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.

我国目前存在儿科"看病难"困境，儿科诊疗下沉至社区卫生服务中心是大势所趋，目前鲜有社区卫生服务中心儿科诊疗疾病谱的相关研究。

通过分析深圳市社区健康服务中心（以下简称社康中心）儿科门诊疾病谱，了解社康中心儿科诊疗现状；并以《住院医师规范化培训内容与标准（2022年版）》全科培训细则中儿科轮转掌握疾病谱（儿科培训细则）为依据，探讨培训内容和实际诊疗之间的差距。

选取2021年4月—9月深圳市10个区签约家庭医生且在社康中心有门诊收费诊疗记录的儿童为研究对象，按年龄段分为婴儿（<1岁）、幼儿（1~3岁）、学龄前儿童（4~6岁）、小学儿童（7~12岁）、初高中儿童（13~18岁），分析实际诊疗疾病谱和诊疗行为；同时与儿科培训细则匹配，分析儿科培训细则中要求掌握内容在实际诊疗中的应用情况。

共入选961 605人次就诊患儿，学龄前儿童较多，占比为38.22%（367 486/961 605）；小学儿童占比27.57%（265 151/961 605）、幼儿占比21.90%（210 621/961 605）、初高中儿童占比8.49%（81 594/961 605），婴儿占比3.82%（36 753/961 605）。疾病谱和诊疗行为前五位依次为：呼吸道疾病、补钙和维生素、儿童体检和保健、创伤和术后换药、皮肤疾病，累计占总诊疗量的67.92%。年龄越小，诊疗行为越集中，婴儿以儿童体检和保健（27.60%，10 142/36 753）、补钙和维生素（25.48%，9 364/36 753）为主；婴儿累计≥80%诊疗量的疾病谱和诊疗行为为5种，初高中儿童累计≥80%诊疗量的疾病谱和诊疗行为为13种；除婴儿外，其他年龄段患儿以呼吸道疾病为就诊首位，不同年龄段创伤和术后换药诊疗量构成比以初高中患儿较高。除新生儿窒息、新生儿肺炎、脊髓灰质炎、婴儿手足搐搦症、病毒性心肌炎外，社康中心儿科诊疗涵盖儿科培训细则要求掌握的疾病谱，其中呼吸道疾病333 172人次（34.65%），儿童体检和保健7 0703人次（7.35%），急性传染病20 893人次（2.17%），小儿腹泻13 622人次（1.42%），小儿腹痛12 526人次（1.30%），而小儿贫血、小儿白血病、VitD缺乏症、小儿糖尿病、营养不良、新生儿黄疸、肾炎和肾病综合征、小儿癫痫、单纯性肥胖症、小儿惊厥诊疗量占比均<1.00%，且小儿贫血、小儿白血病、新生儿黄疸、肾炎和肾病综合征、小儿癫痫、单纯性肥胖症诊疗行为多以转诊和开具化验单为主。

即使深圳市社康中心提供大量儿科诊疗服务，但仍对年龄偏小患儿诊疗量不足；儿科培训细则集中在内科疾病，培训内容与实际诊疗存在差距；儿科细则中一些疾病谱专科化过强，在实际诊疗中数量明显不足，且诊疗行为多以转诊和开具化验单为主。因此，全科规培中儿科培训不仅涉及内科疾病，而是应该视为一个整体来统筹规划，拓展培训内容，加大门诊带教力度，加强对小龄患儿诊疗能力培养。