Editorial (13k)	Vassallo-Agius P*. Paediatrics in the XX century. Images Paediatr Cardiol 2001;7:1-2
*	Consultant Paediatrician, Malta

The foundations of medical sciences were mainly laid during the preceding century or two, and after millennia of care of children by doctors who also cared for adults, the special needs of children were slowly but surely recognised, especially during the latter half of the nineteenth century. Thus the twentieth century started with established basic and crucial developments in anatomy, physiology and biochemistry, therapeutics, anaesthesia and surgery, immunisation and immunology, and genetics. The discoveries in these disciplines were systematically adopted and adapted to the care of children during the twentieth century, with remarkable success. Thus the infant mortality rate, which is a measure of the effectiveness of health services, in those countries where these advances could be brought to fruition dropped dramatically from over one hundred to single figures. There is no doubt that the concurrent improvement in economic and social wellbeing also played a very important part. The emphasis has been on regarding the problems in the care of the child, especially the newborn baby, as needing special care and attention. The child is not a scaled-down adult, and the recognition of its special needs for both physical and mental development was of paramount importance. The number of pediatricians, devoted solely to the care of children, increased dramatically. Children's hospitals, or units in general hospitals for the investigation and treatment of children's ailments only, mushroomed all over the globe. Moreover, the need for subspecialties such as neonatology, cardiology and cardiac surgery, gastroenterology, pulmonology, neurology and so on became evident, especially in the last quarter of the century. There has also been an explosion in the dissemination of knowledge, especially through the use of computers and the internet in the last decade, also reflecting the volume of research into the development of the care of the child as a member of the family unit.

The care of the child has undoubtedly improved dramatically in the last century, though this has also generated problems which hardly were of concern to clinicians at the beginning of the century. Ethical and moral considerations have become increasingly prominent, especially in the last quarter of the century. This is especially evident in the complexities of care of the newborn.  Quality of life and end of life decisions, because of the availability of high tech care and the profusion of high risk situations in this age group, have become very significant, and the solutions are not easy at the best of times, often with controversial decisions. The recent case of the separation of the Maltese (Gozitan) conjoint twins, with the inevitable death of one so that the other was given a chance to lead a more or less normal life, made the world headlines, with the complex bioethical, moral and legal issues which were involved.
 
And there is no doubt that there is more looming on the horizon, in the not too distant future, especially with regard to various aspects of genetics. The ingenuity of the human mind will, no doubt ensure that he will survive. And it is bare survival that is at stake for millions of children born and living in the less privileged areas of the world. The developments in childcare outlined above have not reached the four corners of the world. Indeed, high tech has no place at this stage in the care of millions of children who still lack the basic needs such as adequate nutrition, supply of safe water, immunisation and simple medicines to treat ordinary infectious diseases which readily kill the undernourished. The scourge of AIDS has hit most those nations who lack the funds to fight it  -  though recently there has been a significant breakthrough in this regard. Much more needs to be done. In the recent publication by UNICEF, The State of the World's Children 2000(www.unIcef.org/sowc), while acknowledging that a lot of useful ground has been covered to fully meet the goals of the 1990 World Summit for Children, clearly points out that much more work still needs to be done. “A call is made on leaders in industrialised and developing countries alike to reaffirm their commitment to children. It is a call for vision and leadership within families and communities, where the respect for the rights of children and women is first born and nurtured and where the protection of these rights begin”. Can we honestly leave such a call unanswered?