The difficulty of getting pediatric services still exists in China. It is a general trend that community health centers (CHCs) provide pediatric services. There are rare studies on the spectrum of pediatric illnesses in CHCs.

To understand the current status of pediatric diagnosis and treatment in Shenzhen's CHCs by analyzing the spectrum of pediatric illnesses treated in clinics, and to analyze the gap between actual practical status with the training contents based on Spectrum of Diseases for Resident Rotation in Pediatric Medicine (hereinafter referred to as Pediatric Training Rules) specified in General Residency Training Rules in the Standardized Training Contents and Standards for Residents (2022 Edition) .

Through checking the outpatient medical records in CHCs in Shenzhen's 10 districts during April to September 2021, pediatric care expenditure data of children〔including babies (<1 year old), toddlers (1-3 years old), preschoolers (4-6 years old), gradeschoolers (7-12 years old) and teens (13-18 years old) stratified by age〕 contracting family doctor services were collected. The actual spectrum of diseases and diagnosis and treatment behaviors were analyzed, and compared with the Pediatric Training Rules to assess the practical application of the contents required to be mastered in the Pediatric Training Rules.

A total of 961 605 children were included, among whom preschoolers accounted for the highest percentage (38.22%, 367 486/961 605), followed by gradeschoolers (27.57%, 265 151/961 605), toddlers (21.90%, 210 621/961 605), teens (8.49%, 81 594/961 605), and babies (3.82%, 36 753/961 605). The top five diseases in the spectrum and diagnosis and treatment behaviors were respiratory diseases, calcium and vitamin supplements, pediatric physical examination and health care, trauma and postoperative dressing change, and skin diseases, accounting for 67.92% of the total diagnostic and therapeutic workload. Younger age was associated with increased concentrated diagnosis and treatment behaviors. Physical examination and health care (27.60%, 10 142/36 753), calcium and vitamin supplements (25.48%, 9 364/36 753) were the main diagnosis and treatment behaviors in babies. Five diseases in the spectrum and diagnosis and treatment behaviors accounting for ≥80% of the total diagnostic and therapeutic workload in babies, while in teens, 13 diseases in the spectrum and diagnosis and treatment behaviors accounting for ≥80% of the total diagnostic and therapeutic workload. Except for babies, respiratory diseases were the primary reason for seeking treatment in children of other age groups. The proportion of workload of trauma treatment and postoperative dressing change was the highest in teens. Except neonatal asphyxia, neonatal pneumonia, poliomyelitis, infantile tetany and viral myocarditis, the pediatric diseases encountered in these CHCs were covered by the disease spectrum required to be mastered in the Pediatric Training Rules, and the top five healthcare & treatments were respiratory disease treatment〔333 172 (34.65%) 〕, pediatric physical examination and health care〔70 703 (7.35%) 〕, acute infectious diseases treatment〔20 893 (2.17%) 〕, infantile diarrhea〔13 622 (1.42%) 〕, and pediatric abdominal pain〔12 526 (1.30%) 〕. The amount of diagnosis and treatment workload for pediatric anemia, pediatric leukemia, rickets, infantile diabetes, malnutrition, neonatal jaundice, nephritis and nephrotic syndrome, infantile epilepsy, simple obesity, and infantile convulsion accounted for less than 1.00% of the total amount, among which pediatric anemia, pediatric leukemia, neonatal jaundice, nephritis and nephrotic syndrome, infantile epilepsy and simple obesity were mainly transferred for treatment or prescribed a laboratory test.

In general, the CHCs provide a large number of pediatric diagnosis and treatment services, but the services for younger children are still insufficient. Pediatric Training Rules focus on internal diseases, and relevant trainings have some differences with the actual diagnosis and treatment services. The treatments for some diseases in the spectrum in the rules are too specialized, and the diseases are less frequently encountered in community settings, and such patients mainly are transferred for treatment or examined using a laboratory test. Therefore, the pediatric rotation in standardized general residency training should be planned as a whole since the disease spectrum includes many diseases rather than only internal diseases, and actions should be made to expand the training content, improve outpatient teaching, and strengthen the training for physicians to improve their abilities in diagnosis and treatment of young children.