RAMB - Julho 2016

7 / 139

21st century well-child care
Rev Assoc Med B ras 2016; 62(6):479-481 479
EDITORIAL
21st century well-child care
A puericultura do século XXI
Ana Maria de Ulhôa Escobar1, Sandra Josefina Ferraz Ellero Grisi2*
1Associate Professor, Department of Pediatrics, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
2Full Professor, Department of Pediatrics, FMUSP, São Paulo, SP, Brazil
Pediatrics is the medical specialty devoted to the compre-
hensive care of human growth and development. The idea
of “assisting the human being that is growing and devel-
oping” distinguishes it from all other areas of medicine.
Within such a broad context, the role of preventive pedi-
atrics is guiding pediatrics, given that its aim is the growth
and healthy development of children and adolescents.
The current trend of basing health care on the full appre-
ciation of each person, taking into account their specific
characteristics and all of the circumstances around them,
especially applies to preventive pediatrics and has caused
the revision of concepts and practices.1
In France, preventive pediatrics was proposed as a
standard of conduct directed at child health in 1865 in
social programs, and it was only from the late 19th cen-
tury that it became part of medical language. Its origin
in France came from the idea of standardizing the care
of children in relation to the extreme conditions of pro-
miscuity in which the population of the most popular
neighborhoods lived. It should be taken into account that,
at that time, industrialization promoted an intense flow
of migration from the countryside to the cities, causing
unplanned urbanization and a precarious social environ-
ment, exposing urban workers to epidemics and outbreaks
of infectious diseases. The poor health conditions of the
population led to immediate consequences on absentee-
ism and productivity at work, a fact that created social
tension. The high infant mortality rate resulting from
this scenario was the key factor driving the proposition
of protocols to standardize childcare. Thus, the first pub-
lications on preventive pediatrics were addressed to moth-
ers. The “modern” working family of the late 19th centu-
ry became nuclear, and the mother took the central role
in the responsibility for childcare and became the main
element for transmission of knowledge and values. Ac-
cording to Aries, the “the myth of motherhood is born
with the advent of modern family”.2
In parallel, in the same period, Pasteur’s discoveries
in the field of microbiology provided important elements
for the history of medicine. For the first time, Pasteur es-
tablished a causal relationship between microorganisms
and diseases. This knowledge formed the basis for the
theoretical framework of the concept of etiology of dis-
eases, with prevention techniques arising as a logical con-
sequence and immediately being incorporated into child-
care. At the same time, child nutrition also started to be
seen as fundamental for a healthy life, significantly high-
lighting the importance of breast milk for babies. Thus,
preventive pediatrics became a set of rules on nutrition-
al, anti-infectious and sanitary practices regarding the
health of children, essentially addressed to mothers.3
Preventive pediatrics was introduced in Brazil in 1890
by Moncorvo Filho, a Brazilian doctor who had trained
in France. It is important to emphasize that the ideas and
movements originating in Europe at that time were quick-
ly adopted in our country. 4
With the organization of health care at Health Cen-
ters at the start of the 20th century, preventive pediatrics
became part of the range of activities of these services, ex-
ercising control over children’s health on the one hand,
and proposing health education rules on the other. It
therefore began to incorporate the concepts of the so-
called “hygiene area”, proposing hygiene in the realm of
food and physical, mental and anti-infective environment.5
In the 1970s, in the wake of health reform, preventive
pediatrics was revised and expanded. The Ministry of
Health designed and proposed the Mother-Child Program,
aimed at reducing the alarming mortality rates of moth-
ers and children. To achieve the program’s goals, preven-
tive pediatrics incorporated various health care activities
and its conception was expanded to include comprehen-
sive care of the child, adopting a routine of standardized
checkups in the first 2 years of life and emphasizing nu-
tritional aspects, growth, development, immunization,
and care of the physical environment. 6,7
There is no doubt that these broader standards contrib-
uted significantly to the reduction of childmortality, as well
as to the change in the morbidity profile in childhood, with
a significant reduction in protein-energy malnutrition, gas-
troenteritis and various other infectious diseases.