Who is a pediatrician and how to recognize a real specialist? What organs does a pediatrician treat?

D. Volyanskaya:

The program "Online reception", in the studio I, Daria Volyanskaya. Our guest today is Evgeny Likunov, family doctor, pediatrician, physician general practice. Today we have interesting topic. Today we wanted to talk about family medicine and ask you, as a pediatrician, the most important questions about the health of children.

Eugene, I have a first question for you. In principle, family medicine for our country is not something new, it is not a secret. Also in late XIX century, at the beginning of the 20th century, the family doctor was the main doctor who observed the whole family, both children and adults. With coming Soviet power the concept of a family doctor has sunk into oblivion, the population preferred to be treated directly in hospitals and clinics. Can you tell our viewers what family medicine is, how it differs from conservative medicine in general, what are the advantages of family medicine?

E. Likunov:

I will answer your question with great pleasure. The model of family medicine in Russia, after all, is no longer the family medicine of county doctors of the 19th century. This is an American model and differs in that personal doctor, the family receives the necessary documents. He is either a pediatrician, just a highly specialized one, or he is a generalist, for this he needs to confirm his specialization by passing special certification courses, cycles in the specialty “general practitioner” or “family medicine doctor”. Such specialties are now being prepared in large cities, in Moscow, in St. Petersburg, in Kazan, and, accordingly, it is not a problem to get such an education now.

The difference from a general practitioner or a pediatrician in a state clinic is that the family doctor is a key figure in working with the family. He is a coordinating doctor, he coordinates with other narrow specialists, with an ultrasound doctor, with other diagnosticians. A family doctor must have great professional and practical skills, including in order to work correctly and efficiently. As a rule, a general practitioner is a pediatrician who subsequently receives retraining in family medicine, in therapy. There are already a huge number of family doctors in Russia, mainly in large cities, and a huge number of graduates of certified specialized courses in family medicine. That is, today's profession is far from new.

D. Volyanskaya:

Are there any fears that, in general, a pediatrician is a highly qualified doctor and a child's body differs from an adult's. How can one doctor treat the whole family? After all, there is a narrow-profile specialist, some kind of research, for this, maybe, go to the same hospital?

E. Likunov:

You see, if we are talking about outpatient practice, when the family doctor leads outpatient appointment in a specially equipped medical office, then, in principle, his practice and skills are enough to cure respiratory infections, cure angina, cure mild infection urinary tract. If a we are talking about hospitalization and treatment in a specialized institution with an inpatient diagnosis, of course, the family doctor only gives a referral and sends you to a hospital with a specific diagnosis. He does not treat difficult patients, both children and adults in his office.

D. Volyanskaya:

Eugene, when you go to the clinic to see a pediatrician. Now there are standards for temporary inspections. 18 minutes, of which 10 - filling out the form and 8 minutes for the inspection. What are the limitations of a family pediatrician?

E. Likunov:

A family doctor is not a doctor for large, not for wide use, so to speak, so the duration of the appointment takes at least 30 minutes. Sometimes, if a difficult patient comes across and you need to spend more additional research, ultrasound, fences, swabs, etc., the appointment can last up to an hour.

D. Volyanskaya:

Eugene, family doctor, family pediatrician - is this a luxury for the rich, so to speak, not for everyone?

E. Likunov:

In the American and European model of medicine today there are clinics, very expensive, branded, they have a family doctor - this is a luxury. Highly high price its yearly maintenance and very high costly admission. If we are talking about a doctor, a family doctor who has completed his specialization and works for himself, then he is available for any category.

D. Volyanskaya:

Is it in our country?

E. Likunov:

In the country, yes. In America, in Europe, in Switzerland - it's completely different. Our family doctor is available to all people who are willing to pay for his services.

D. Volyanskaya:

Can you roughly tell in numbers how much it costs per month, per year, a family doctor?

E. Likunov:

A family doctor for a child from zero to a year old, with the most expensive option, costs 50 thousand rubles a year, and with the cheapest option, it costs about 15-20 thousand if he just comes to the clinic and the family doctor does not go home. For adults, a family doctor costs about 30 thousand a year.

D. Volyanskaya:

Where can I find a family doctor? How, in general, does this happen? For example, I want the whole family, with children, to be served by a family doctor. What do I need to do, where to run, how does this process happen?

E. Likunov:

There are two options. The first option: you can attach yourself to a family doctor in a multidisciplinary clinic. Both in branded ones, as in insurance, and buy an observation program in a specific multidisciplinary clinic. Secondly, you can find a number of family doctors who now, today already practice in Moscow, have licenses, have individual entrepreneurs and work for themselves, renting, renting premises either in a medical center or in a room that is fully certified and standardized. He already has his own monitoring programs, he, the family doctor, has contracts for hospitalization, for diagnostics, for consultations related specialists. Let's say here the volume of observation is small, this doctor cannot take a huge number of patients, but his prices are much lower than branded multidisciplinary ones.

D. Volyanskaya:

What are the advantages of the first model and the second? Which option is the most preferred and convenient for patients?

E. Likunov:

The model is convenient for the patient, so that there is only one doctor, so that the family doctor does not change, this is the first and second, so that the teams of doctors who work with this family doctor are the same. Professionals with 10-15 years of experience, candidates of sciences, but so that the child is examined by the same orthopedist or ophthalmologist, so that the dynamics can be clearly understood in 10-15 years, when the patient is already an adult, so that you can transfer, go from a children's network to an adult.

D. Volyanskaya:

Do such doctors have a gradation according to the age of children, or do you observe children of all ages, from zero to eighteen?

E. Likunov:

I can say that by law I see everyone from zero to 18, but from my experience, mostly parents come with children under one year old and parents come with children from three to seven years old, before entering school. Why from zero to a year? Because this is the most anxious time for parents. A lot of vaccinations need to be given, a lot of examinations, a lot of ultrasound examinations, and from three to five, up to seven years old, children mostly get sick, because they start walking in Kindergarten.

D. Volyanskaya:

Eugene, in your opinion, what is the fundamental difference between a family doctor, a family pediatrician and an ordinary one? Is there a difference in approach based on your experience?

E. Likunov:

I can name five points of difference. The first point: a family doctor acts according to world standards, European ones, and not according to the standards that were invented by a particular institution. This is the first. He works within evidence-based medicine. Secondly, the family doctor fights very hard for his authority, because his authority directly depends on the number of new patients who come, he works for himself and he must work well. The third point is that the family doctor has both medical and legal responsibility; it works regardless medical institution, responsibility lies on him even more, because only he is responsible for the health of the patient. Neither chief physician, no chief medical officer, etc.

D. Volyanskaya:

Eugene, how are things going? It seems to me that this is also psychological point vision is a huge burden. How many families do you lead, for example, in your practice now?

E. Likunov:

I can say so. If we are talking about children from zero to one year old, then I take about one hundred and fifty children and try not to take more.

D. Volyanskaya:

So you see children and adults? Or just children?

E. Likunov:

No, look. Mostly, of course, I observe children, because I have experience in pediatrics for about 12 years. I see adults under the program of annual medical examinations, treatment of acute diseases and referral to the necessary related subspecialists. I have annual programs for adults, but parents are mostly worried about small children who often get sick.

D. Volyanskaya:

Do you receive in the clinic, in your office? And do you go home?

E. Likunov:

In the office, yes. I go home, of course.

D. Volyanskaya:

Do you do inspections? Is it included in the program? Or is it seperate? How does this happen?

E. Likunov:

Of course, for the convenience of the doctor, for the convenience of the family, examinations for diseases are carried out at home, if there is no need for blood sampling, X-rays, ultrasound diagnostics. The observation program, for example, from zero to a year, includes ten monthly scheduled patronages with circumference measurement, weighing, and discussion of complementary foods. Approximately 10-12 times. For older children and adults, very often I go to medical offices, very often I go to hotels to see adult patients. There, basically, there are no scheduled examinations, if we are talking about adults, there are examinations for acute diseases.

D. Volyanskaya:

But, you, Eugene, are probably on the phone 24 hours a day. A young mother is the most terrible patient. These are constant calls: “My God, he pooped twice, not 3”, “How to change diapers?” or something else. You must always be in touch and ready for such an attack.

E. Likunov:

Indeed, I position myself as a doctor who works 24 hours a day, 7 days a week. But they mostly call me, of course, on medical issues, and not on organizational issues. My patronage lasts probably about an hour, during which time we have time to discuss all the issues of complementary foods, diapers. How to cut your nails, what drugs to reduce colic to give correctly, etc. Therefore, basically, the current issues of medicine. Mobile communication is used when a child is sick, we discuss how to reduce the temperature before my arrival, or before the ambulance arrives, to reduce the manifestations of intestinal colic, if we are talking about children, or to reduce high blood pressure in an adult.

D. Volyanskaya:

Eugene, in your opinion, how is a pediatrician fundamentally different from other doctors? What qualities should he have?

E. Likunov:

The pediatrician initially differs in that he works with a patient who cannot speak mostly or cannot express his thoughts. This is the complexity of the work of a pediatrician. This is the first. The second thing is that young children get sick very often, here, when you look at a sick child, you need to have such qualities in order to show subordination in the family, explain to your mother, because she is very anxious at the moment when the child is sick, how to behave correctly what doses to lower the temperature. You need to have the gift of persuasion and have a little authority in the family, so that dad, grandmother, and nanny really listen to how to properly treat a patient. Indeed, the pediatrician is very different. Why? I communicate with many therapists, they call me. They are doctors, they have a diploma, a certificate and a lot of experience, but they do not know how to treat children, or rather, they are afraid to treat. They may be able, but they are afraid. In my understanding, a real family doctor is, after all, primarily a pediatrician who later trained as a therapist. Because in my understanding, if a person has been a therapist for 10 years, and then he suddenly decides to become a pediatrician, it will really be difficult for him.

It is easier for a pediatrician to become a family doctor than for an internist, because the internist has little knowledge of pediatrics.

D. Volyanskaya:

Eugene, in my opinion, a pediatrician is, first of all, very good psychologist. Because not only do you need to be able to find contact with the child during the reception, he is small, he cries, he, as you say, does not know how to talk, he also needs to calm his mother, and dad, and the whole family. Do you have your own tricks? You come to the house, or they come to you for an appointment, the child screams, cannot calm down, and you need to look at him.

E. Likunov:

Several receptions. First, I don't wear a bathrobe. I have cotton clothes that are constantly changed, and I do not have a suspicious dressing gown, which is very annoying and frightening for children. This is the first. Secondly, there are toys in the office, I always have a few small toys, stickers, plasters, all kinds of interesting medical devices in my bag. By the way, we don’t have these, they all came from abroad, and we order them from abroad, they come, we entertain them, calm the child. Thirdly, you need to have some charisma so that children really love, that appearance disposed to trust, you need to smile in response. Before the inspection, you need to talk a little. Talk to mom, talk to dad, then the child will understand that he is not in danger and he will really be ready for a quality examination. Of course, one must be able to work, this also does not come in the first year.

D. Volyanskaya:

Eugene, why did you decide to become a doctor? Why did you choose this particular specialization?

E. Likunov:

I will explain for two reasons why I chose pediatrics. Firstly, I believe that pediatrics is a profession in which you see the result of your work. Children grow, they grow, they get sick, they recover, they are formed, they mature. You see how they go to kindergarten, how they go to school, how they go to college. There is a marked progression here. Secondly, in my understanding, it has always been interesting to work with children. In fact, it’s becoming interesting for me with adults now, because in many respects I have already studied some issues in pediatrics, and I want to cover more, more. But children are very interesting creatures and it is interesting to work with them, it is interesting to conduct an inspection with them, it is interesting to delve into the problem. Children are fundamentally different, of course, from adults. They are more interesting than grumbling, 60-year-old, chronically ill adults.

D. Volyanskaya:

A very sincere answer. Thank you for it! Eugene, you have been in pediatrics for a long time, you have been working with children for a long time. What are the most common misconceptions parents have about their children's health, in your opinion? After all, a lot of myths, beliefs.

E. Likunov:

I think that the biggest misconception of today's parents is that if their child is constantly sick 10, 12, 14 times a year, then in the adult network he will be a completely sick chronic patient. This is a misconception that I very often discuss with parents. Modern child will get sick, especially those who go to kindergarten in an organized way, will get sick often and not every child will have a complication. So that parents understand: children get sick.

D. Volyanskaya:

Returning to the conversation about family medicine, I wanted to ask you: what to do in a situation if a general practitioner comes across a case of a serious illness, or you are not sure of the diagnosis? What do you do in such cases?

E. Likunov:

First, if we are talking about an infectious disease, let's say suspected meningitis, suspected severe intestinal rotavirus infection, then you need to call an ambulance medical care on themselves in order to hospitalize the patient in a hospital even with suspected infectious diagnosis. This patient is not treated on an outpatient basis in the office, he is treated in a hospital. This is the first. Second, it happens at home a difficult situation when you come for an examination and see a serious patient. You can take a rapid urine test quickly in the laboratory within 30-40 minutes to suspect the diagnosis. Thirdly, there are situations when you do not need to go for an examination at all or wait until the patient gets to the office. This patient needs to be quickly admitted to the hospital with the help of an ambulance, without waiting for the examination of the family doctor. Situations are completely different, of course.

D. Volyanskaya:

We started talking about international experience and, in my opinion, this is an interesting topic, an interesting question. When I was preparing for an interview with you, I began to read that in our country, already in the history of the new Russia, the first family offices appeared in 1996, and, in general, the practice developed widely. In Europe, in general, everything has been established for a very long time and the fact is that people there trust family doctors, and sometimes they trust even more than specialists in insurance clinics, where it is impossible to get at all.

In my opinion, there is a certain myth about European healthcare, which is reliable and wide. For example, as a person who has lived in Europe for a long time, in many places, I can say that even with very good insurance to get to a doctor, to a very good specialist It can take up to three or four months. The same MRI is generally very difficult to do. As a rule, there people are treated by family doctors. If you have a cold or an exacerbation of a chronic disease, a person can call his doctor on the phone, quickly get an appointment, he writes out a prescription for him, even over the Internet, based on the tests sent. That is, telemedicine, which we have been talking about for a long time now. This prescription immediately, automatically goes to the pharmacy with the help of information system to the pharmacist, she writes it out and the person does not even need to go to a specialist. How are things going with us, in general, with trust in the family doctor and with the development of this institution?

E. Likunov:

I can tell you that in our time, somewhere in the nineties, trust in the doctor has fallen very much. This was due to the fact that we are indeed very far behind in medicine from foreign countries, these are mainly America and Europe. Now, in the 2000s, trust in the doctor has been restored, as a rule, trust in the doctor of private medicine, and trust in the doctor of large federal medical centers. Therefore, there are no problems with trust in a doctor now, especially in large cities, because, indeed, there are highly qualified specialists in large cities, I can tell you for sure. In the regions, of course, the situation is different.

As for the question of how a family doctor differs from an ordinary doctor. Still, an ordinary doctor is subject to the influence of the administration of his clinic, so trust in him falls a little. People don't like it, that there are certain reception standards, a certain number of analysis spectra, the rest is for money, and so on, the queue for an MRI, as you said above. In private medicine, we still dominate in service moments.

D. Volyanskaya:

That is, a more individual, professional approach.

E. Likunov:

Indeed, an approach, but not only an approach, but still we are working here. The difference is that we do not work on a stream. We work on a certain number of families, on recommendations. We have the most best recommendation family doctor is not the Internet, not Facebook, not Instagram. These are recommendations from families that have been followed up for several years.

A family doctor does not work on the flow of patients, but on the recommendations of families that were observed earlier.

D. Volyanskaya:

Are family offices now equipped with diagnostic equipment? Something has changed?

E. Likunov:

I will now explain the position why there is no positron emission tomograph in the offices of family doctors. Because it's not necessary. The family doctor acts as a coordinator. He treats ENT pathologies, he treats viral respiratory infections, but he does not treat complex diagnoses. He directs to related institutions to specific specialized doctors. Firstly, there is no need for complex equipment, and secondly, the family doctor does not set the task of treating such diagnoses.

D. Volyanskaya:

Does the family doctor issue bulletins, referrals for tests, preferential prescriptions?

E. Likunov:

A licensed family doctor issues all the medical documents that are stated in the license, including sick leave certificates, certificates for the pool, a pioneer camp, for admission to a university, and so on. What does he have a license for?

D. Volyanskaya:

Is the family doctor also involved in medical examinations?

E. Likunov:

Yes, the doctor directs. He refers to a mammologist, a gynecologist, an orthopedic surgeon, an ophthalmologist. The family doctor himself cannot carry out medical examinations, because he does not have a license for this. He is only licensed to be an outpatient visit as both a pediatrician and an internist.

D. Volyanskaya:

Question from a spectator during live broadcast: can a pregnant woman be observed not in antenatal clinic, but what about a family doctor, if, for example, his office is located right in her house?

E. Likunov:

Observed as a therapist, she can. At the same time, it is possible and most likely that the family doctor will suggest a competent obstetrician-gynecologist, to whom this woman will go for planned ultrasound scans and will take the necessary screenings. The family doctor will not do this. It will be possible to consult a doctor in terms of prescribing and coordinating some medications together with a gynecologist - for example, therapeutic drugs to reduce pressure and so on during pregnancy. These questions can be discussed. Further, the family doctor will know how the pregnancy proceeded. After the birth - please, the mother will come with the child under the supervision of a family doctor.

D. Volyanskaya:

Eugene, let's move on to the hot part of our questions about children. Today there is a discussion about vaccinations. One side passionately defends the opinion of medical specialists that vaccination is a dangerous thing and parents have joined the same camp that children should not be vaccinated because of the consequences. Other representatives of a wonderful profession say that vaccinations are necessary and in this way you can protect your children. But, unfortunately, now more and more parents refuse to vaccinate their children. Your opinion? Are vaccines really dangerous and why should they be given?

E. Likunov:

The division into two camps happened, again, somewhere in the 2000s. The first camp says that "we will not do any vaccinations in principle, because we believe that these are intrigues, experiments of the bourgeois and capitalists on our country, we will not do anything." The second camp says that "we will do all the vaccinations, and perhaps even the American one, according to European standard foreign, imported vaccines certified and registered in Russia”. At the moment, the second camp is large multidisciplinary clinics who make a huge amount of imported vaccines for a child up to a year old, just as is done in Europe and America. This is a camp that does everything. As for the first camp, people who have a negative attitude towards vaccinations in general. I think this is an opinion about those vaccines that were synthesized in the 1960s and gave a huge number of complications. People, having read on the Internet, the experience of their acquaintances, friends, simply got scared and stopped doing any vaccinations. But here many more immunologists have joined in, they say: the effectiveness of these vaccinations has not been proven, and so on and so forth.

D. Volyanskaya:

But do you think it is necessary to vaccinate? What do you recommend? If good vaccines.

E. Likunov:

First, we have already decided that vaccines must be imported and registered in Russia. The child must be, first of all, healthy. If he has jaundice, if he has a urinary tract infection, no vaccinations can be given. Initially, the jaundice should go away and the child should be cured of the urinary tract infection. Therefore, the main, main point is the health of the child, that is, a completely healthy child without medical contraindications to vaccination. This is the first. Second, vaccinations should be done, basically, before the year, because up to a year a stable lifelong immunity to infections is formed. It is better to make them before the year when the child is healthy. Mandatory, although it is not included in the standard, you need to take blood and urine tests. It is not standard to conduct tests before vaccination, but sometimes we find interesting moments, interesting cases, therefore the analysis of a blood and urine needs to be done.

Vaccinations should be given to a child under one year old, because up to a year a stable lifelong immunity to infections is formed.

D. Volyanskaya:

In Russia, there is a calendar of medical examinations by specialists, vaccinations for children of different ages. In your opinion, is this system outdated? What inspections are really needed for different stages child's life?

E. Likunov:

Now I have encountered such a problem in our city clinics, I think there are too many examinations of narrow specialists in the first year of life. Sometimes, they conduct examinations a month, at three, at six at nine, at twelve, a huge number of specialists: an orthopedist, a neurologist, an oculist, a psychologist, almost a psychiatrist, an ECG, and all this for a small baby. In my understanding, it is absolutely necessary to perform an ultrasound examination of the child in the first month of life, go through specialists, necessarily an ophthalmologist, orthopedist, ENT doctor and neuropathologist. In the future, you can go at 6 months and a year, if there are no medical indications for a more frequent examination. If the child is healthy, the most important thing is that the optometrist does not miss at 6 months, there are such reserves of vision, astigmatism and complex diagnoses, so that the orthopedist is convinced that there is no dysplasia and immaturity hip joints so that the neurologist does not miss the expansion of the lymphatic spaces in the head. If the child is healthy, this will not happen, so the doctor will not miss it.

In the first month of life, it is imperative to perform an ultrasound examination, go through specialists: an oculist, an orthopedist, an ENT doctor and a neuropathologist.

D. Volyanskaya:

For small child Is this amount of ultrasound harmful?

E. Likunov:

We are talking only about mandatory studies per month. In the future, if they are not needed, no one will do them. I emphasize that no one does an ultrasound scan a month, three, six, nine, and a year. No one does them, even in city clinics.

D. Volyanskaya:

Eugene, how do you rate state of the art pediatrics on post-Soviet space, including ours? Is there a positive or negative trend in the global geopolitical map?

E. Likunov:

Relative to the 1990s, there was a colossal breakthrough in the treatment of oncohematology in pediatrics, just a colossal breakthrough. We have learned to treat those diseases that are treated in Germany, Israel and the USA. As for pediatrics, there are also great successes. Why? Because many doctors began to travel abroad to study, to take on the experience of their colleagues, to invite professors to Russia for lectures and consultations. Today's pediatric medicine has become evidence-based, we adopted a lot of treatment standards from abroad and, accordingly, we also treat according to their standards. Therefore, medicine today has become much better, both in pediatrics and in other specialties.

D. Volyanskaya:

Is it worth going to the doctor in any situation? The child has a banal runny nose, it seems you know how to treat it, he dripped for seven days, or as they say, it will pass without drops in 7 days, with drops in a week.

E. Likunov:

There is a concept acute illness, there is a concept medical indication for inspection. If this is a common cold, you can call your doctor, discuss the problem, he will prescribe soft drops and treatment. If the child has a fever for three days with a high temperature, then it is not necessary to wait for the temperature to normalize. An examination must be carried out, because under the mask high temperature can hide a huge number of diseases.

D. Volyanskaya:

By the way, do you often consult by phone? Some doctors usually refuse, are conservative. How are you doing it, not doing it? How do you feel about remote counseling?

E. Likunov:

First, a law on telemedicine and teleconsultations will soon be adopted. I'm really looking forward to this law. I'll explain why. Because there are a huge number of points that a competent, competent doctor can discuss with a patient over the phone. Of course, not prescribing antipsychotics, of course, not treating meningoencephalitis over the phone, but everyday issues, issues of issuing medical documents, issuing all kinds of certificates to various authorities - this, of course, will make life easier for both the patient and the doctor. Advice on ordinary colds, tans, all kinds minor injuries. Of course, then the doctor will consult more widely, moreover, at the legislative level.

D. Volyanskaya:

Again, I can do tests at the clinic and send them to you.

E. Likunov:

Undoubtedly. I can tell you one thing. When it comes to healthy patient, we can safely do this, and if we are talking about a patient with huge amount chronic concomitant diseases, then even a banal analysis may need to be consulted in a clinic or office, because additional examinations may be needed.

D. Volyanskaya:

Question from the audience: is it necessary to give the child vitamins, if so, which ones? Practically, all pediatricians strongly recommend giving to children. Do children need vitamin D, both in summer and winter? How justified is this?

E. Likunov:

Regarding vitamin D. Firstly, it is better to give water solution vitamin D, because it is better absorbed and less side effects From him. Not oily, but aqueous solution. For example, Aqua D3. "Vigantol" is an oily solution. This is first. Prevention of rickets should be given to all healthy children from the age of one month; as they grow older, the dose of vitamin D increases. I have not seen in my practice severe overdoses vitamin D, also, as I have not seen rickets. Perhaps this is due to the fact that normal level life and yet no one has rickets. But we provide prevention.

D. Volyanskaya:

Previously, Soviet pediatricians used to say that it is necessary in winter when there is no sun. And now in the summer. Is it really so necessary?

E. Likunov:

It really is. I'll explain why. Because we don't live in the United Arab Emirates, we don't have a lot of sun, that's one thing. Secondly, I will tell you what we are facing, pediatric neonatologists, that children have an immature work of the gastrointestinal tract and not always everything necessary products absorbed in the right amount. Therefore, calcium in the form of vitamin D, as a source of calcium formation, is necessary. Just the only thing that you should not give 5-6 drops, as many do and cause an overdose. It is necessary to give 1-2 drops per day to a healthy child. This is especially true for mothers who are breastfeeding, because there is much more calcium and vitamin D in adapted mixtures than in breast milk.

D. Volyanskaya:

The favorite question of all grandmothers: is it necessary to protect children from pets in the family? Are there any diseases that animals can actually pass on to children other than allergies?

E. Likunov:

I will immediately dispel the myth: children under three to five years old do not have an allergy to pets, they will not be allergic to pet hair. Therefore, you can and probably should have pets.

Children under three to five years of age do not have allergies to pets.

D. Volyanskaya:

Until the age of 3, allergies do not manifest themselves, right?

E. Likunov:

There is another allergy. There is a food allergy associated with the immaturity of the gastrointestinal tract, the immaturity of enzymes. And pollen, or an allergy to pet hair, is later, after 3 years. Very often happens, but after 3 years. Regarding the fact that animals can transmit toxoplasmosis and other dangerous diseases. If a pet is observed by a veterinarian, if it is vaccinated against all major diseases, then it is not a threat to the child.

D. Volyanskaya:

And if he took it from the street: “Oh, what a wonderful kitten! Mommy, can he stay with us?”

E. Likunov:

If the child is vaccinated against tetanus, if the kitten is not so unsettled, then there will be nothing to worry about. They often bit, often scratched, but nothing happened to anyone.

D. Volyanskaya:

My favorite question, the leader from the audience and parents. Is there any rational grain in the fashion to breastfeed up to three or four years and sleep with the child?

E. Likunov:

D. Volyanskaya:

Is it true that after a year milk no longer has such useful properties is it just water?

E. Likunov:

No, it does, but the psychological moment is very important. It is very difficult to wean the baby from the breast. Until the main teething is underway for up to a year, until complementary foods are fully introduced, it is correct to breastfeed. But at three years of age, breastfeeding is not necessary. This is not necessary both from a psychological point of view and from a medical point of view. But it is especially wrong when a child sleeps with his parents during the entire period of early age. The child should have his own room, his own bed in which he should sleep.

D. Volyanskaya:

Is it critical to completely abandon breastfeeding? What are the consequences of formula feeding a child from the very first days of his life?

E. Likunov:

Out of a hundred breastfeeding mothers, ten, unfortunately, do not have milk for some reason. Today's modern adapted formulas easily replace breastfeeding. If for some reason there is no milk, the child will develop completely on dry mixtures. Today this is not a problem.

D. Volyanskaya:

Are there risks in terms of hygiene? You make a mixture, the quality of the water, microbes can get there.

E. Likunov:

No. Firstly, today's equipment, today's sterilizers, jars, and so on, make it possible to feed formula with pure bottled water, dilute mixtures with this water. No problem. I didn't see any problem that the infection was from the mixture. By the way, mixtures purchased in good pharmacies, also all tested, certified and therefore no problem.

D. Volyanskaya:

Lure. Is it possible to start complementary foods with a jar of mashed potatoes, or is it better to cook it yourself? As before, fresh.

E. Likunov:

It all depends on how many teeth the child has at the time of the introduction of complementary foods. If he has no teeth, it is better to feed from cans, because the child completely likes the homogeneous mass in the can, it is very crushed. You can't do that with a blender.

D. Volyanskaya:

I once tried from a jar. Canned such muck, broccoli! There is simply impossible!

E. Likunov:

For adults, this is disgusting, but children are happy to eat canned food, so it's not a problem.

D. Volyanskaya:

And the meat in the jar - isn't there only one starch?

E. Likunov:

No. Today's baby food banks are tested, they comply with the norms, unlike adult food.

D. Volyanskaya:

Should a child's diet be different from an adult's diet?

E. Likunov:

It is different. Even nutrition after a year, which is already close to an adult, is quite different. You can’t eat nuts, you can’t eat salty, fatty foods, limit sweets.

D. Volyanskaya:

Sometimes you talk to young mothers, they proudly report: “And in my year I already put a fried chicken leg in his mouth, gave him black caviar.”

E. Likunov:

It happens. It happens that parents feed from the common table and there are no problems. It's their business. But in my understanding, up to 3 years, the work of the gastrointestinal tract is approximately formed, and up to 3 years, according to all recommendations, you need to follow the children's table.

D. Volyanskaya:

E. Likunov:

Absolutely correct. I'll explain why. For two positions. The first position - the pancreas is not ready for a lot of sweets, this is the first, and the second - sweets in in large numbers affects teeth. Thirdly, in my understanding, there is sweetness in fruits, vegetables, cereals, it is not necessary to give sweets, all sorts of chocolates.

D. Volyanskaya:

Is it true that soup should be eaten every day? Is it really an urgent need?

E. Likunov:

For a child after a year, closer to three years, one would really like to eat hot, soup or vegetable stew based on vegetables, meat and liquid. It would be desirable, nevertheless, to give every day.

D. Volyanskaya:

How critical is the absence of meat in a child's diet if the parents are vegetarians and want to raise a child as a vegetarian? Do you have these?

E. Likunov:

I have such families. We agree with them so that the first year they feed meat, because it is necessary for normal growth and the formation, maturation of the child, and already further, for example, at three years old, they can replace it with herbal products. But all my families are fed meat for up to a year.

D. Volyanskaya:

There is also a moral aspect. How is it possible for a person who cannot yet make a decision himself to decide in advance? You do not try to dissuade, to convince such parents? The child was given at least.

E. Likunov:

And they give the child. I don't have such problems. They give meat to their child. They do not eat themselves, but they give meat to a child up to three, up to two years.

D. Volyanskaya:

Is it necessary to force a child to eat at all, and why do children sometimes eat little and refuse food? What to do here? If healthy.

E. Likunov:

It is not necessary to force a child to eat so that it leads to hysteria, some kind of phobia. The child will still eat when he needs to. Another question is that there are children with anemia, with chronic disease, for them there is the concept of "diet". They are observed by a nutritionist, where you need to eat according to certain patterns and schedules. There is a must there. Healthy child can run all day long, not eat, but eat in the evening. There is no problem, you don’t need to force it under duress or with a belt.

D. Volyanskaya:

If both parents are allergic? Are there ways to reduce the chance that a child will also have an allergy?

E. Likunov:

You answered your own question. First, do not give sweets, do not give citrus fruits, do not give any exotic products such as black caviar, seafood, which are very popular today. Try not to give a bunch of medicines during the period when the child is sick, which is currently very much practiced. Because all medicines are available in pharmacies and people buy them. They come to a pharmacist, ask for symptoms, how to treat, and the pharmacist dispenses a whole range of medicines that are not needed in principle.

D. Volyanskaya:

Colic in a child is a terrible period for all parents, parents will remember him for a lifetime. Again, in Soviet times, they believed that everything would pass, natural process, be patient, nothing can be done, you won’t sleep for a month, and then everything will be fine. Now there are a huge number of drops, all kinds of medicines on the market. Is this an interference with digestive system child, if you constantly give him? Some parents drip every hour. There is a slippery moment, how to be? Or is it better, really, to let it go by itself?

E. Likunov:

All modern children are immature gastrointestinal tract. It is absolutely not scary if the mother, according to a certain scheme, will give a drug to reduce gas formation in the intestines. All these drugs are safe, they are based on simethicone and should be given in correct timing possible and necessary. This will make life easier for the child. It is not necessary to heal with some kind of enzymes, a huge amount of probiotics, because after 3 months the work of the gastrointestinal tract will mature.

D. Volyanskaya:

Last question for you. We live in a terrible information age of oversaturation. Very often you can see children already with iPads, with iPhones from the age of six months, because parents are too lazy to talk and communicate, they sit in a restaurant, put them in. How to be here? Is it really dangerous for a child up to a year to give him gadgets, and then. Cartoons from how old, after all, to show?

E. Likunov:

Until the age of one, the child does not need to show TV and give mobile devices

D. Volyanskaya:

Not up to 3 years old?

E. Likunov:

Up to a year for sure. Then you can gradually watch TV, about 15-20 minutes a day. It would be good for the child to be absolutely healthy, he would have neither astigmatism nor myopia, and it would be good if the ophthalmologist allowed this, because often the ophthalmologists do not say anything, and the child has a weak visual reserve. But up to 3 years it is desirable, of course, to limit views. After three years, there will be a need, because the child will need to be prepared for school, and at school you can’t do without these devices, in principle.

D. Volyanskaya:

Eugene, thank you very much for an interesting conversation!

The Mediametrics channel was on the air, the program “ Online appointment". Our guest was Evgeniy Likunov, pediatrician, general practitioner. Today we talked about family medicine and children's health.

E. Likunov:

Thank you bye!

What is the difference between these doctors, who, in fact, perform the same functions, you can find out from the article.

Main differences

At first glance, the therapist and the pediatrician have the same duties - to listen to the complaints of patients, to examine them and prescribe the medicines necessary for recovery. However, there is a difference between the activities carried out by these doctors, and it lies, first of all, in the specialization of each of them.

For example, a general practitioner is a specialist who diagnoses and treats internal organs. Its main activity is correct setting diagnosis based on complaints received from the patient and the results of the examination. The therapist is considered a generalist doctor, since in his area of ​​​​competence the most various diseases including those requiring surgical intervention.

A pediatrician is considered to be a doctor who is on guard for the order of the state of health of children from the moment they are born until they reach adulthood. The duties of the local doctor (pediatrician) include not only the diagnosis and treatment of small patients, but also the protection of their health. This specialist monitors the developmental trend of newborns, directs them to routine vaccinations, advises young parents, and also sees patients who have complaints or questions about their health.

The pediatrician is able to be one of the first to identify a predisposition to the appearance of pathology in order to take timely measures and prescribe appropriate treatment. Thus, the district doctor exercises direct control over the state of health of the child, while the adult therapist treats the disease that has already arisen.

These experts examine the body little patient in general, in order to timely diagnose any ailment and prescribe appropriate preventive measures or a course of therapy, and, if necessary, issue a referral for a more thorough examination (testing, X-ray, ultrasound procedure, etc.).

In custody

From the moment the baby is born until the age of one, visits to the pediatrician should be regular. As a rule, visits to the local doctor in the first year of a child's life should be made monthly. Upon reaching this age by the child and in the next two years, scheduled inspection the pediatrician takes place every three months. During the first years of a baby's life, the pediatrician observes his development - an increase in weight and height. He can advise the baby's parents on vitamin intake, diet, and care for the baby so that he grows up healthy and happy. In the future, you can contact the pediatrician in case of complaints.

The offer is valid for all varieties. initial appointment, including appointments of leading doctors, candidates of medical sciences and children's specialists. Take advantage of this great opportunity to benefit from a consultation with one of the leading medical companies Moscow! .

A pediatrician is a doctor who is responsible for the health of a child from the first days of life until the age of eighteen.

For little patients who still cannot formulate their complaints precisely, a visit to the doctor sometimes turns into a real test. Parents need support to instill a culture of health care in their children. experienced pediatrician. A doctor with deep knowledge in child psychology and physiology will accurately determine the cause of the ailment and prescribe a treatment that is safe for the growing body.

It is important that the child visits the pediatrician regularly - not only in case of illness, but also for prevention purposes.

If you need a paid pediatrician in Moscow, contact JSC "Family Doctor". You can make an appointment with a pediatrician at any of the clinics. Consultations take place in a calm and comfortable environment. Children understand that treatment is not painful and not scary, and parents receive detailed and understandable answers to all their questions.

Diseases treated by a pediatrician

viral and bacterial infections;

digestive disorders;

allergic reactions;

conditions caused by a deficiency of enzymes necessary for the child's body;

different kinds injuries.

The competence of the pediatrician includes consultations on the care of the child, monitoring of his physical development, vaccination to prevent childhood infections.

A child goes through several stages in his development. Each of them has features that require heightened attention parents and pediatrician.

In the first weeks after birth, the body of a newborn adapts to new living conditions, vision and hearing develop, and reflexes form. At this stage, the task of the pediatrician is to control the development of the baby, teach parents how to care for the newborn, and organize his nutrition.

Within six months after birth and during breastfeeding, the baby is protected from infections by the mother's immunity. This makes it easier to adapt to the environment. After a year (and artificial feeding even earlier) the child's body has to independently resist the attacks of bacteria and viruses. The task of the pediatrician and parents at this stage is to identify the disease in time, cure it and prevent the development of complications. Vaccination helps build protection against childhood infections.

Between the ages of one and seven years, a child usually suffers from several childhood infections (thanks to vaccination, they occur in a mild form). The pediatrician monitors child health, helps to identify risk factors (including the stress that accompanies the arrival of a child in kindergarten and the transition from kindergarten to school, as well as growing workloads) and organize the daily routine correctly.

Puberty, growth spurt and accompanying hormonal changes affect the work of all organs and systems of the body. Regular visits to the pediatrician are needed in order to notice the problem in time and correct conditions that can negatively affect the health and quality of later adult life.

Symptoms of childhood diseases

The reason for making an appointment with a pediatrician should be not only the appearance obvious symptoms diseases, but also any deviations from the norm in the child's condition:

causeless anxiety and tearfulness;

passivity, lethargy, drowsiness;

increase in body temperature;

the appearance of a rash on the skin;

runny nose, discharge and nasal congestion;

complaints of swallowing disorders and sore throat;

reduced tolerance physical activity, dizziness, pale skin, blue lips, fingertips;

loss of appetite;

increased gas formation, intolerance individual products nutrition;

violation of urination, anxiety and crying during urination.

Preventive examinations at the pediatrician

The first examination of the baby, as a rule, takes place at home. Follow-up visits to the clinic (or house calls) are recommended at least once a month. The pediatrician not only examines the baby himself, but also coordinates the work of other specialists involved in the medical examination. He draws up an individual disease prevention program, including a vaccination plan.

In the second year of a child's life, preventive examinations are planned every three months, upon reaching 2 years - once every six months. Preventive examination includes examination by a pediatrician and specialists of a narrow profile, laboratory and instrumental research which allow you to control the growth and development of the baby.

At the age of three, a visit to the pediatrician is necessary for a large dispensary examination before entering kindergarten. At the end of the medical examination, parents are given and in which information is collected about all the vaccinations carried out.

Similar examinations are carried out at 5-6 years old, when it is issued.

If you have the opportunity to contact a paid pediatrician, it is worth evaluating the benefits of such a choice. In the network of clinics "Family Doctor" your child will be able to undergo preventive examination before entering kindergarten or school without stress, in a friendly and comfortable environment. The private clinic allows proper TB tests ( or ), providing required quality drugs used and the procedure itself.

Vaccination to protect against infections

Vaccination is the introduction of an antigenic drug into the body to produce specific immunity to pathogens of specific diseases. A timely vaccination will prevent infection or significantly alleviate the course of the disease, protecting the child's body from possible complications.

In the clinics of the "Family Doctor" network, you can get all the vaccinations provided for by the National Calendar preventive vaccinations, including vaccination against, pneumococcal infection,). Proven domestic ones are used (including DPT and), Regevak (against hepatitis B), as well as the best imported vaccines: (against pneumococcal infection), complex -,

In medicine, you can find concepts that have a different name, but the same meaning. For example, a pediatrician is often confused with a general practitioner. In fact, it is not difficult to understand the difference between them.

A general practitioner is a specialist who deals with the diagnosis and treatment of internal organs. The very word "therapist" comes from the meaning of therapy. Therapy is a science that studies diseases of the internal organs. In this science, the origin, diagnosis and treatment of internal organs are studied. From the Greek language, the concept of "therapist" is translated as - caring for the sick. Several narrower areas come from the specialty of the therapist - cardiology, rheumatology, etc.

What does a therapist do

A certain set of diseases is dealt with exclusively by a therapist. First of all, this includes cold infections- ARI, SARS, flu, tonsillitis, runny nose. In addition, the therapist can diagnose cardiovascular system organism. The therapist deals with the treatment of certain heart diseases, for example, such as VVD, ischemia, hypertension. Some blood diseases (anemia) are also treated by a general practitioner.

When to See a Therapist

Here are a few symptoms that indicate that a visit to therapy medical office becomes necessary.

1. Unexpected weight loss. Losing weight for no apparent reason is the first bell that indicates the urgency of visiting a therapist.

2. Symptoms of an approaching stroke are fatigue, ringing in the ears, paralysis, incoherence of speech. In this case, the therapist should be contacted as soon as possible.

3. Black chair color. This is a pretty serious sign. The consequence can be an ulcer and even cancer of the stomach.

4. Strong headache, gradually heading to the neck, may be a harbinger of meningitis. A sharp headache may be a sign of a cerebral hemorrhage.

Pediatrician is one of the most important medical specialties, because it is this medical worker is actively following proper development toddler and child. Tracking the development of the baby by a pediatrician begins from the first days of a child's life.

Responsibilities of a Pediatrician

In the period from birth to adulthood, a district pediatrician observes a person. It is this doctor who must foresee diseases and have knowledge from all areas of medicine. The vaccination schedule, as well as monitoring their implementation, is the responsibility of the pediatrician. It is he who should give parents advice that will help their child develop properly and grow healthy.

In any children's institution(school, kindergarten, camp) has its own personal pediatrician. The pediatrician should be able to find a common language with children and their parents.

Similarities Between Pediatrician and Therapist

1. Knowledge from various areas medicine.
2. Observation and control over the treatment of the patient.
3. Identification and treatment of colds.

Differences between a pediatrician and a general practitioner

Therapist is most often approached by people with an already defined health problem, and the pediatrician monitors the health of the child and is one of the first to detect the presence of any disease. He observes the health of a person until he comes of age, and the therapist - after his onset.

Therapist is a general practitioner who treats internal diseases, pediatrician - a narrower specialty, concluded in monitoring the health of the child.

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The profession of a pediatrician is most in demand in modern pediatric medicine. It is the pediatrician who evaluates the neuropsychic and physical development of a small patient, subsequently assessing his school maturity. The pediatrician, as part of his appointment, also determines which health group the children belong to, selects the most favorable recommendations regarding the feeding of the child and his upbringing, and carries out the prevention of chronic diseases in children.

Pediatrician in without fail has knowledge regarding the symptoms of the main types of diseases, as well as knowledge of borderline conditions that are relevant for childhood, knowledge of the causes of the onset and subsequent development of infectious diseases, diseases of organs. Additionally, the pediatrician also takes into account modern tendencies applied in therapeutic methods, and has the basics of pharmacology, corresponding to the category of childhood. Here is just a small part of the general information, which in one way or another relates to the reception of this doctor.

How does a pediatrician work?

Undoubtedly, parents are interested in this issue, and therefore we will try to clarify in a little more detail the main points of visiting a pediatrician. Thus, the appointment of a pediatrician implies the need for him to collect an anamnesis, that is, information regarding the condition of the child in the light of the disease that is relevant to him (health, medical history), an examination is performed. Then, after the initial consultation, a direction corresponding to the information received is issued, focused on its addition due to a specific type of research (blood, urine, culture, etc.).

The results of studies determined in advance by the pediatrician determine, in turn, the measures of treatment or additional direction, but already involving a consultation with a specialist of a specific profile (cardiologist, allergist, etc.).

When to go to the pediatrician?

An examination by a pediatrician can be both planned and unscheduled for a child. Consider the features of both options.

Scheduled inspection

• before birth. Where to go to the pediatrician for the first time, how and when to go to him, future mom can find out even during pregnancy - that's when she becomes registered. The place of registration is determined based on the nearest place of residence, it is necessary to go, as you might guess, to the children's clinic.
• Within a month from the date of discharge from the hospital. AT this case the pediatrician comes to the house, which is done several times.
• After the first month of a child's life. The child is shown to the doctor, which is an ordinary scheduled visit. This technique consists in weighing, examining and measuring growth.
• During the next year. A visit to the pediatrician should take place monthly - such a scheme makes monitoring the child regular, with monitoring of developmental features, possible deviations. This will also allow you to receive the required appointments regarding, for example, routine vaccinations.
• After a year. Here, the pediatrician's office is already visited as needed, if you do not take into account several visits, during each of which vaccinations are given (which is done once every 3 months).

Unscheduled inspection

As the reasons requiring a mandatory visit to the pediatrician, the following are distinguished:

• elevated temperature;
• pain, especially in the joints, in the abdomen or in the head;
• digestive disorders;
• symptoms indicating the possible relevance of allergic or infectious diseases (cough, runny nose, rash, redness of the eyes, hoarseness, etc.);
• the emergence of doubts in parents that the child is developing normally (this applies to both the physical and mental aspects of development).

It is extremely important to remember the following points:

• if the baby is sick or it is necessary to pass his tests, best solution there will be a call to the doctor at home, you can also take tests at home, which will eliminate any danger to the baby when visiting a medical facility;
• the pediatrician maintains a card in which the history of the development of the child is recorded, as well as the features of the course of his diseases. This card should be taken very carefully, because it is often with its help that you can subsequently determine the causes of a particular disease, but already at an older age.

What does a pediatrician treat?

First of all, such a specialist as a pediatrician must necessarily be able to determine which diagnosis is relevant in each specific case, as well as to perform the required treatment in case of infectious diseases(dysentery, measles, whooping cough, acute respiratory infections, influenza, mumps, chickenpox, scarlet fever, etc.), food poisoning, etc.

In addition, the pediatrician must have the necessary knowledge to diagnose diseases of the heart, blood vessels, kidneys, various types of gastrointestinal lesions, CNS lesions, infectious lesions, metabolic disorders, etc. All this implies not only necessary diagnostics, but also the definition of a narrow-profile specialist to whom the patient should be referred with subsequent control on his part over the treatment being performed.

How to find a good pediatrician?

Undoubtedly, there are quite a lot of pediatricians, which, however, does not indicate the highly qualified level of each of them. It is for this reason that the issue of finding a good pediatrician is extremely important for the parents of a small patient.

First of all, the choice of the clinic itself is important, and the doctor who will monitor the health of your child there must have sufficient experience as a pediatrician.

No one will be surprised by the data that the more significant the practice of a specialist in this field, the correspondingly fewer mistakes they make. Initial stages development of children do not give children the opportunity to express what exactly worries them, and by the age of five it is difficult to achieve the correct formulation of such important issue about their condition. It is thanks to the efforts of an experienced specialist that it is possible to determine the real cause of crying or fever, without relying on the need for verbal explanations from the child.

At the same time, do not be guided in your own search by a specialist with, for example, forty years of work experience. The optimal experience for a pediatrician is an experience of 10-20 years - it is during this time that he manages to improve his knowledge and develop a certain practice, keeping up with current trends in medicine and in his own field in particular. Not less than positive moment for a pediatrician is the experience of working in a hospital.

By the way, a good pediatrician always makes sure that even after receiving the minimum optimal experience, he does not miss the opportunity for professional improvement. Such specialists understand that it is important to apply already proven, albeit somewhat outdated, methods along with modern methods. This, in turn, encourages them to continue their education while simultaneously improving their own theoretical and practical base.

The best example indicating the professional development of a doctor is a certificate of completion of advanced training courses, as well as the receipt by this specialist of additional specializations (surgery, allergology, etc.). Most often, specialists of this level conduct appointments in good clinics, the management of which encourages such training in every possible way.

Pediatric services: what does it include?

• General therapeutic collection of anamnesis, patient complaints;
• General therapeutic visual examination;
• General therapeutic palpation;
• General therapeutic listening to sounds;
• General therapeutic tapping (i.e. percussion);
• General thermometry;
• Measurement of height and body weight.