Tema 1. Concepto de Pediatría. Demografía Infantil.: Prof. Dr. Manuel Sobrino Toro

12/2/23
Tema 1. Concepto de Pediatría.

Demografía infantil.
Pediatría. Grado de Medicina. Universidad de Sevilla.

Curso 2022-2023. Grupo D. Campus Virgen del Rocío
Prof. Dr. Manuel Sobrino Toro.

sobrino@us.es
Pediatría: concepto
- Pediatría: estudio de las enfermedades de los niños, en sentido estricto.
- Puericultura: Pediatría Preventiva o higiene del niño.
- Pediatría Social.
- Ecopediatría: salud del niño y ambiente.
- Pediatría Rehabilitadora.
“Pediatría y sus Áreas Específicas”: especialidad médica en España.
Prof. Cruz Hdez (2020)
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Pediatría: facetas:
① Pediatría clínica: menor individualmente enfermo que requiere
asistencia especializada.
② Pediatría Preventiva o Puericultura: niño sano con especiales

normas de higiene y profilaxis.
③ Pediatría Social: niño sano o enfermo sometido a la influencia física

y psíquica de la comunidad.
Pediatría Social:
Áreas de actuación:
- Niños con problemas de salud de causa social.
- Niños con problemas de salud con consecuencias sociales.
- Atención en salud infantil en la sociedad.
- Abarca cuatro áreas de atención:

1) Pediatría curativa.
2) Promoción de la salud.
3) Prevención de la enfermedad.
4) Rehabilitación.
- Convención de los Derechos del Niño (1989).
Prof. Dr. M. Sobrino
2
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Periodos de la edad pediátrica

RECIÉN NACIDO:
Primer mes de vida. Desde el nacimiento hasta los 28 días (4 semanas)
LACTANTE:
Entre los 28 días y el final del primer año (“infant”).
NIÑO PEQUEÑO, DE CORTA EDAD O PÁRVULO:

Entre 2-3 años (“toddler”)
PREESCOLAR:
Entre 4-5 años (“child”).
ESCOLAR:
Entre 6-13 años (incluyendo el inicio de la pubertad).
ADOLESCENCIA:
Entre 14-18 años.
Características propias de la Pediatría (1):

-Crecimiento. Fisiología especial
-Evolución morfológica. No adulto en miniatura.
-Inmadurez orgánica. SNC / Hígado/Pulmón/Riñón/ órganos sensoriales o intestino

-Importancia de la nutrición y el metabolismo. Desnutrición,
obesidad, errores dietéticos, anorexia (nerviosa).
-Inmunidad. Profilaxis.
-Solidaridad funcional. Inmunidad, Inmadurez neurovegetativa, estado de SN y

labilidad metabólica.
-Semiología especial.

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Características propias de la Pediatría (2):
-Marcada influencia de la genómica y del periodo fetal.

Manifestación de procesos en edades pediátricas.
-Terapéutica especializada.
-Repercusión sobre la demografía.
-Interdependencia con la patología del adulto.
-Influencia del entorno.
-Importancia de la salud y la profilaxis.
-Características psicológicas.
4
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Determinantes de la Salud Infantil
Ambiente
Estilo de Socio
vida Económico
Ambiente
Biologia Físico
humana (casa, aire, agua,
polución,…)
Modificado de Blair and cols. “Child Public Health” (2010))

The Lancet Commissions

Child rights to survive, thrive, and participate with no exposure to discrimination and best
Healthy development
interests at heart, and protected sexual and reproductive rights
Protective factors Skilled birth Birth Immunisations School Safe learning Universal
attendant registration Support for achievement environments access
Child rights to survive, thrive, and participate with no exposure to discrimination and best Responsive Social and
early child Parity in
ICT
literacy
to SRH
Healthy development
development education
interests at heart, and protected sexual and reproductive rights care group
support
Social and
Protective factors Skilled birth Birth Immunisations School Safe learning Universal environmental
determinants
attendant registration Intergenerationalenvironments
Support for achievement access (embedding)
effect from ICT to SRH
parents
Responsive Social and literacy Child development
care group development education equity gap at
adulthood
support
Equity gap
preconception
Maternal Neonatal risks: Malnutrition Child Commercial Child Adolescent
Vulnerability factors Social
deprivation and
• Low birthweight and poor labour exploitation marriage birth
• Prematurity growth
environmental
determinants
Intergenerational
(embedding) Exposure to physical, sexual, and psychological violence
effect from Birth Life course
parents Preconception Pregnancy Newborn Infancy Childhood Adolescence and adulthood
Child development
Figure 1: Sustainable Development Goals measuring protective and risk factorsequity gap at across the life course
for child wellbeing
ICT=information communication technology. SRH=sexual and reproductive health.
adulthood
during pregnancy shape the future trajectory of abilities Fetal and early-life nutrition is also essential for long-
and health.27 Before pregnancy, women and adolescent term health, cognitive development, and economic out-
girls should receive nutritional and counselling inter- comes.36,37 Poor fetal growth or stunting in the first 2 years
Equity gap ventions to ensure they are healthy and equipped to make of life leads to irreversible damage, including reduced
decisions about whether and when to become mothers. adult height, lower attained schooling, and lower adult
preconception
Maternal health interventions are critical to prevent, income. Children who are undernourished in the first
Maternal Neonatal risks: Malnutrition detect,Commercial
Child and treat problems
Child early during pregnancy and 2 years of life and who put on weight rapidly later in
Adolescent
deprivation • Low birthweight and poor ensureexploitation
labour women havemarriage
access to high-quality
birth care in case of childhood or in adolescence are at high risk of obesity and
Vulnerability factors complications. Food and iodine supplementation before later chronic diseases, such as diabetes, heart attack, and
or during pregnancy and antenatal corticosteroids for stroke.37 Early-life nutritional interventions, such as the
women at risk of preterm birth in HICs have beneficial promotion of breastfeeding and iodine supplementa-
effects on child development. 28,29
Smoking cessation tion, consistently show benefit-cost ratios that exceed
during pregnancy, which can be supported by psychosocial one.38 Improving gender equality also has benefits for
programmes, also reduces low birthweight, and preterm child nutrition, and is an independent predictor of child
Exposure to physical, sexual, and psychological violencestrongly related to improving early malnutrition and mortality in cross-country comparisons.39
births30—outcomes
childhood development. Research has also shown the Yet an estimated 250 million children younger than
Birth developmental origins of adult diseases like diabetes, 5Life yearscourse
old in low and middle-income countries (LMICs)
heart attacks, and strokes.31,32 Prenatal exposure to envir- are at risk of not reaching their developmental potential.40
Preconception Pregnancy Newborn Infancy onmentalChildhood
contaminantsAdolescence
is associated and adulthood
with epigenetic At the same time, we know what children need for healthy
changes, such as DNA-methylation, linked to the develop- development: nurturing and responsive care to promote
ment of diseases later in life. For example, studies their health, nutrition, security, safety, and opportun-
33
Figure 1: Sustainable Development Goals measuring protective and risk factors for child wellbeing across the life course in Sweden on the radioactive fallout following the acci- ities TheforLancet Commissions
early learning.41
Children with disabilities or an
ICT=information communication technology. SRH=sexual and reproductive health. dent at the Chernobyl nuclear power plant, Pripyat, impairment of functioning require screening and early
Ukraine, show that in-utero exposure affected educational interventions so that they too can reach their full potential.
attainment and income many years later. Economists’ Follow-up studies of children exposed to poverty, from a
34
work on fetal exposures has also suggested long-term wide range of countries, show the beneficial effects of
during pregnancy shape the future trajectory of abilities Fetal and early-life nutrition is also essential for long-
Aeconomic
future for effects, including reduced test scores and early childhood interventions for adult earnings, cogni-
the world’s children? A WHO–UNICEF–Lancet
earnings.35 tive and educational achievement, health biomarkers,
and health. Before pregnancy, women and adolescent
27
term health, cognitive development, and economic out-
Commission
girls should Prof.
receive nutritional and counselling inter-
Dr. M. Sobrino
comes.36,37 Poor fetal growth or stunting in theVolfirst
www.thelancet.com 395 February2 years
22, 2020
Helen Clark*, Awa Marie Coll-Seck*, Anshu Banerjee, Stefan Peterson, Sarah L Dalglish, Shanthi Ameratunga, Dina Balabanova, 611
Maharaj Kishan Bhan†, Zulfiqar A Bhutta, John Borrazzo, Mariam Claeson, Tanya Doherty, Fadi El-Jardali, Asha S George, Angela Gichaga,
ventions to ensure they are healthy and equipped to make of life leads to irreversible damage, including reduced Lu Gram, David B Hipgrave, Aku Kwamie, Qingyue Meng, Raúl Mercer, Sunita Narain, Jesca Nsungwa-Sabiiti, Adesola O Olumide, David Osrin,
Timothy Powell-Jackson, Kumanan Rasanathan, Imran Rasul, Papaarangi Reid, Jennifer Requejo, Sarah S Rohde, Nigel Rollins, Magali Romedenne,
decisions about whether and when to become mothers. adult height, lower attained schooling, and lower adult Harshpal Singh Sachdev, Rana Saleh, Yusra R Shawar, Jeremy Shiffman, Jonathon Simon, Peter D Sly, Karin Stenberg, Mark Tomlinson,
Rajani R Ved, Anthony Costello
Maternal health interventions are critical to prevent, income. Children who are undernourished
Executive summary in the first costs are not prohibitive: an analysis of the SDGs suggests Lancet 2020; 395: 605–58
10
Despite dramatic improvements in survival, nutrition, and a financing gap of US$195 per person. To ensure stronger Published Online
detect, and treat problems early during pregnancy and 2 years of life and who put on weight uncertain future.rapidly laterdegradation,
education over recent decades, today’s children face an
Climate change, ecological in economic and human development, each government
must assess how to mobilise funding using instruments
February 18, 2020
https://doi.org/10.1016/
S0140-6736(19)32540-1
migrating populations, conflict, pervasive inequalities, that help the poorest proportion of the population to meet
ensure women have access to high-quality care in case of childhood or in adolescence are at high risk
and predatory of obesity
commercial practices threatenand
and future of children in every country. In 2015, the
the health this gap for children, and frame these as the most
powerful investments a society can make. But investments
See Editorial page 538
See Comment page 541
complications. Food and iodine supplementation before later chronic diseases, such as diabetes, heart attack, and
world’s countries agreed on the Sustainable Development
Goals (SDGs), yet nearly 5 years later, few countries have
are not just monetary: citizen participation and com-
munity action, including the voices of children them-
*Commission co-chairs
†Dr Bhan died in January, 2020
The Helen Clark Foundation,
or during pregnancy and antenatal corticosteroids for stroke.37 Early-life nutritional interventions,
Commission presents thesuch aschildren,
theaged
recorded much progress towards achieving them. This selves, are powerful forces for change that must be
Auckland, New Zealand
case for placing mobilised to reach the SDGs. Social movements must (H Clark MA); Partnership for
0–18 years, at the centre of the SDGs: at the heart of the play a transformational role in demanding the rights Maternal Newborn & Child
women at risk of preterm birth in HICs have beneficial promotion of breastfeeding and concept iodine supplementa-
of sustainability and our shared human endeavour.
Governments must harness coalitions across sectors to
that communities need to care for children and provide
for families.
Health, Geneva, Switzerland
(H Clark); Senegal Presidency,
Dakar, Senegal
effects on child development.28,29 Smoking cessation tion, consistently show benefit-cost children ratios that
receive their rights exceed
overcome ecological and commercial pressures to ensure
and entitlements now and a Government has a duty of care and protection across all
(A M Coll-Seck MD); Department
of Maternal Newborn Child
liveable planet in the years to come. sectors and Adolescent Health
during pregnancy, which can be supported by psychosocial one.38 Improving gender equality Invest also has benefits for
in children’s health for lifelong, intergenerational,
Countries that support future generations put a high
priority on ensuring all children’s needs are met, by
(A Banerjee MD, N Rollins MD,
J Simon DSc), Department of
Health Systems Governance and
programmes, also reduces low birthweight, and preterm child nutrition, and is an independent predictor
and economic benefits
of child delivering entitlements, such as paid parental leave, free
5
Financing, WHO, Geneva,
The evidence is clear: early investments in children’s primary health care at the point of delivery, access to Switzerland (K Stenberg MSc);
Health Division (S Peterson MD,
health, education, and development have benefits that healthy—and sufficient amounts of—food, state-funded
births30—outcomes strongly related to improving early malnutrition and mortality in cross-country
compound throughout comparisons. 39
the child’s lifetime, for their future
children, and society as a whole. Successful societies
or subsidised education, and other social protection
measures. These countries make sure children grow up in
D B Hipgrave PhD, J Requejo PhD),
HIV, Data, and Analytics Division
UNICEF, New York, NY, USA
childhood development. Research has also shown the Yet an estimated 250 million children
evident from countries younger
that have done well on than
invest in their children and protect their rights, as is
health and
safe and healthy environments, with clean water and air
and safe spaces to play. They respect the equal rights
(J Requejo); Department of
International Health, Johns
Hopkins School of Public Health,
economic measures over the past few decades. Yet many of girls, boys, and those with non-conforming gender
developmental origins of adult diseases like diabetes, 5 years old in low and middle-income politicianscountries (LMICs)
still do not prioritise investing in children, nor
see it as the foundation for broader societal improvements.
identities. Policy makers in these countries are concerned
with the effect of all policies on all children, but especially
Baltimore, MD, USA
(S L Dalglish PhD, Y R Shawar PhD,
Prof J Shiffman PhD); School of
heart attacks, and strokes.31,32 Prenatal exposure to envir- are at risk of not reaching their developmental
conditions of absolute poverty, potential.
Even in rich countries, many children go hungry or live 40 in
especially those belong-
those in poorer families and marginalised populations,
starting by ensuring birth registration so that the govern-
Population Health, University of
Auckland, Auckland,
New Zealand
onmental contaminants is associated with epigenetic At the same time, we know what children
populations andneed forToohealthy
ing to marginalised social groups—including indigenous ment can provide for children across the life course, and (Prof S Ameratunga MBChB,
ethnic minorities. often, the potential help them to become engaged and productive adult P Reid MBChB); Department of
Global Health and
of children with developmental disabilities is neglected, citizens. The rights and entitlements of children are
changes, such as DNA-methylation, linked to the develop- development: nurturing and responsive care to promote
Development, London School of
restricting their contributions to society. Additionally, enshrined within the UN Convention on the Rights of the Hygiene and Tropical Medicine,
many millions of children grow up scarred by war or Child (CRC) ratified by all countries, except the USA. London, UK (D Balabanova PhD,
ment of diseases later in life.33 For example, studies their health, nutrition, security, safety, and opportun-
insecurity, excluded from receiving the most basic health, Countries might provide these entitlements in different T Powell-Jackson PhD); Health
Systems Transformation
educational, and developmental services. ways, but their realisation is the only pathway for countries Platform, Tata Trusts, Mumbai,
Decision makers need a long-term vision. Just as good to achieve the SDGs for children’s health and wellbeing, India (M K Bhan MD); Centre for
41 health and nutrition in the prenatal period and early years and requires decisive and strong public action. Global Child Health, Hospital
program.”
health facilities.”
linkages in between.”
center and the hospital.“
providing the right care.”
newborn and child health.”
12
and a productive life. Another11
community level to clinical services.”

recognising that safe childbirth is critical to
Prof.
indicates that care has to be provided in a seamless
MNCH programmes is the ‘continuum of care’. This
and nutrition services. Substantial—and sustained—
related continuum is
high impact program delivery, supported by enabling

“The right person, at the right time, in the right place,
Panel 1: Definitions of the MNCH continuum of care
and strengthened comprehensive health system, from

reduction of the risk of dying once pregnant, however,
required to link households to hospitals by improving

“The core principle underlying the strategies to develop
“The time has come for these health interventions for
theDr.health
“The household to hospital continuum of care approach

health programmes…The continuum-of-care approach
“Programs succeed best when they provide a package of
provides pragmatic steps to ensure the availability of and

to the first-referral level, supported by a public education
health facilities and district hospitals, while strengthening

they need, and increasing access to and quality of care at
of
expression has two meanings. First it means care has to be
newborn babies to be integrated into maternal and child
“This encompasses a continuum of essential interventions

environment, encompassing strong political commitment
delivery, the immediate postnatal period, and childhood,
homebased practices, mobilising families to seek the care

M. Sobrino
start in life is an essential step towards a sound childhood

adolescence, pregnancy, childbirth and childhood. Second it
provided as a continuum throughout the lifecycle, including
as continuum that follows through the lifecycle of maternal,

continuum that spans the home, the community, the health
“The continuum of care that follows the life-cycle is part of a
that should be accessible to mothers, newborns and children

promotes care for mothers and children from pregnancy to
at household, community, district and national levels, as well

requires an effective continuum of care from the community
access to quality maternal and newborn services at peripheral

services, including community-based family planning, health
both the woman and the newborn child—and that a healthy
PMNCH, 20064
Mangiaterra and colleagues, 200615
Save the Children, 200514
The Lancet Neonatal Survival Series, 20052
World Health Report 20051
Centers for Disease Control/CARE International, 200113
World Bank, 199312

B
A
Adolescence and
before pregnancy
years
ive
uct
Determinantes
od
pr
Re
5OP RJ I )'( ; ORE J RSJ <R SS ORPORB E 3 RJ I S R S R E

ce
Figure 1: Continuum of care

Pre
can die within hours

Pregnancy
Death
Ageing
scen
g na
ncy
Adulthood
Table 7.2 Comparison of some important social determinants of health and key health problems in children in the developed
20 years
Adole
sociales
and developing world (see also chapter 4)
Birth
UO 3 3 5O R > 8
Birth
Family and community care

Hospitals and health facilities
10 years
Developed world Developing world
or even de
Outpatient and outreach services
age
Neonatal p
5 RB 0B O J K1 J EO OP
BR RO
28 days
Important social Inappropriate nutrition—e.g. overconsumption Malnutrition

5 years
ool-
minutes
erio
Childhood
(mother)
d
Postnatal
Postnatal
(newborn)
determinants of health of saturated fats and sugar Absolute poverty

Sc h
5R B E ROM US S O )')' '- ), ('.)'. )

1 year
access to care for those who need it most.

Inf
Lack of exercise Lack of sanitation

a
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nc
Risk behaviour—e.g. substance misuse Availability of education y
la Salud
rs
yea
Relative poverty/income inequality War and violence up ool
Ap
Presch
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w-
Family structure and relationships Famine, drought, and flooding

Maternal health
op
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if appropriate
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Social attitudes and stigma Climate change
Infancy Childhood
riat
e referral and fo
from Partnership for Maternal, Newborn and Child Health, with permission.4,5
Time spent watching TV/playing Availability of health care, especially antenatal,
Infantil
Connecting care during the lifecycle (A) and at places of caregiving (B). Adapted
www.thelancet.com Vol 370 October 13, 2007

Mothers and babies are especially vulnerable to death: a
care
at home, commonly because of delays in reaching care.21
The place dimension of the continuum can be defined

labour leads not only to deaths but also to poor outcomes
woman with postpartum haemorrhage or a baby with
as the physical location where care is provided. The

such as intrapartum stillbirths, neonatal illness and
babies18 and children,19 and many maternal deaths20 occur
facility-based care at primary and referral sites. These

basis of the skill and intensity of service delivery and the
but three distinct approaches can be differentiated on the
is not provided. Delayed attention to complications during
birth asphyxia, sepsis, or complications of preterm birth
complications, which is typically provided through

complications.21 Long distances, financial constraints,
of mothers, babies, and children with illness or

care—consists of individual-oriented case management
obstacles to care.22 The first approach—clinical
operational levels of different health systems vary widely,
poor communication and transport, weak referral links,
and at times, low-quality care in health facilities, can limit
disability, obstetric fistula, and other long-term obstetric
video games perinatal, and preventive services
Performance-related stress Family structure and relationships
Family planning and family size
Review
Child labor
Migration Review
OM AC B K IR 1 I P.&& COOK
Injury risk
5IJ E I B I . 3 POPU B JO P RSP J

Key health Acute illnesses (usually not fatal) Respiratory infections
Continuum of care for maternal, newborn, and child health:
problems Obesity & other lifestyle problems Diarrheal diseases Continuum of care for maternal, newborn, and child health:
from slogan to
from slogan to service delivery
service delivery
Emotional and behavioral problems Vaccine-preventable infectious diseases and other acute
Kate J Kerber, Joseph E de Graft-Johnson, Zulfiqar A Bhutta, Pius Okong, Ann Starrs, Joy E Lawn
Kate J Kerber, Joseph E de Graft-Johnson, Zulfiqar A Bhutta, Pius Okong, Ann Starrs, Joy E Lawn
Prof. Dr. M. Sobrino, 2010

Disability (due to increasing survival of illnesses (more often fatal) The continuum of care has become the yearly Lancet 2007; 370: 1358–69
toll of a million deaths,
<RO=U S 6COOK
The continuum
a rallying callof
to care
reducehas become a half
rallying callmaternal
to reduce Lancet 2007; 370: 1358–69
the4 million
yearly toll of half a million maternal deaths, 4 million
neonatal deaths, and 6 million child deaths. The continuum for maternal, newborn, and child health usually refers to
neonatal
continuity of individual care. deaths,
Continuity of careandis necessary child deaths.
6 millionthroughout The continuum
the lifecycle (adolescence, forSee Editorial page 1283
maternal, newborn, and child health usually refers to
pregnancy,
preterm infants and injury) HIV, TB, and hepatitis B See Comment page 1285
childbirth, the postnatal period, and childhood)
continuity and also between
of individual care. places of caregiving
Continuity (including
of care
Saving Newborn Lives, Save is necessary and
households throughout
See Comment page 1285 the lifecycle (adolescence, pregnancy,
outreach services,
communities, outpatient andchildbirth, and clinical-care the Children, Washington DC,
settings). We defi ne a population-level or public-health
the postnatal period, and childhood) and also between
USA (K J Kerber MPH, Saving Newborn Lives, Save
places of caregiving (including households and
Chronic illnesses & malignancy framework based on integrated service delivery throughout the lifecycle, and propose eight packages to promote
Disability (related to birth injury, polio, accidents, war communities, outpatient and J E de Graft-Johnson MD, the Children, Washington DC,
outreach services, and clinical-care settings). We define a population-level or public-health
health for mothers, babies, and children. These packages can be used to deliver more than 190 separate interventions,
J E Lawn MRCP); ACCESS
RB PROQU S OM BR 1 AC B K S
framework based on integrated service delivery throughoutUSA (K J Kerber MPH,
the lifecycle, and propose eight packages to promote
which would be difficult to scale up one by one. The packages encompass three which are delivered through clinical
Program, Baltimore, MD, USA
and conflict) (J E de Graft-Johnson);
J E de Graft-Johnson MD,
care (reproductive health, obstetric
healthcare,
for and care of sick
mothers, newborn
babies, andbabies and children);
children. Thesefourpackages outpatient
through can be used
and to deliver more than 190 separate interventions,
Department of Pediatrics and outreach J E Lawn MRCP); ACCESS
services (reproductive health, antenatal care, postnatal care and child health services); and one through
Child Health, Aga Khan Program, Baltimore, MD, USA which would be difficult to scale up one by one. The packages encompass three which are delivered through clinical
integrated family and community care throughout the lifecycle. Mothers and babies are at high risk in the first days
University, Pakistan
(J E de Graft-Johnson); care (reproductive health, obstetric care, and care of sick newborn babies and children); four through outpatient and
(Prof Z A Bhutta PhD); after birth, and the lack of a defined postnatal care package is an important gap, which also contributes to discontinuity
HIV: human immunodeficiency virus; TB: tuberculosis. Department of Obstetrics and Department of Pediatrics
between maternal andand
child health programmes. Similarly, because the family and community package tends not to
outreach services (reproductive health, antenatal care, postnatal care and child health services); and one through
Gynaecology, Nsambya Child Health, Khan
be regarded as part
Agaof the health system, few countries have made systematic efforts to scale it up or integrate it with
Hospital, Uganda and integrated family and community care throughout the lifecycle. Mothers and babies are at high risk in the first days
University, Pakistan
International Federation of other levels of care. Building the continuum of care for maternal, newborn, and child health with these packages will
1 URSOR. POJ
Gynecology and Obstetrics need eff (Prof
ectiveness
Z A Bhuttatrials after birth, and the lack of a defined postnatal care package is an important gap, which also contributes to discontinuity
PhD);in various settings; policy support for integration; investment to strengthen health systems;
Committee on Maternal and Department of Obstetrics
and results-based and
operational management, especially at district level.
between maternal and child health programmes. Similarly, because the family and community package tends not to
Newborn Health, London, UK
Gynaecology, Nsambya
(P Okong MD); Family Care be regarded as part of the health system, few countries have made systematic efforts to scale it up or integrate it with
International, New York, USA Introduction
Hospital, Uganda and Millennium Development Goals 4 and 5, which was
(A Starrs MPA); and Partnership The continuum
International Federation other levels of care. Building the continuum of care for maternal, newborn, and child health with these packages will
of careofhas recently been highlighted as called for at the World Health Assembly 2007, also
for Maternal, Newborn, and a core principle of programmes for maternal, newborn, emphasises the continuum of care.6
need effectiveness trials in various settings; policy support for integration; investment to strengthen health systems;
Gynecology and Obstetrics
Child Health, Geneva,
and child health, and as a means to reduce the burden The goal of this approach is to avoid dichotomies,
Switzerland (A Starrs) Committee on Maternal and and results-based operational management, especially at district level.
of half a million maternal deaths, 4 million neonatal between either mothers and children, places of service
Correspondence to: Newborn Health, London, UK 7,8
Dr Joy E Lawn, Saving Newborn deaths,(P Okongand million
MD);6Family Carechildren who die between the delivery, or single health issues (table 1). Within the
R/ 2I P.&& COOK
ages of 1 month
Lives, Save the Children-US, 11 International, New York, 5 years.1–3 The continuum of care is continuum, all women should have access to reproductive
and USA Introduction Millennium Development Goals 4 and 5, which was
South Way, Pinelands, Cape a recurrent theme in the World Health Report 20051 and health choices and during pregnancy childbirth,
Town 7405, South Africa(A Starrs MPA); and Partnership
The continuum of care has recently beencarehighlighted as andcalled for at the World Health Assembly 2007, also
The Lancet Neonatal Survival Series.2 The continuum and all babies should be able to grow into children who
joylawn@yahoo.co.uk for Maternal, Newborn, and principle of programmes 9
maternal, newborn, emphasises the continuum of care.6
also provides the foundation a corefor the conceptual survive andfor
thrive.
Child Health, Geneva,
framework of the Partnership andfor Maternal,
child Newborn
health, and as aThe continuum-of-care
means to reduce approach
the burdenhas been used
Theasgoala of this approach is to avoid dichotomies,
Switzerland (A Starrs) 4
and Child Health (PMNCH) and Opportunities
of half for rallying
a million maternal call for integration
deaths, programmes for
4 millionof neonatal between
maternal, either mothers and children, places of service
Africa’s Correspondence
Newborns.5 to: The Global Business Plan for neonatal, and child health, but often without a clear
Dr Joy E Lawn, Saving Newborn deaths, and 6 million children who die between the delivery, or single health issues (table 1).7,8 Within the
Lives, Children-US, 11 ages 1 month and 5 years.1–3 The continuum of care is continuum, all women should have access to reproductive
RB PROQU S
Policy
Saveconfl
theicts Win–win
ofstrategies
South Way, Pinelands, Cape 1
recurrent
Competing voices of advocates for a Mothers, neonates, theme
and children all
inbenefi World
thet from essentialHealth
packages in aReport 2005
continuum of care and health choices and care during pregnancy and childbirth,
6
12/2/23
Town
health 7405, South
of women and children,
Africawith MDG 4 and 5, for child survival and maternal health, respectively, are2both intimately linked with health of neonates
those
The Lancet Neonatal Survival Series. The continuum and all babies should be able to grow into children who
for newborn babies not heard More attention on health of mothers, neonates, and children, but need for financial investment
joylawn@yahoo.co.uk 9
Global health-policy
also provides shift; organisations
the foundation
with disparate agendasfor the Partnership
formed the for Maternal, Newborn
conceptual and
survive and thrive.
Child Health in 2005
framework of the Partnership for Maternal, Newborn The continuum-of-care approach has been used as a
OM0&B2
Facility-based vs community care Systematic, phased strengthening of health systems (including community-based care) with emphasis on universal
Vertical vs horizontal programming coverage packages for health 4
of mothers, neonates, children
and Child
of essentialHealth (PMNCH) andandOpportunities for rallying call for integration of programmes for maternal,
Integration between essential packages for health of mothers, neonates, and children and integration of these packages
5
with other programmes,
Africa’s Newborns. such as those for
TheHIV, malaria,
Global and vaccine-preventable
Businessdiseases Plan for neonatal, and child health, but often without a clear
12/2/23
Gráfico 2-8 Tendencia en la prevalencia de problemas de salud crónicos declarados en población de 15 y más años. España, 1993-2017
Hipertensión Arterial Colesterol alto Diabetes

25
19,8
20 18,4 18,5 18,4
17,2
Porcentaje de población
17,9
14,4 14,5 16,4 16,5
15
11,9 14,0
11,2
11,3 10,9 Cruz – Tratado Pediatría (2014)
10 9,5 10,5
8,2 8,2
13 5
5,6 5,9 6,2 5,9
7,0 6,8
7,8
4,7 5,0
4,1
0
1993 1995 1997 2001 2003 2006 2009 2011 2014 2017
Observaciones: Se considera que padece algunos de esos problemas de salud si en la entrevista se declara “padecido en los últimos 12 meses” y “se lo ha dicho
un médico que lo padece”. Año 2009, sin datos correspondientes a colesterol alto.
Fuente: Ministerio de Sanidad, Consumo y Bienestar Social e Instituto Nacional de Estadística. Encuesta Nacional y Encuesta Europea de Salud en España.
2.2.2 Enfermedades y problemas de salud crónicos en población

infantil
La enfermedad crónica con mayor prevalencia en la infancia (0 a 14 años) con independencia del grupo
de edad, es la alergia, seguida del asma. La alergia afecta a 1 de cada 10 menores y el asma a 1 de cada
20.
Tabla 2-17 Problemas de salud crónicos o de larga duración en población infantil menor 15 años. Distribución porcentual según sexo.
España, 2017
Ambos sexos Niños Situación
Niñas de salud
Alergia crónica (asma alérgica excluida) 10,6 11,3 9,8 Anual
Informe
Asma 4,5 5,3 del 3,7
Sistema Nacional
Trastornos de la conducta (incluye hiperactividad) 1,8 2,8 de Salud
0,7 2018
Trastornos mentales (ansiedad, depresión…) 0,6 0,5 0,7
Autismo a trastornos del espectro autista (TEA)(>2 años) 0,6 1,0 0,2
Lesiones o defectos permanentes por un accidente 0,4 0,6 0,3
Diabetes 0,2 0,2 0,2
Epilepsia 0,2 0,2 0,2
Tumores malignos (incluye leucemia y linfoma) 0,1 0,1 0,1
Fuente: Ministerio de Sanidad, Consumo y Bienestar Social e Instituto Nacional de Estadística. Encuesta Nacional de Salud de España.
Situación de Salud
Informe Anual
del Sistema Nacional
de Salud 2018
INFORMES, ESTUDIOS E INVESTIGACIÓN 2020
MINISTERIO DE SANIDAD
14
INFORMES, ESTUDIOS E INVESTIGACIÓN 2020
MINISTERIO DE SANIDAD
7
INFORME ANUAL DEL SISTEMA NACIONAL DE SALUD, 2018 29
12/2/23
Gráfico 2-9 Principales problemas o enfermedades crónicas o de larga evolución en población infantil menor de 15 años. Distribución
porcentual según grupo de edad. España, 2017
Alergia crónica Asma Trastornos de la conducta
18
16,4
16
Porcentaje de poblacion infantil
14
12
10,6
9,8
10
8
6,3
6 5,0
4,5 4,5
4 2,9
2,6
1,8 1,9
2
0,3
0
0 - 14 >5 5-9 10 - 14
Observaciones: Los trastornos de la conducta incluyen hiperactividad.

2.2.3 Limitaciones para las actividades básicas de la vida diaria

El 80,4% de la población de 65 y más años, el 86,8% de los hombres y el 75,5% de las mujeres, no tiene
15 dificultad para realizar las actividades básicas de la vida diaria. La ausencia de dificultades disminuye con
la edad. En el grupo de 85 y más años no tienen dificultades el 48,1% de las personas, el 58,9% de los
hombres y 42,6% de las mujeres.
Tabla 2-18 Autonomía para las actividades básicas de la vida diaria en población de 65 y más años. Distribución porcentual según sexo y
grupo de edad. España, 2017
Total de 65 a 69 años de 70 a 74 años de 75 a 79 años de 80 a 84 años de 85 y más años
Ambos sexos 80,4 92,8 90,6 82,2 70,6 48,1
86,8 95,4 92,8 86,6 79,8 58,9
Causas de mortalidad países desarrollados:
Hombres
Mujeres 75,5 90,5 88,6 78,7 64,4 42,6
Observaciones: Como actividades básicas de la vida diaria se han considerado: alimentarse, sentarse, levantarse de una silla o de una cama, acostarse, vestirse
-Primer año de la vida:

y desvestirse, ir al servicio, ducharse o bañarse.
Neonatal: Prematuridad, bajo peso al nacer, traumatismos

- autónomas el porcentaje más alto de población de 65 y más años que declara ausencia
Por comunidades
de limitaciones para las actividades básicas de la vida diaria corresponde a Illes Balears (88,2%) y el más
neonatales y anoxia, malformaciones.
bajo a Extremadura (68,8%). Los hombres de la Comunidad Foral de Navarra (93,2%) y las mujeres de
Illes Balears (85,1%) son las personas de 65 y más años que declaran tener más autonomía para las
actividades de la vida diaria. Los porcentajes menores los encontramos en los hombres de la Región de
Postneonatal: enf. diarreicas y trastornos respiratorios.
- y en las mujeres de Extremadura (60,2%).
Murcia (78,7%)
-Entre 1 y 14 años:
30
- Accidentes. INFORMES, ESTUDIOS E INVESTIGACIÓN
- Neoplasias.
- Consecuencias de la patología congénita.
16
8
12/2/23
Prof. Dr. M. Sobrino Cruz – Tratado Pediatría (2014)
17
18
9
12/2/23
19
Causas de mortalidad países “menos adelantados”:

Elementos:
- No transición epidemiológica: infecciones.
- Patología neonatal.
- …en relación a factores determinantes…
- “Ventana de oportunidad o de los 1000 días”.
20
10
12/2/23
Levels & Trends in Report 2020

Child Estimates developed by the
Mortality UN Inter-agency Group for

Child Mortality Estimation
Prof. Dr. M. Sobrino United

Nations
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Levels & Trends in 2019

Report 2014
Child Estimates Developed
Estimates developed by
by the
the
Mortality
UN Inter-agency
UN Inter-agencyGroup
Groupfor
for
Child Mortality
Child MortalityEstimation
Estimation

United
Nations
28
14
12/2/23

Report 2014
by the
the
Mortality
UN Inter-agency
Groupfor
for
Child Mortality
Estimation

Nations
29

Report 2014
by the
the
Mortality
UN Inter-agency
Groupfor
for
Child Mortality
Estimation

United
Nations
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Published by UNICEF since 1980, The

State of the World’s Children report seeks to ACKNOWLEDGEMENTS
This report is the result of collaboration among many SPE
deepen knowledge and raise awareness of
key issues affecting children and advocates for individuals and institutions. The report team thanks all UNIC
solutions that improve children’s lives. who gave so willingly of their time, expertise and energy, Chin
in particular: Indo
REPORT TEAM Serb
Brian Keeley, Editor in Chief; Céline Little, Editor; SENIOR ADVISORY GROUP facili
Juliano Diniz de Oliveira, Research and Policy Victor M. Aguayo, Francesco Branca, Sandro Demaio,
Specialist; Eric Zuehlke, Editor; Gregory Sclama, Jessica Fanzo, Lawrence Haddad, Purnima Menon, Ellen Alex
Researcher; Kasper Vrolijk, Data Analyst; Piwoz, Victoria Quinn, Juan Rivera, Meera Shekar, Cesar Mari
Upasana Young, Programme Associate (Design); Victora, Keith West for strategic direction, technical Peru
Dawit Ghebremichael, Programme Associate; guidance, and policy advice. Halim
and David Anthony, Chief of Policy Analysis. Kual
INTERNAL ADVISORY GROUP Mari
NUTRITION DATA ANALYTICS AND
Maaike Arts, Yarlini Balarajan, France Begin, Silaja Birks, Mad
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Chika Hayashi, Richard Kumapley and Vrinda
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Salze, French Editor; Xinyi Ge and Yasmine DATA AND ANALYTICS Libe
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T H E STAT E O F T H E WO R L D ' S C H I L D R E N 2 019
Children, food
<data.unicef.org>.
and nutrition Selenge Lkhagva, Gbolayemi Lufadeju, Najwa Mekki,
Deve
Growing well in a changing world
Christine Mills, Christine Nesbitt, Edita Nsubuga, Priyanka

Suggested citation: UNICEF (2019). Pruthi, Leah Selim, Michael Sidwell, Tanya Turkovich, Judith
The State of the World’s Children 2019. Yemane and Dennis Yuen. Lisa
Children, Food and Nutrition: Growing well this
in a changing world. UNICEF, New York. THE UNITED KINGDOM COMMITTEE FOR UNICEF
Pauline Castres, Kirtbir Chahal, Ceri Gautama, Roxanne UNI
ISBN: 978-92-806-5003-7 Portnoi and Liam Sollis. the
© United Nations Children’s Fund (UNICEF)
October 2019. UNICEF NEW YORK HEADQUARTERS The
Prof. Dr. M. Sobrino Cover photo: A girl eats lunch in the Hanaq
Chuquibamba community in Peru.
Diana Cordero, Kathleen Edison, Andres Franco, Hongwei
Gao, Dennis Gayanelo, Bindu Kotimreddy, Ganesh
by t
Laur
Narahari, Brina Seidel and Arber Stublla.
© UNICEF/Vilca/2019
31 The Lancet Commissions
Adolescent health Child rights to survive, thrive, and participate with no exposure to discrimination and best
Adolescent interests at heart, and protected sexual and reproductive rights
Healthy development
Scale (low income) Adolescent

education Protective factors wellbeing Skilled birth Birth Immunisations School Safe learning Universal
20 BCR 12·6 (low income)
attendant registration Support for achievement
environments
ICT
access
to SRH
Responsive Social and literacy
care group development education
11·0 support
15 BCR Social and

environmental
Water and Adolescent child marriage
Intergenerational
determinants
(embedding)
sanitation (low income) effect from
parents
10 BCR 6·9 Child development

equity gap at
Adolescent transport adulthood
(low income) Health

6·6 Equity gap
(lower-middle
5 BCR
preconception
20
income) Maternal Neonatal risks: Malnutrition Child Commercial Child Adolescent
deprivation • Low birthweight and poor labour exploitation marriage birth
Basic sanitation (low-income and middle-income countries) 2·9 Vulnerability factors
Basic drinking water

3·3
(low-income and middle-income countries) Exposure to physical, sexual, and psychological violence
Birth Life course
Eliminate open defecation Health

Preconception Pregnancy Newborn Infancy Childhood Adolescence and adulthood
5·8
(low-income and middle-income countries) 1·5 9·0 (low income)
Figure 1: Sustainable Development Goals measuring protective and risk factors for child wellbeing across the life course
ICT=information communication technology. SRH=sexual and reproductive health.
Education Health
(upper-middle during pregnancy shape the future trajectory of abilities Fetal and early-life nutrition is also essential for long-
and health.27 Before pregnancy, women and adolescent term health, cognitive development, and economic out-
income) 3·8 girls should receive nutritional and counselling inter- comes.36,37 Poor fetal growth or stunting in the first 2 years
ventions to ensure they are healthy and equipped to make of life leads to irreversible damage, including reduced
Education decisions about whether and when to become mothers. adult height, lower attained schooling, and lower adult
(lower-middle 11·3 health interventions are critical to prevent, income. Children who are undernourished in the first
Maternal
7·2
income) Maternal
detect, and
and treat problems early during pregnancy and 2 years of life and who put on weight rapidly later in
6·1 Maternal
child
ensure health
women have access to high-quality care in case of childhood or in adolescence are at high risk of obesity and
Maternal and and child health complications. Food and iodine supplementation before later chronic diseases, such as diabetes, heart attack, and
(lower-middle
child health (low income) or during pregnancy and antenatal corticosteroids for stroke.37 Early-life nutritional interventions, such as the
income)
women at risk of preterm birth in HICs have beneficial promotion of breastfeeding and iodine supplementa-
10·0 (upper-middle effects on child development.28,29 Smoking cessation tion, consistently show benefit-cost ratios that exceed
Education Maternal and
Education income) during pregnancy, which can be supported by psychosocial one.38 Improving gender equality also has benefits for
programmes, also reduces low birthweight, and child healthchild nutrition, and is an independent predictor of child
preterm
(low income)
births —outcomes strongly related to improving early malnutrition and mortality in cross-country comparisons.39
30
childhood development. Research has also shown the Yet an estimated 250 million children younger than
developmental origins of adult diseases like diabetes, 5 years old in low and middle-income countries (LMICs)
heart attacks, and strokes.31,32 Prenatal exposure to envir- are at risk of not reaching their developmental potential.40
onmental contaminants is associated with epigenetic At the same time, we know what children need for healthy
Figure 2: Benefit-cost ratios: returns on every US dollar invested changes, such as DNA-methylation, linked to the develop- development: nurturing and responsive care to promote
ment of diseases later in life.33 For example, studies their health, nutrition, security, safety, and opportun-
BCR=benefit-cost ratio. LMIC=low and middle-income countries. MCH=maternal and child health. A benefit-cost ratio of one (grey circle) indicates costs and benefits
in Sweden on the radioactive fallout following the acci- ities TheforLancet Commissions
early learning.41
Children with disabilities or an
are the same. A ratio of more than one indicates that the benefits are more than the costs. Each concentric ring equals
denta BCR
at theofChernobyl
10. The majority of countries
nuclear power excluded
plant, Pripyat, impairment of functioning require screening and early
are high-income countries with some exceptions. The figure shows high returns to investment in children’s health and wellbeing
Ukraine, show thatacross
in-uteroaexposure
varietyaffected
of domains. BCRinterventions
educational is so that they too can reach their full potential.
attainment and income many years later. Economists’ Follow-up studies of children exposed to poverty, from a
34
calculated by dividing the monetary benefit of an intervention by the monetary cost of implmenting it. work on fetal exposures has also suggested long-term wide range of countries, show the beneficial effects of
Aeconomic
future for
earnings.35
effects, including reduced test scores and early childhood interventions for adult earnings, cogni-
the world’s children? A WHO–UNICEF–Lancet tive and educational achievement, health biomarkers,
Commission
shows that investing in strategies to reduce child marriage might also be exposedwww.thelancet.com
to alcohol use and abuse, second-
Vol 395 February 22, 2020
Helen Clark*, Awa Marie Coll-Seck*, Anshu Banerjee, Stefan Peterson, Sarah L Dalglish, Shanthi Ameratunga, Dina Balabanova, 611
Prof.road
and Dr. M.accidents
Sobrino will also generate benefits that far hand tobacco smoke, and unhealthy diets, with links to
Maharaj Kishan Bhan†, Zulfiqar A Bhutta, John Borrazzo, Mariam Claeson, Tanya Doherty, Fadi El-Jardali, Asha S George, Angela Gichaga,
Lu Gram, David B Hipgrave, Aku Kwamie, Qingyue Meng, Raúl Mercer, Sunita Narain, Jesca Nsungwa-Sabiiti, Adesola O Olumide, David Osrin,
exceed costs (figure 2). Although no analogous benefit-cost food policy and regulatory schemes upon which families
Timothy Powell-Jackson, Kumanan Rasanathan, Imran Rasul, Papaarangi Reid, Jennifer Requejo, Sarah S Rohde, Nigel Rollins, Magali Romedenne,
Harshpal Singh Sachdev, Rana Saleh, Yusra R Shawar, Jeremy Shiffman, Jonathon Simon, Peter D Sly, Karin Stenberg, Mark Tomlinson,
Rajani R Ved, Anthony Costello
ratio calculations exist outside the health and education have little direct influence.
Executive summary costs are not prohibitive: an analysis of the SDGs suggests Lancet 2020; 395: 605–58
32 Good housing is essential. The rush to urbanisation

a financing gap of US$195 per person. To ensure stronger
sectors, interventions in all sectors are widely understood
Despite dramatic improvements in survival, nutrition, and Published Online
education over recent decades, today’s children face an economic and human development, each government February 18, 2020
https://doi.org/10.1016/
uncertain future. Climate change, ecological degradation, must assess how to mobilise funding using instruments
to be investments in current and future societal outcomes, has created a planet of slums. Informal settlements,
S0140-6736(19)32540-1
migrating populations, conflict, pervasive inequalities, that help the poorest proportion of the population to meet
and predatory commercial practices threaten the health this gap for children, and frame these as the most
See Comment page 541
and future of children in every country. In 2015, the powerful investments a society can make. But investments
rather than just spending. in which approximately 40% of the world’s children
world’s countries agreed on the Sustainable Development
Goals (SDGs), yet nearly 5 years later, few countries have
are not just monetary: citizen participation and com-
munity action, including the voices of children them-
*Commission co-chairs
†Dr Bhan died in January, 2020
currently live, intensify many of the previously men-

recorded much progress towards achieving them. This
Commission presents the case for placing children, aged
selves, are powerful forces for change that must be
mobilised to reach the SDGs. Social movements must
The Helen Clark Foundation,
Auckland, New Zealand
(H Clark MA); Partnership for
All sectors are responsible for children’s wellbeing

0–18 years, at the centre of the SDGs: at the heart of the play a transformational role in demanding the rights
tioned threats through a combination of substandard
Maternal Newborn & Child
concept of sustainability and our shared human endeavour. that communities need to care for children and provide Health, Geneva, Switzerland
Governments must harness coalitions across sectors to for families. (H Clark); Senegal Presidency,
Sectors beyond health and education can, and must, work housing or illegal and inadequate buildingGovernment structures.
Dakar, Senegal
overcome ecological and commercial pressures to ensure (A M Coll-Seck MD); Department
has a duty of care and protection across all
children receive their rights and entitlements now and a of Maternal Newborn Child
liveable planet in the years to come. sectors and Adolescent Health
to improve the health and educational attainment of Residents face overcrowding and high density, unhealthy
Invest in children’s health for lifelong, intergenerational,
Countries that support future generations put a high
priority on ensuring all children’s needs are met, by
(A Banerjee MD, N Rollins MD,
J Simon DSc), Department of
Health Systems Governance and
children, to capture valued societal and economic benefits. living conditions and hazardous location, poor access
and economic benefits delivering entitlements, such as paid parental leave, free
16
Financing, WHO, Geneva,
The evidence is clear: early investments in children’s primary health care at the point of delivery, access to Switzerland (K Stenberg MSc);
Health Division (S Peterson MD,
health, education, and development have benefits that healthy—and sufficient amounts of—food, state-funded
The socioecologic environment in which children live can to basic services, poverty and social exclusion, and
compound throughout the child’s lifetime, for their future
children, and society as a whole. Successful societies
or subsidised education, and other social protection
measures. These countries make sure children grow up in
D B Hipgrave PhD, J Requejo PhD),
HIV, Data, and Analytics Division
UNICEF, New York, NY, USA
be seen as a series of concentric circles.69 At the centre is insecurity of tenure.70 Although we have too few locally
invest in their children and protect their rights, as is
evident from countries that have done well on health and
safe and healthy environments, with clean water and air
and safe spaces to play. They respect the equal rights
(J Requejo); Department of
International Health, Johns
Hopkins School of Public Health,
economic measures over the past few decades. Yet many of girls, boys, and those with non-conforming gender
the home, surrounded by its immediate environs, locality, disaggregated data,71 we require no more evidence that
Baltimore, MD, USA
politicians still do not prioritise investing in children, nor identities. Policy makers in these countries are concerned (S L Dalglish PhD, Y R Shawar PhD,
see it as the foundation for broader societal improvements. with the effect of all policies on all children, but especially Prof J Shiffman PhD); School of
and wider urban or rural area. Each of these circles these exposures and constraints have harmful effects
Population Health, University of
Even in rich countries, many children go hungry or live in those in poorer families and marginalised populations,
Auckland, Auckland,
conditions of absolute poverty, especially those belong- starting by ensuring birth registration so that the govern- New Zealand
ing to marginalised social groups—including indigenous ment can provide for children across the life course, and (Prof S Ameratunga MBChB,
balances opportunity with exposure and constraint. In on child health. Furthermore, the common division
populations and ethnic minorities. Too often, the potential
of children with developmental disabilities is neglected,
help them to become engaged and productive adult
citizens. The rights and entitlements of children are
P Reid MBChB); Department of
Global Health and
Development, London School of
the home, potentially harmful exposures include indoor of household labour means that the greatest burden
restricting their contributions to society. Additionally,
many millions of children grow up scarred by war or
enshrined within the UN Convention on the Rights of the
Child (CRC) ratified by all countries, except the USA.
Hygiene and Tropical Medicine,
London, UK (D Balabanova PhD,
T Powell-Jackson PhD); Health
insecurity, excluded from receiving the most basic health, Countries might provide these entitlements in different
air pollution, tainted water and inadequate sanitation, of indoor air pollution from burning of biomass fuels is
educational, and developmental services.
Decision makers need a long-term vision. Just as good
ways, but their realisation is the only pathway for countries
to achieve the SDGs for children’s health and wellbeing,
Systems Transformation
Platform, Tata Trusts, Mumbai,
India (M K Bhan MD); Centre for
health and nutrition in the prenatal period and early years and requires decisive and strong public action. Global Child Health, Hospital
12/2/23
33
Construir la salud
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Tema 1. Concepto de Pediatría. Demografía Infantil.: Prof. Dr. Manuel Sobrino Toro

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Tema 1. Concepto de Pediatría. Demografía Infantil.: Prof. Dr. Manuel Sobrino Toro

Cargado por

Copyright:

Formatos disponibles

12/2/23

Tema 1. Concepto de Pediatría.

Pediatría. Grado de Medicina. Universidad de Sevilla.

Prof. Dr. Manuel Sobrino Toro.

“Pediatría y sus Áreas Específicas”: especialidad médica en España.

Prof. Cruz Hdez (2020)

② Pediatría Preventiva o Puericultura: niño sano con especiales

③ Pediatría Social: niño sano o enfermo sometido a la influencia física

Prof. Cruz Hdez (2020)

- Abarca cuatro áreas de atención:

- Convención de los Derechos del Niño (1989).

Prof. Dr. M. Sobrino

Periodos de la edad pediátrica

NIÑO PEQUEÑO, DE CORTA EDAD O PÁRVULO:

Características propias de la Pediatría (1):

-Evolución morfológica. No adulto en miniatura.

-Inmadurez orgánica. SNC / Hígado/Pulmón/Riñón/ órganos sensoriales o intestino

-Solidaridad funcional. Inmunidad, Inmadurez neurovegetativa, estado de SN y

Prof. Cruz Hdez (2013)

Características propias de la Pediatría (2):

-Marcada influencia de la genómica y del periodo fetal.

-Repercusión sobre la demografía.

-Interdependencia con la patología del adulto.

-Influencia del entorno.

-Importancia de la salud y la profilaxis.

Determinantes de la Salud Infantil

Modificado de Blair and cols. “Child Public Health” (2010))

The Lancet Commissions

interests at heart, and protected sexual and reproductive rights

newborn and child health.”

community level to clinical services.”

high impact program delivery, supported by enabling

and strengthened comprehensive health system, from

required to link households to hospitals by improving

“The time has come for these health interventions for

“The household to hospital continuum of care approach

provides pragmatic steps to ensure the availability of and

health facilities and district hospitals, while strengthening

newborn babies to be integrated into maternal and child

“This encompasses a continuum of essential interventions

homebased practices, mobilising families to seek the care

start in life is an essential step towards a sound childhood

as continuum that follows through the lifecycle of maternal,

“The continuum of care that follows the life-cycle is part of a

that should be accessible to mothers, newborns and children

at household, community, district and national levels, as well

access to quality maternal and newborn services at peripheral

both the woman and the newborn child—and that a healthy

Prof. Dr. M. Sobrino

5OP RJ I )'( ; ORE J RSJ <R SS ORPORB E 3 RJ I S R S R E

Figure 1: Continuum of care

can die within hours

Family and community care

Developed world Developing world

Important social Inappropriate nutrition—e.g. overconsumption Malnutrition

determinants of health of saturated fats and sugar Absolute poverty

5R B E ROM US S O )')' '- ), ('.)'. )

access to care for those who need it most.

Lack of exercise Lack of sanitation

Family structure and relationships Famine, drought, and flooding

BJR : 6ES )'(

www.thelancet.com Vol 370 October 13, 2007

The place dimension of the continuum can be defined