“If we change the beginning of the story, we change the whole story.” Raffi Cavoukian In this pandemic year, children and adolescents were put to the test . In clinical practice, there have been frequent cases in which we have seen that they have overcome adversity better than adults, adapting to hygiene and contact restriction measures that sometimes are too demanding and incompatible with being a child. As we have seen, children rarely develop serious illness and contribute little to the spread of the SARS-CoV-2 virus, unlike adults. However, in face of a new infectious disease and due to fears and doubts, they were also deprived of normal contact with their peers and had to follow a teaching regime that, although transitory, made their learning different and more complex. This change in their life, with one year of greater social isolation, a lifestyle that tends to be more sedentary and in view of the months that are still uncertain may aggravate health problems or be at their origin. It is up to us adults who accompany children - mainly parents or other caregivers, teachers, and health professionals - to be able to “change the beginning of history”. Doing everything possible to ensure well-being will contribute to not compromising the future of children or aggravate inequality. Only then can the future be better. Medical care for children and young people With regard to doctors, pediatricians are responsible for the medical follow-up and health surveillance of children and young people , being important a holistic approach (more important than knowing everything about a disease is knowing everything that affects the patient health), and, thus, guide them according to their needs. Pediatrics offers four types of care : Disease prevention and early care; Rearing care; Assistance in acute illness and follow-up of complex and/or chronic illnesses; Transition care. Disease prevention and early care This first level of care can start before birth , in a prenatal consultation, and must be maintained afterwards according to the monitoring recommended in the Portuguese child and youth health bulletin: At birth, 1, 2, 4, 6, 9, 12, 15, 18 months; At 2, 3, 4, 5, 6/7, 8, 10, 12/13 and 15/18 years of age. In this area of pediatric care, it is never too much to remember the need to keep the vaccines of the national vaccination program up to date . This is a universal and free program, financed by the Portuguese state and which must be complied with. There is no time to be afraid of life-saving vaccines. With regard to vaccines against COVID-19 , their safety and efficacy in some age groups of pediatric age is the subject of ongoing studies, and their use may prove to be yet another weapon in the fight against the disease. Rearing care The second level of care, or rearing care, may involve childcare, breastfeeding, nutrition and promotion of a stable environment , supported by parents and other caregivers such as the school, seeking to protect children from threats and guaranteeing their rights, according to the Convention on the Rights of the Child, ratified by Portugal in 1990. Assistance in acute illness and follow-up of complex and/or chronic illnesses It is the pediatrician who provides the necessary care in acute diseases that arise in pediatric age and, therefore, who should be referred to. In this third level of care, the follow-up care for complex diseases which may arise early, often chronic ones, stands out. Examples are: Endocrines diseases, such as diabetes; Rheumatological disorders diseases, such as juvenile idiopathic arthritis; Gastroenterological diseases diseases, such as inflammatory bowel disease; Respiratory diseases, such as asthma; Nephrourological diseases, such as nephritis; Neurological diseases, such as epilepsy. The COVID-19 pandemic has demonstrated unequivocally that we must be judicious when using medical care, whether in hospitals or health centers. However, we must not think that some diseases have disappeared and let the fear of going to the hospital win over the search for clarifications about our health. The use of a mask and the hygiene measures adopted as a result of the pandemic have shown its usefulness in other contexts, for example by reducing the incidence of other infectious diseases that are transmitted in a similar way, as the flu. But that does not mean that the regular medical monitoring of children is changed. Transition care It is the role of the pediatrician to try to ensure that the adolescent has health care and clinical follow-up when becomes an adult. This level of care, or transition care, seeks to prevent addictive behaviors, clarify sexuality issues, and allows adolescents to better self-knowledge and of their clinical condition . Transition care can start early, at 12-14 years old, especially if there is a chronic disease, require a reevaluation at around 16 years of age and end with the beginning of adulthood, which does not always necessarily start at 18 years of age. The history of Pediatrics in Portugal is already long. We are pleased with the work done and are happy with the low infant mortality rate achieved in our country. However, especially now, Portuguese society should aim to improve a national indicator that is often overlooked - child and youth well-being. Sources: Eurochild. Putting children at the heart of Europe recover y. Mahase E. Covid vaccine could be rolled out to children by autumn . BMJ 2021;372:n723. OECD. Children . UNICEF. A Convenção sobre os direitos da criança . Author : João Miguel Nascimento Meet the pediatrics team from Hospital da Luz network . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
