Differential Diagnosis in Pediatrics

The continuing development of sub specialties in pediatrics may be justifiably considered to be progress. Due to this fact, complex syn­ dromes can be analyzed today in their pathogenesis, are better under­ stood in their symptomatology, and can be therapeutically controlled. Therapy has reached an unexpectedly high level of effectiveness through this specialization, never dreamed of even a few years ago. No pediatrician can afford to do without it. However, this gain in knowledge inevitably places new burdens on the individual physician because of the confusing diversity of the diseases under consideration. The colleague in private practice who is called upon to treat an acutely ill child is all too likely to have the patient admitted to the hospital without necessity or without the de­ sired diagnostic insight. The hospital-based physician, confronted with the same situation, tends to rely more on a haphazard utilization of the laboratory facilities or the specialists. Should an illness not present itself strictly according to the textbook, the wide range of biochemical investigations and "tolerance tests" to which the patient is subjected offers the physician, made insecure by the diversity of the diagnostic possibilities, an opportunity for thinking and reading on the problem. Medical literature, however, has reached such enormous proportions that many physicians give up trying to keep abreast of it. Be it for lack of time or some other reason, they may consult pediatric literature only superficially or not at all-to the harm of the sick child.