Preface

It is a great honor for me to be editor of the book Complementary Pediatrics. Currently; there is a lot of classical pediatric text books describing various topics. In these kinds of text books, there have always been similar topics with the same styles. In this book volume, beyond classical themes, a different approach was made to current pediatric issues and topics.

This book volume covers complementary issues of pediatric subspecialties consisting of ophthalmologic, surgical, psychosocial and administrative issues of frequently used medications. Book consists of 16 chapters which will help get us and patients enlightened with the new developments on these subspecialties' area.

First section of the book is pediatric ophthalmology, which concisely explains most common eye disorders encountered during childhood until adolescence. Pediatric Surgery section discusses very classical but unsettled approaches for issues related to circumcision and cryptorchidism. An interesting approach also has been defined for the treatment of anal fissure.

Section of special and interdisciplinary care entails pain management, snake bites, oral health, oxidative stress and a model of specialized interdisciplinary management. Oxidative stress of newborn is described in detail and therapeutic options are explained. In addition, the use of melatonin is mentioned as a useful tool to combat oxygen toxicity in newborns.

Section on psychosocial issues is usually not mentioned in old pediatric textbooks, but it is not forgotten in this book volume. This section starts with adolescent psychosocial development and continues with commonly encountered problems such as alcohol intoxication and unwanted sexual experience. Moreover, as a paramedical issue, professional liability section describes liability in detail in this book.

Frequently used medications section, lists the administration and dose of most frequently used pediatric drugs as a directory. This manual will help decrease administrative medication and calculation errors.

#### X Preface

In conclusion; with these 16 chapters, this book volume completes knowledge on pediatric subspecialties including psychosocial and special / interdisciplinary issues.

Before I finish my last words, I feel obliged to my father Orhan and father-in-law Hasan Baş for their support during this period time.

#### **Öner Özdemir, MD**

Assoc. Prof. of Pediatrics İstanbul Medeniyet University Göztepe Research/Training Hospital 3rd Clinic of Pediatrics, Division of Pediatric Allergy/Immunology Kadköy, İstanbul, Turkey

X Preface

In conclusion; with these 16 chapters, this book volume completes knowledge on pediatric subspecialties including psychosocial and special / interdisciplinary issues.

Before I finish my last words, I feel obliged to my father Orhan and father-in-law

3rd Clinic of Pediatrics, Division of Pediatric Allergy/Immunology

**Öner Özdemir, MD**  Assoc. Prof. of Pediatrics İstanbul Medeniyet University Göztepe Research/Training Hospital

Kadköy, İstanbul,

Turkey

Hasan Baş for their support during this period time.

**Part 1** 

**Pediatric Ophtalmology**

**Part 1** 

**Pediatric Ophtalmology**

**1** 

*Turkey* 

**Pediatric Ophthalmology / Eye and Disorders** 

The growth and development of eye harbors many challenging anatomical and physiological alterations starting from the intrauterine life until the early puberty. After the early puberty, the axial length of eye, which is defined as the anterior posterior diameter of the eye, remains unaltered in healthy subjects. However, the refractive status of the eye may still change in adults due to aging processes. The eye development starts in the 3-week embryo, from the optic vesicles. The eye is an organ which derives from all three of the germ layers (ectoderm, endoderm and mesoderm). The initial 3 years of life is the critical period for eye development, and rapid increase in dimensions of the organ takes place in these years. Clear vision is mandatory for the development of visual cortex in this critical period. It is accepted that normal adult visual capacity develops at 3 years

The coordinated growth of eye's refractive components to reach a plano refraction is called emmetropization. If any failure happens in this process, refractive errors develop. The axial length is either too short, causing hypermetropia, or too long, causing myopia. Astigmatism is due to abnormal shapes in cornea. Very high degrees of hypermetropia (>5D) is not normal in newborns. The cornea and lens may flatten normally within years, but the axial length often pauses behind. This causes permanent hyperopia, which is called nanophthalmos. Generally, eyes with hyperopia of greater than 5 diopters have little chance

All anatomical alterations occur in order to achieve emmetropization. The corneal diameter at birth is about 9.5-10.5 mm. The average adult size is 12 mm. The corneal refractive power is 52 diopters at birth and 42-44 diopters in adulthood. Axial length is 17 mm at birth. It enlarges to 20 mm by the end of 12 months with continued rapid growth until 2 years old, then a slow increase to 24 mm by adulthood. The most rapid eye growth occurs within the first two years. At birth the power of the crystalline lens is 34 diopters. By 6 months of age power averages 28 diopters. By the adulthood the lens power reaches about 20 diopters. As cornea, lens, and axial length grow and change rapidly over the first months and years of

life, the harmonization between these three components become crucial.

**1. Introduction** 

of age (Fredrick, 2004).

of emmetropization (Mutti, 1992).

**1.1 Growth and development of child's eye** 

Ahmet Ozer, Nazmiye Erol, Huseyin Gursoy and Afsun Sahin

Hikmet Basmak, Nilgun Yildirim, Seyhan Topbas,

*Eskisehir Osmangazi University Medical Faculty,* 

*Department of Ophthalmology,* 
