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Not just small adults: the metaphors of paediatrics
  1. Jonathan Gillis1,
  2. Patricia Loughlan2
  1. 1
    Paediatric Intensive Care Unit, Children’s Hospital at Westmead, Sydney, and the University of Sydney, Sydney, Australia
  2. 2
    Faculty of Law, University of Sydney, Sydney, Australia
  1. Jonathan Gillis, Intensive Care Unit, Children’s Hospital at Westmead, Locked Bag 4001, Westmead 2145, Sydney, NSW, Australia; jong{at}chw.edu.au

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It is time to acknowledge that both children and adults belong to the human race

When called upon to lecture and teach others about the essential elements of paediatric practice, paediatricians usually resort to the well worn phrase “children are not just small adults”.1 2 Whilst this may be a useful idea for the calculation of drug doses and the assessment of physiological parameters, the definition of child medicine in such defensive, negative and exclusionary terms carries with it some inherent dangers and misconceptions. Both children and adults belong to the human race. Progress in medicine more often than not can be applied to and be of benefit to all and the transition from childhood to adulthood should be one of continuity rather than migration. By emphasising that children are not small adults, we unconsciously negate all that is to be gained through a vision which takes in human beings throughout their lives. There are indeed special qualities in the practice of paediatrics, but they need to be expressed with positive inspiration and a firm recognition of the commonalities of adults and children.

One way to rediscover such a perspective is to look back at the nineteenth and the early twentieth century, when the discipline of paediatrics was being established, to see how early practitioner authors tried to impart what they saw as the unique qualities of their speciality. These authors employed two main metaphors in which the paediatrician was either a veterinary surgeon or an explorer. These metaphors continue to resonate today within contemporary paediatric practice.

Medical texts and commentaries of the period were preoccupied with a fundamental dilemma in the clinical assessment of children, the lack of ability to obtain direct patient history. For Michael Underwood in the preface to the fourth edition of his A treatise …

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