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95-642: Pediatrics ( American English ) also spelled paediatrics ( British English ), is the branch of medicine that involves the medical care of infants , children , adolescents , and young adults. In the United Kingdom , pediatrics covers many of their youth until the age of 18. The American Academy of Pediatrics recommends people seek pediatric care through the age of 21, but some pediatric subspecialists continue to care for adults up to 25. Worldwide age limits of pediatrics have been trending upward year after year. A medical doctor who specializes in this area

190-707: A cot–caught merger , which is rapidly spreading throughout the whole country. However, the South, Inland North, and a Northeastern coastal corridor passing through Rhode Island, New York City, Philadelphia, and Baltimore typically preserve an older cot–caught distinction. For that Northeastern corridor, the realization of the THOUGHT vowel is particularly marked , as depicted in humorous spellings, like in tawk and cawfee ( talk and coffee ), which intend to represent it being tense and diphthongal : [oə] . A split of TRAP into two separate phonemes , using different

285-665: A NICU ). The earliest mentions of child-specific medical problems appear in the Hippocratic Corpus , published in the fifth century B.C., and the famous Sacred Disease . These publications discussed topics such as childhood epilepsy and premature births. From the first to fourth centuries A.D., Greek philosophers and physicians Celsus , Soranus of Ephesus , Aretaeus , Galen , and Oribasius , also discussed specific illnesses affecting children in their works, such as rashes, epilepsy, and meningitis. Already Hippocrates , Aristotle , Celsus , Soranus , and Galen understood

380-520: A pronunciations for example in gap [æ] versus gas [eə] , further defines New York City as well as Philadelphia–Baltimore accents. Most Americans preserve all historical /r/ sounds, using what is known as a rhotic accent . The only traditional r -dropping (or non-rhoticity) in regional U.S. accents variably appears today in eastern New England , New York City , and some of the former plantation South primarily among older speakers (and, relatedly, some African-American Vernacular English across

475-480: A Child as an ethical principle for pediatric decision-making, and it is still being used today. The majority of the time, parents have the authority to decide what happens to their child. Philosopher John Locke argued that it is the responsibility of parents to raise their children and that God gave them this authority. In modern society, Jeffrey Blustein, modern philosopher and author of the book Parents and Children: The Ethics of Family , argues that parental authority

570-405: A child and predict to what extent it will affect the child in the future. Genetic and intellectual disorders in children make them incapable of making moral decisions, so people look down upon this kind of testing because the child's future autonomy is at risk. It is still in question whether parents should request these types of testing for their children. Medical experts argue that it could endanger

665-629: A college or university, which will get them a BS, BA or other bachelor's degree. After completing college, future pediatricians will need to attend 4 years of medical school (MD/DO/MBBS) and later do 3 more years of residency training, the first year of which is called "internship." After completing the 3 years of residency, physicians are eligible to become certified in pediatrics by passing a rigorous test that deals with medical conditions related to young children. In high school, future pediatricians are required to take basic science classes such as biology, chemistry, physics, algebra, geometry, and calculus. It

760-631: A complex phenomenon of "both convergence and divergence": some accents are homogenizing and leveling , while others are diversifying and deviating further away from one another. Having been settled longer than the American West Coast, the East Coast has had more time to develop unique accents, and it currently comprises three or four linguistically significant regions, each of which possesses English varieties both different from each other as well as quite internally diverse: New England ,

855-447: A consonant, such as in pearl , car and fort . Non-rhotic American accents, those that do not pronounce ⟨r⟩ except before a vowel, such as some accents of Eastern New England , New York City , and African-Americans , and a specific few (often older ones) spoken by Southerners , are often quickly noticed by General American listeners and perceived as sounding especially ethnic, regional, or antiquated. Rhoticity

950-514: A lack of knowledge in pediatric medicine. Sushruta Samhita , an ayurvedic text composed during the sixth century BCE, contains the text about pediatrics. Another ayurvedic text from this period is Kashyapa Samhita . A second century AD manuscript by the Greek physician and gynecologist Soranus of Ephesus dealt with neonatal pediatrics. Byzantine physicians Oribasius , Aëtius of Amida , Alexander Trallianus , and Paulus Aegineta contributed to

1045-541: A larger volume of distribution than adults, which directly affects the dosing of hydrophilic drugs such as beta-lactam antibiotics like ampicillin. Thus, these drugs are administered at greater weight-based doses or with adjusted dosing intervals in children to account for this key difference in body composition. Infants and neonates also have fewer plasma proteins. Thus, highly protein-bound drugs have fewer opportunities for protein binding, leading to increased distribution. Drug metabolism primarily occurs via enzymes in

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1140-591: A merger with the THOUGHT ( caught ) set. Having taken place prior to the unrounding of the cot vowel, it results in lengthening and perhaps raising, merging the more recently separated vowel into the THOUGHT vowel in the following environments: before many instances of /f/ , /θ/ , and particularly /s/ (as in Austria, cloth, cost, loss, off, often, etc.), a few instances before /ŋ/ (as in strong, long, wrong ), and variably by region or speaker in gone , on , and certain other words. Unlike American accents,

1235-636: A nice day , for sure); many are now distinctly old-fashioned (swell, groovy). Some English words now in general use, such as hijacking, disc jockey , boost, bulldoze and jazz , originated as American slang. American English has always shown a marked tendency to use words in different parts of speech and nouns are often used as verbs . Examples of nouns that are now also verbs are interview, advocate, vacuum, lobby, pressure, rear-end, transition, feature, profile, hashtag, head, divorce, loan, estimate, X-ray, spearhead, skyrocket, showcase, bad-mouth, vacation , major, and many others. Compounds coined in

1330-480: A process of extensive dialect mixture and leveling in which English varieties across the colonies became more homogeneous compared with the varieties in Britain. English thus predominated in the colonies even by the end of the 17th century's first immigration of non-English speakers from Western Europe and Africa. Additionally, firsthand descriptions of a fairly uniform American English (particularly in contrast to

1425-655: A result, mothers, midwives, "wise women", and general practitioners treated the children instead of doctors. Since mothers could not rely on professional medicine to take care of their children, they developed their own methods, such as using alkaline soda ash to remove the vernix at birth and treating teething pain with opium or wine. The absence of proper pediatric care, rights, and laws in health care to prioritize children's health led to many of their deaths. Ancient Greeks and Romans sometimes even killed healthy female babies and infants with deformities since they had no adequate medical treatment and no laws prohibiting infanticide. In

1520-680: A series of other vowel shifts in the same region, known by linguists as the " Inland North ". The Inland North shares with the Eastern New England dialect (including Boston accents ) a backer tongue positioning of the GOOSE /u/ vowel (to [u] ) and the MOUTH /aʊ/ vowel (to [ɑʊ~äʊ] ) in comparison to the rest of the country. Ranging from northern New England across the Great Lakes to Minnesota, another Northern regional marker

1615-525: A survey, completed in 2003, polling English speakers across the United States about their specific everyday word choices, hoping to identify regionalisms. The study found that most Americans prefer the term sub for a long sandwich, soda (but pop in the Great Lakes region and generic coke in the South) for a sweet and bubbly soft drink , you or you guys for the plural of you (but y'all in

1710-453: A variation of American English in these islands. In 2021, about 245 million Americans, aged 5 or above, spoke English at home: a majority of the United States total population of roughly 330 million people. The United States has never had an official language at the federal level, but English is commonly used at the federal level and in states without an official language. 32 of the 50 states, in some cases as part of what has been called

1805-672: Is also advisable to learn a foreign language (preferably Spanish in the United States) and be involved in high school organizations and extracurricular activities. After high school, college students simply need to fulfill the basic science course requirements that most medical schools recommend and will need to prepare to take the MCAT (Medical College Admission Test) in their junior or early senior year in college. Once attending medical school, student courses will focus on basic medical sciences like human anatomy, physiology, chemistry, etc., for

1900-654: Is also associated with the United States, perhaps mostly in the Midwest and the South. American accents that have not undergone the cot–caught merger (the lexical sets LOT and THOUGHT ) have instead retained a LOT – CLOTH split : a 17th-century distinction in which certain words (labeled as the CLOTH lexical set ) separated away from the LOT set. The split, which has now reversed in most British English, simultaneously shifts this relatively recent CLOTH set into

1995-664: Is also home to a creole language known commonly as Hawaiian Pidgin , and some Hawaii residents speak English with a Pidgin-influenced accent. American English also gave rise to some dialects outside the country, for example, Philippine English , beginning during the American occupation of the Philippines and subsequently the Insular Government of the Philippine Islands ; Thomasites first established

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2090-538: Is common in most American accents despite being now rare in England because, during the 17th-century British colonization, nearly all dialects of English were rhotic, and most North American English simply remained that way. The preservation of rhoticity in North America was also supported by continuing waves of rhotic-accented Scotch-Irish immigrants, most intensely during the 18th century (and moderately during

2185-401: Is considered to be the founder of modern pediatrics as a medical specialty, while his work The diseases of children, and their remedies (1764) is considered to be "the first modern textbook on the subject". However, it was not until the nineteenth century that medical professionals acknowledged pediatrics as a separate field of medicine. The first pediatric-specific publications appeared between

2280-418: Is essential to degrading certain oral drugs before systemic absorption. Therefore, the absorption of these drugs in children is greater than in adults due to decreased breakdown and increased preservation in a less acidic gastric space. Children also have an extended rate of gastric emptying, which slows the rate of drug absorption. Drug absorption also depends on specific enzymes that come in contact with

2375-402: Is granted because the child requires parents to satisfy their needs. He believes that parental autonomy is more about parents providing good care for their children and treating them with respect than parents having rights. The researcher Kyriakos Martakis, MD, MSc, explains that research shows parental influence negatively affects children's ability to form autonomy. However, involving children in

2470-442: Is known as a pediatrician , or paediatrician . The word pediatrics and its cognates mean "healer of children", derived from the two Greek words: παῖς ( pais "child") and ἰατρός ( iatros "doctor, healer"). Pediatricians work in clinics, research centers, universities, general hospitals and children's hospitals , including those who practice pediatric subspecialties (e.g. neonatology requires resources available in

2565-451: Is needed to better understand how these factors should affect the decisions of healthcare providers when prescribing and administering medications to the pediatric population. Many drug absorption differences between pediatric and adult populations revolve around the stomach. Neonates and young infants have increased stomach pH due to decreased acid secretion, thereby creating a more basic environment for drugs that are taken by mouth. Acid

2660-420: Is often identified by Americans as a "country" accent, and is defined by the /aɪ/ vowel losing its gliding quality : [aː] , the initiation event for a complicated Southern vowel shift, including a " Southern drawl " that makes short front vowels into distinct-sounding gliding vowels . The fronting of the vowels of GOOSE , GOAT , MOUTH , and STRUT tends to also define Southern accents as well as

2755-458: Is often largely under the control of ' pediatric organizations (see below) rather than universities and depends on the jurisdiction. Subspecialties of pediatrics include: ( not an exhaustive list ) ( not an exhaustive list ) American English American English , sometimes called United States English or U.S. English , is the set of varieties of the English language native to

2850-505: Is that children are not simply "little adults". The clinician must take into account the immature physiology of the infant or child when considering symptoms, prescribing medications, and diagnosing illnesses. Pediatric physiology directly impacts the pharmacokinetic properties of drugs that enter the body. The absorption , distribution , metabolism , and elimination of medications differ between developing children and grown adults. Despite completed studies and reviews, continual research

2945-693: Is the Hôpital des Enfants Malades ( French : Hospital for Sick Children ), which opened in Paris in June 1802 on the site of a previous orphanage. From its beginning, this famous hospital accepted patients up to the age of fifteen years, and it continues to this day as the pediatric division of the Necker-Enfants Malades Hospital , created in 1920 by merging with the nearby Necker Hospital , founded in 1778. In other European countries,

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3040-556: Is the common language at home, in public, and in government. Cornelius Roelans He was born in Mechlen in 1450. At the age of 16 he entered the University of Leuven , and while there, he must have made good use of his time in studying the books and manuscripts of the early writers. Later, he returned to Mechlin, where he practiced until he died, in 1525. In 1494, he married Caecilie von Duffel, they had two children. He wrote

3135-421: Is the concept of paternalism, which negates autonomy when it is in the patient's interests. This concept aims to keep the child's best interests in mind regarding autonomy. Pediatricians can interact with patients and help them make decisions that will benefit them, thus enhancing their autonomy. However, radical theories that question a child's moral worth continue to be debated today. Authors often question whether

3230-469: Is the variable fronting of /ɑ/ before /r/ , for example, appearing four times in the stereotypical Boston shibboleth Park the car in Harvard Yard . Several other phenomena serve to distinguish regional U.S. accents. Boston , Pittsburgh , Upper Midwestern , and Western U.S. accents have fully completed a merger of the LOT vowel with the THOUGHT vowel ( /ɑ/ and /ɔ/ , respectively):

3325-570: Is why it is important to consider lower doses and greater dosing intervals for this population. Diseases that negatively affect kidney function can also have the same effect and thus warrant similar considerations. A major difference between the practice of pediatric and adult medicine is that children, in most jurisdictions and with certain exceptions, cannot make decisions for themselves. The issues of guardianship , privacy, legal responsibility, and informed consent must always be considered in every pediatric procedure. Pediatricians often have to treat

3420-707: The Charité (a hospital founded in 1710) in Berlin established a separate Pediatric Pavilion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (now Wrocław ), both in 1837. In 1852 Britain's first pediatric hospital, the Hospital for Sick Children, Great Ormond Street was founded by Charles West . The first Children's hospital in Scotland opened in 1860 in Edinburgh . In

3515-482: The English-only movement , have adopted legislation granting official or co-official status to English. Typically only "English" is specified, not a particular variety like American English. (From 1923 to 1969, the state of Illinois recognized its official language as "American", meaning American English.) Puerto Rico is the largest example of a United States territory in which another language – Spanish –

3610-622: The Mid-Atlantic states (including a New York accent as well as a unique Philadelphia–Baltimore accent ), and the South . As of the 20th century, the middle and eastern Great Lakes area , Chicago being the largest city with these speakers, also ushered in certain unique features, including the fronting of the LOT /ɑ/ vowel in the mouth toward [a] and tensing of the TRAP /æ/ vowel wholesale to [eə] . These sound changes have triggered

3705-551: The Native American languages . Examples of such names are opossum , raccoon , squash , moose (from Algonquian ), wigwam , and moccasin . American English speakers have integrated traditionally non-English terms and expressions into the mainstream cultural lexicon; for instance, en masse , from French ; cookie , from Dutch ; kindergarten from German , and rodeo from Spanish . Landscape features are often loanwords from French or Spanish, and

3800-517: The Pediatric Incunabula , four great medical treatises on children's physiology and pathology. While more information about childhood diseases became available, there was little evidence that children received the same kind of medical care that adults did. It was during the seventeenth and eighteenth centuries that medical experts started offering specialized care for children. The Swedish physician Nils Rosén von Rosenstein (1706–1773)

3895-722: The francophile tastes of the 19th century Victorian era Britain (for example they preferred programme for program , manoeuvre for maneuver , cheque for check , etc.). AmE almost always uses -ize in words like realize . BrE prefers -ise , but also uses -ize on occasion (see: Oxford spelling ). There are a few differences in punctuation rules. British English is more tolerant of run-on sentences , called " comma splices " in American English, and American English prefers that periods and commas be placed inside closing quotation marks even in cases in which British rules would place them outside. American English also favors

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3990-596: The 1790s and the 1920s. The term pediatrics was first introduced in English in 1859 by Abraham Jacobi . In 1860, he became "the first dedicated professor of pediatrics in the world." Jacobi is known as the father of American pediatrics because of his many contributions to the field. He received his medical training in Germany and later practiced in New York City . The first generally accepted pediatric hospital

4085-709: The 18th century; apartment , shanty in the 19th century; project, condominium , townhouse , mobile home in the 20th century; and parts thereof ( driveway , breezeway, backyard ) . Industry and material innovations from the 19th century onwards provide distinctive new words, phrases, and idioms through railroading (see further at rail terminology ) and transportation terminology, ranging from types of roads ( dirt roads , freeways ) to infrastructure ( parking lot , overpass , rest area ), to automotive terminology often now standard in English internationally. Already existing English words—such as store , shop , lumber —underwent shifts in meaning; others remained in

4180-546: The 20th century. The use of English in the United States is a result of British colonization of the Americas . The first wave of English-speaking settlers arrived in North America during the early 17th century, followed by further migrations in the 18th and 19th centuries. During the 17th and 18th centuries, dialects from many different regions of England and the British Isles existed in every American colony, allowing

4275-627: The British form is a back-formation , such as AmE burglarize and BrE burgle (from burglar ). However, while individuals usually use one or the other, both forms will be widely understood and mostly used alongside each other within the two systems. While written American English is largely standardized across the country and spoken American English dialects are highly mutually intelligible, there are still several recognizable regional and ethnic accents and lexical distinctions. The regional sounds of present-day American English are reportedly engaged in

4370-413: The East Coast (perhaps in imitation of 19th-century London speech), even the East Coast has gradually begun to restore rhoticity, due to it becoming nationally prestigious in the 20th century. The pronunciation of ⟨r⟩ is a postalveolar approximant [ ɹ̠ ] or retroflex approximant [ ɻ ] , but a unique "bunched tongue" variant of the approximant r sound

4465-571: The Inland North. Rather than one particular accent, General American is best defined as an umbrella covering an American accent that does not incorporate features associated with some particular region, ethnicity, or socioeconomic group. Typical General American features include rhoticity , the father–bother merger , Mary–marry–merry merger , pre-nasal "short a " tensing , and other particular vowel sounds . General American features are embraced most by Americans who are highly educated or in

4560-573: The South), sneakers for athletic shoes (but often tennis shoes outside the Northeast), and shopping cart for a cart used for carrying supermarket goods. American English and British English (BrE) often differ at the levels of phonology, phonetics, vocabulary, and, to a much lesser extent, grammar and orthography. The first large American dictionary, An American Dictionary of the English Language , known as Webster's Dictionary ,

4655-528: The U.S. Several verbs ending in -ize are of U.S. origin; for example, fetishize, prioritize, burglarize, accessorize, weatherize , etc.; and so are some back-formations (locate, fine-tune, curate, donate, emote, upholster and enthuse). Among syntactic constructions that arose are outside of, headed for, meet up with, back of, etc. Americanisms formed by alteration of some existing words include notably pesky, phony, rambunctious, buddy, sundae , skeeter, sashay and kitty-corner. Adjectives that arose in

4750-570: The U.S. are for instance foothill , landslide (in all senses), backdrop , teenager , brainstorm , bandwagon , hitchhike , smalltime, and a huge number of others. Other compound words have been founded based on industrialization and the wave of the automobile: five-passenger car, four-door sedan, two-door sedan, and station-wagon (called an estate car in British English). Some are euphemistic ( human resources , affirmative action , correctional facility ). Many compound nouns have

4845-676: The U.S. are, for example, lengthy, bossy, cute and cutesy, punk (in all senses), sticky (of the weather), through (as in "finished"), and many colloquial forms such as peppy or wacky . A number of words and meanings that originated in Middle English or Early Modern English and that have been in everyday use in the United States have since disappeared in most varieties of British English; some of these have cognates in Lowland Scots . Terms such as fall ("autumn"), faucet ("tap"), diaper ("nappy"; itself unused in

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4940-530: The U.S. while changing in Britain. Science, urbanization, and democracy have been important factors in bringing about changes in the written and spoken language of the United States. From the world of business and finance came new terms ( merger , downsize , bottom line ), from sports and gambling terminology came, specific jargon aside, common everyday American idioms, including many idioms related to baseball . The names of some American inventions remained largely confined to North America ( elevator [except in

5035-427: The U.S.), candy ("sweets"), skillet , eyeglasses , and obligate are often regarded as Americanisms. Fall for example came to denote the season in 16th century England, a contraction of Middle English expressions like "fall of the leaf" and "fall of the year." Gotten ( past participle of get ) is often considered to be largely an Americanism. Other words and meanings were brought back to Britain from

5130-597: The U.S., especially in the second half of the 20th century; these include hire ("to employ"), I guess (famously criticized by H. W. Fowler ), baggage , hit (a place), and the adverbs overly and presently ("currently"). Some of these, for example, monkey wrench and wastebasket , originated in 19th century Britain. The adjectives mad meaning "angry", smart meaning "intelligent", and sick meaning "ill" are also more frequent in American (and Irish) English than British English. Linguist Bert Vaux created

5225-692: The US), usually lasting four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Medical graduates hold a degree specific to the country and university in and from which they graduated. This degree qualifies that medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for " internship " or "conditional registration". Pediatricians must undertake further training in their chosen field. This may take from four to eleven or more years depending on jurisdiction and

5320-769: The US, the first similar institutions were the Children's Hospital of Philadelphia , which opened in 1855, and then Boston Children's Hospital (1869). Subspecialties in pediatrics were created at the Harriet Lane Home at Johns Hopkins by Edwards A. Park . The body size differences are paralleled by maturation changes. The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Congenital defects, genetic variance, and developmental issues are of greater concern to pediatricians than they often are to adult physicians. A common adage

5415-538: The United States and the United Kingdom suggest that, while spoken American English deviated away from period British English in many ways, it is conservative in a few other ways, preserving certain features 21st-century British English has since lost. Full rhoticity (or "R-fulness") is typical of American accents, pronouncing the phoneme /r/ (corresponding to the letter ⟨r⟩ ) in all environments, including in syllable-final position or before

5510-524: The United States. English is the most widely spoken language in the United States ; the de facto common language used in government, education, and commerce; and an official language in 32 of the 50 U.S. states . Since the late 20th century, American English has become the most influential form of English worldwide. Varieties of American English include many patterns of pronunciation, vocabulary, grammar and particularly spelling that are unified nationwide but distinct from other English dialects around

5605-605: The West and Midwest, and New York Latino English , spoken in the New York metropolitan area . Additionally, ethnic varieties such as Yeshiva English and " Yinglish " are spoken by some American Orthodox Jews , Cajun Vernacular English by some Cajuns in southern Louisiana , and Pennsylvania Dutch English by some Pennsylvania Dutch people. American Indian Englishes have been documented among diverse Indian tribes. The island state of Hawaii , though primarily English-speaking,

5700-555: The accents spoken in the " Midland ": a vast band of the country that constitutes an intermediate dialect region between the traditional North and South. Western U.S. accents mostly fall under the General American spectrum. Below, ten major American English accents are defined by their particular combinations of certain vowel sounds: In 2010, William Labov noted that Great Lakes, Philadelphia, Pittsburgh, and West Coast accents have undergone "vigorous new sound changes" since

5795-505: The aeronautical sense ], gasoline ) as did certain automotive terms ( truck , trunk ). New foreign loanwords came with 19th and early 20th century European immigration to the U.S.; notably, from Yiddish ( chutzpah , schmooze, bupkis, glitch ) and German ( hamburger , wiener ). A large number of English colloquialisms from various periods are American in origin; some have lost their American flavor (from OK and cool to nerd and 24/7 ), while others have not ( have

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5890-407: The age of 13. Recently, studies made on the decision-making of children have challenged that age to be 12. Technology has made several modern advancements that contribute to the future development of child autonomy, for example, unsolicited findings (U.F.s) of pediatric exome sequencing. They are findings based on pediatric exome sequencing that explain in greater detail the intellectual disability of

5985-442: The autonomous rights the child will possess in the future. However, the parents contend that genetic testing would benefit the welfare of their children since it would allow them to make better health care decisions. Exome sequencing for children and the decision to grant parents the right to request them is a medically ethical issue that many still debate today. Aspiring medical students will need 4 years of undergraduate courses at

6080-406: The country), though the vowel-consonant cluster found in "bird", "work", "hurt", "learn", etc. usually retains its r pronunciation, even in these non-rhotic American accents. Non-rhoticity among such speakers is presumed to have arisen from their upper classes' close historical contact with England, imitating London's r -dropping, a feature that has continued to gain prestige throughout England from

6175-572: The decision-making process allows children to develop their cognitive skills and create their own opinions and, thus, decisions about their health. Parental authority affects the degree of autonomy the child patient has. As a result, in Argentina, the new National Civil and Commercial Code has enacted various changes to the healthcare system to encourage children and adolescents to develop autonomy. It has become more crucial to let children take accountability for their own health decisions. In most cases,

6270-592: The degree of specialization. In the United States, a medical school graduate wishing to specialize in pediatrics must undergo a three-year residency composed of outpatient, inpatient, and critical care rotations. Subspecialties within pediatrics require further training in the form of 3-year fellowships. Subspecialties include critical care, gastroenterology, neurology, infectious disease, hematology/oncology, rheumatology, pulmonology, child abuse, emergency medicine, endocrinology, neonatology, and others. In most jurisdictions, entry-level degrees are common to all branches of

6365-505: The differences in growing and maturing organisms that necessitated different treatment: Ex toto non sic pueri ut viri curari debent ("In general, boys should not be treated in the same way as men"). Some of the oldest traces of pediatrics can be discovered in Ancient India where children's doctors were called kumara bhrtya . Even though some pediatric works existed during this time, they were scarce and rarely published due to

6460-614: The diverse regional dialects of British English) became common after the mid-18th century, while at the same time speakers' identification with this new variety increased. Since the 18th century, American English has developed into some new varieties, including regional dialects that retain minor influences from waves of immigrant speakers of diverse languages, primarily European languages. Some racial and regional variation in American English reflects these groups' geographic settlement, their de jure or de facto segregation, and patterns in their resettlement. This can be seen, for example, in

6555-742: The double quotation mark ("like this") over the single ('as here'). Vocabulary differences vary by region. For example, autumn is used more commonly in the United Kingdom, whereas fall is more common in American English. Some other differences include: aerial (United Kingdom) vs. antenna, biscuit (United Kingdom) vs. cookie/cracker, car park (United Kingdom) vs. parking lot, caravan (United Kingdom) vs. trailer, city centre (United Kingdom) vs. downtown, flat (United Kingdom) vs. apartment, fringe (United Kingdom) vs. bangs, and holiday (United Kingdom) vs. vacation. AmE sometimes favors words that are morphologically more complex, whereas BrE uses clipped forms, such as AmE transportation and BrE transport or where

6650-502: The field. The Byzantines also built brephotrophia ( crêches ). Islamic Golden Age writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own, especially Haly Abbas , Yahya Serapion , Abulcasis , Avicenna , and Averroes . The Persian philosopher and physician al-Razi (865–925), sometimes called the father of pediatrics, published a monograph on pediatrics titled Diseases in Children . Also among

6745-586: The first books about pediatrics was Libellus [Opusculum] de aegritudinibus et remediis infantium 1472 ("Little Book on Children Diseases and Treatment"), by the Italian pediatrician Paolo Bagellardo. In sequence came Bartholomäus Metlinger 's Ein Regiment der Jungerkinder 1473, Cornelius Roelans (1450–1525) no title Buchlein, or Latin compendium, 1483, and Heinrich von Louffenburg (1391–1460) Versehung des Leibs written in 1429 (published 1491), together form

6840-505: The first three years, the second year of which is when medical students start to get hands-on experience with actual patients. The training of pediatricians varies considerably across the world. Depending on jurisdiction and university, a medical degree course may be either undergraduate-entry or graduate-entry. The former commonly takes five or six years and has been usual in the Commonwealth . Entrants to graduate-entry courses (as in

6935-517: The following two centuries) when this ethnic group eventually made up one-seventh of the colonial population. Scotch-Irish settlers spread from Delaware and Pennsylvania throughout the larger Mid-Atlantic region, the inland regions of both the South and North, and throughout the West: American dialect areas that were all uninfluenced by upper-class non-rhoticity and that consequently have remained consistently rhotic. While non-rhoticity spread on

7030-944: The hospital , BrE to hospital ; contrast, however, AmE actress Elizabeth Taylor , BrE the actress Elizabeth Taylor ). Often, these differences are a matter of relative preferences rather than absolute rules; and most are not stable since the two varieties are constantly influencing each other, and American English is not a standardized set of dialects. Differences in orthography are also minor. The main differences are that American English usually uses spellings such as flavor for British flavour , fiber for fibre , defense for defence , analyze for analyse , license for licence , catalog for catalogue and traveling for travelling . Noah Webster popularized such spellings in America, but he did not invent most of them. Rather, "he chose already existing options on such grounds as simplicity, analogy or etymology." Other differences are due to

7125-421: The importance of putting patients' interests first, making autonomy for patients a top priority in health care.   In ancient times, society did not view pediatric medicine as essential or scientific. Experts considered professional medicine unsuitable for treating children. Children also had no rights. Fathers regarded their children as property, so their children's health decisions were entrusted to them. As

7220-674: The influence of 18th-century Protestant Ulster Scots immigrants (known in the U.S. as the Scotch-Irish ) in Appalachia developing Appalachian English and the 20th-century Great Migration bringing African-American Vernacular English to the Great Lakes urban centers. Any phonologically unmarked North American accent falls under an umbrella known as General American. This section mostly refers to such General American features. Studies on historical usage of English in both

7315-438: The late 18th century onwards, but which has conversely lost prestige in the U.S. since at least the early 20th century. Non-rhoticity makes a word like car sound like cah or source like sauce . New York City and Southern accents are the most prominent regional accents of the country, as well as the most stigmatized and socially disfavored. Southern speech, strongest in southern Appalachia and certain areas of Texas,

7410-478: The liver and can vary according to which specific enzymes are affected in a specific stage of development. Phase I and Phase II enzymes have different rates of maturation and development, depending on their specific mechanism of action (i.e. oxidation , hydrolysis , acetylation , methylation , etc.). Enzyme capacity, clearance , and half-life are all factors that contribute to metabolism differences between children and adults. Drug metabolism can even differ within

7505-434: The medical profession, but in some jurisdictions, specialization in pediatrics may begin before completion of this degree. In some jurisdictions, pediatric training is begun immediately following the completion of entry-level training. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing pediatric (or any other) specialization . Specialist training

7600-427: The mid-nineteenth century onwards, so they "are now more different from each other than they were 50 or 100 years ago", while other accents, like of New York City and Boston, have remained stable in that same time-frame. However, a General American sound system also has some debated degree of influence nationwide, for example, gradually beginning to oust the regional accent in urban areas of the South and at least some in

7695-617: The most formal contexts, and regional accents with the most General American native features include North Midland, Western New England, and Western accents. Although no longer region-specific, African-American Vernacular English , which remains the native variety of most working- and middle-class African Americans , has a close relationship to Southern dialects and has greatly influenced everyday speech of many Americans, including hip hop culture . Hispanic and Latino Americans have also developed native-speaker varieties of English. The best-studied Latino Englishes are Chicano English , spoken in

7790-575: The oral drug as it travels through the body. Supply of these enzymes increase as children continue to develop their gastrointestinal tract. Pediatric patients have underdeveloped proteins , which leads to decreased metabolism and increased serum concentrations of specific drugs. However, prodrugs experience the opposite effect because enzymes are necessary for allowing their active form to enter systemic circulation. Percentage of total body water and extracellular fluid volume both decrease as children grow and develop with time. Pediatric patients thus have

7885-418: The parents and sometimes, the family, rather than just the child. Adolescents are in their own legal class, having rights to their own health care decisions in certain circumstances. The concept of legal consent combined with the non-legal consent (assent) of the child when considering treatment options, especially in the face of conditions with poor prognosis or complicated and painful procedures/surgeries, means

7980-402: The past forms of a few verbs (for example, AmE/BrE: learned / learnt , burned / burnt , snuck/sneaked , dove/dived ) although the purportedly "British" forms can occasionally be seen in American English writing as well; different prepositions and adverbs in certain contexts (for example, AmE in school, BrE at school ); and whether or not a definite article is used, in very few cases (AmE to

8075-494: The pediatric population, separating neonates and infants from young children. Drug elimination is primarily facilitated via the liver and kidneys. In infants and young children, the larger relative size of their kidneys leads to increased renal clearance of medications that are eliminated through urine. In preterm neonates and infants, their kidneys are slower to mature and thus are unable to clear as much drug as fully developed kidneys. This can cause unwanted drug build-up, which

8170-471: The pediatrician must take into account the desires of many people, in addition to those of the patient. The term autonomy is traceable to ethical theory and law, where it states that autonomous individuals can make decisions based on their own logic. Hippocrates was the first to use the term in a medical setting. He created a code of ethics for doctors called the Hippocratic Oath that highlighted

8265-407: The pediatrician, parent, and child work as a team to make the best possible medical decision. The pediatrician has the right to intervene for the child's welfare and seek advice from an ethics committee. However, in recent studies, authors have denied that complete autonomy is present in pediatric healthcare. The same moral standards should apply to children as they do to adults. In support of this idea

8360-399: The text of the third incunabulum in pediatrics: De aegritudinibus infantium (1483), the first two being Ein Regiment der Jungerkinder 1473 by Bartholomäus Metlinger and Versehung des Leibs 1429 by Heinrich von Louffenburg . His book is a rare one, but fortunately it is now available through the efforts of Karl Sudhoff , who, in his "Erstlinge der Pädiatrische Literatur," has reproduced

8455-570: The traditional standard accent of (southern) England, Received Pronunciation (RP), has evolved a trap–bath split . Moreover, American accents preserve /h/ at the start of syllables, while perhaps a majority of the regional dialects of England participate in /h/ dropping , particularly in informal contexts. However, General American is also innovative in a number of its own ways: The process of coining new lexical items started as soon as English-speaking British-American colonists began borrowing names for unfamiliar flora, fauna, and topography from

8550-756: The treatment and equality of a child and an adult should be the same. Author Tamar Schapiro notes that children need nurturing and cannot exercise the same level of authority as adults. Hence, continuing the discussion on whether children are capable of making important health decisions until this day. According to the Subcommittee of Clinical Ethics of the Argentinean Pediatric Society (SAP), children can understand moral feelings at all ages and can make reasonable decisions based on those feelings. Therefore, children and teens are deemed capable of making their own health decisions when they reach

8645-699: The twentieth century, medical experts began to put more emphasis on children's rights. In 1989, in the United Nations Rights of the Child Convention, medical experts developed the Best Interest Standard of Child to prioritize children's rights and best interests. This event marked the onset of pediatric autonomy. In 1995, the American Academy of Pediatrics (AAP) finally acknowledged the Best Interest Standard of

8740-417: The verb-and-preposition combination: stopover, lineup, tryout, spin-off, shootout , holdup, hideout, comeback, makeover , and many more. Some prepositional and phrasal verbs are in fact of American origin ( win out, hold up, back up/off/down/out, face up to and many others). Noun endings such as -ee (retiree), -ery (bakery), -ster (gangster) and -cian (beautician) are also particularly productive in

8835-775: The word corn , used in England to refer to wheat (or any cereal), came to denote the maize plant, the most important crop in the U.S. Most Mexican Spanish contributions came after the War of 1812 , with the opening of the West, like ranch (now a common house style ). Due to Mexican culinary influence, many Spanish words are incorporated in general use when talking about certain popular dishes: cilantro (instead of coriander), queso, tacos, quesadillas, enchiladas, tostadas, fajitas, burritos, and guacamole. These words usually lack an English equivalent and are found in popular restaurants. New forms of dwelling created new terms ( lot , waterfront) and types of homes like log cabin , adobe in

8930-609: The world. Any American or Canadian accent perceived as lacking noticeably local, ethnic, or cultural markers is known in linguistics as General American ; it covers a fairly uniform accent continuum native to certain regions of the U.S. but especially associated with broadcast mass media and highly educated speech. However, historical and present linguistic evidence does not support the notion of there being one single mainstream American accent . The sound of American English continues to evolve, with some local accents disappearing, but several larger regional accents having emerged in

9025-469: Was written by Noah Webster in 1828, codifying several of these spellings. Differences in grammar are relatively minor, and do not normally affect mutual intelligibility; these include: typically a lack of differentiation between adjectives and adverbs, employing the equivalent adjectives as adverbs he ran quick / he ran quickly ; different use of some auxiliary verbs ; formal (rather than notional) agreement with collective nouns ; different preferences for

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