. By this, a person not only protects himself from infection, but also shows that he respects the health of others. If we respect each other’s right to health and life, together we can defeat any pandemic.
Igor Dmitriev: At the beginning of the pandemic, I happened to work with newborns. We received children, including those with positive tests for coronavirus infection from covid-positive mothers. The difficulty was that protective suits and three layers of gloves distort perception a little – it is not easy to feel the same nuances from the baby’s skin. From manipulations, the placement of a venous catheter became a difficult task. This is a difficult, interesting and very demanding job.
EDITOR’S NOTE: This article is a translation. Apologies should the grammar and or sentence structure not be perfect.