CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fifth Edition

William W. Hay, Jr., MD Professor, Department of Pediatrics Director, Training Program in Neonatal-Perinatal Medicine Director, Neonatal Clinical Research Center University of Colorado School of Medicine and The Childrens Hospital, Denver Myron J. Levin, MD Professor, Departments of Pediatrics and Medicine Head, Section of Pediatric Infectious Diseases University of Colorado School of Medicine and The Childrens Hospital, Denver

Authors
Preface
Milestone 25th Silver Anniversary Edition
1. Advancing the Quality & Safety of Care

Introduction
Current Context
Strategies & Models for Quality Improvement (QI)
Principles of Patient Safety (Incident Reporting, Just Culture, Disclosure, FMEA, RCA, Reliability, Data, & Checklists)


2. The Newborn Infant

Introduction
The Neonatal History
Assessment of Growth & Gestational Age
Examination at Birth
Examination in the Nursery
Care of the Well Neonate
Common Problems in the Term Newborn
Neonatal Intensive Care
Cardiac Problems in the Newborn Infant
Gastrointestinal & Abdominal Surgical Conditions in the Newborn Infant
Infections in the Newborn Infant
Hematologic Disorders in the Newborn Infant
Renal Disorders in the Newborn Infant
Neurologic Problems in the Newborn Infant
Metabolic Disorders in the Newborn Infant
Quality Assessment & Improvement in the Newborn Nursery & NICU


3. Child Development & Behavior

Introduction
Normal Development
Behavioral & Developmental Variations
Enuresis & Encopresis
Common Developmental Concerns
Well-Child Surveillance & Screening


4. Adolescence

Introduction
Epidemiology
Providing A Medical Home for Adolescents
Relating to the Adolescent Patient
Guidelines for Adolescent Preventive Services
Growth & Development
Adolescent Gynecology & Reproductive Health


5. Adolescent Substance Abuse

Scope of the Problem
Morbidity Data
Predicting the Progression From Use to Abuse
Evaluation of Substance Abuse
Treatment & Referral
Prevention
References


6. Eating Disorders

Introduction
Etiology
Incidence
Predisposing Factors & Clinical Profiles
Anorexia Nervosa
Bulimia Nervosa
Binge-Eating Disorder
Avoidant/Restrictive Food Intake Disorder
Prognosis, Quality Assessment, & Outcomes Metrics
Resources for Practitioners & Families


7. Child & Adolescent Psychiatric Disorders & Psychosocial Aspects of Pediatrics

Introduction
Models of Care Encompassing Behavioral Health in the Primary Care Setting
Prevention, Early Identification, & Developmental Context
Lifestyle Recommendations
Identification & Assessment During Health Supervision Visits
Tools for Mental Health Screening in the Primary Care Office Setting
Psychiatric Disorders of Childhood & Adolescence


Obsessive-Compulsive & Related Disorders

Attention-Deficit/Hyperactivity Disorder
Mood Disorders
Suicide in Children & Adolescents
Disruptive, Impulse-Control, & Conduct Disorders
High-Risk Patients & Homicide
Somatic Symptom & Related Disorders
Adjustment Disorders
Psychotic Disorders
Other Psychiatric Conditions
References


8. Child Abuse & Neglect

Introduction
Prevention
Clinical Findings
Differential Diagnosis
Treatment
Prognosis


9. Ambulatory & Office Pediatrics

Introduction
Pediatric History
Pediatric Physical Examination
Health Supervision Visits
Mental & Behavioral Health
Telephone Management & Web-Based Information
Advocacy & Community Pediatrics
Toxic Stress
Common General Pediatric Issues


10. Immunization

Standards for Pediatric Immunization Practices
Routine Childhood & Adolescent Immunization Schedules
Vaccinations for Special Situations


11. Normal Childhood Nutrition & Its Disorders

Nutritional Requirements
Infant Feeding
Nutrition for Children 2 Years & Older
Nutrition Support


12. Emergencies & Injuries

Introduction to Pediatric Emergencies & Injuries
Approach to the Pediatric Trauma Patient
Head Injury
Burns
Disorders Due to Extremes of Environment
Submersion Injuries
Lacerations
Animal & Human Bites
Pain Management & Procedural Sedation


13. Poisoning

Introduction
Pharmacologic Principles of Toxicology
Preventing Childhood Poisonings
General Treatment of Poisoning


Management of Specific Common Poisonings

Acetaminophen (Paracetamol)
Alcohol, Ethyl (Ethanol)
Amphetamines & Related Drugs (Stimulants, Methamphetamine, 3,4-Methylenedioxy-N-Methylamphetamine)
Anesthetics, Local
Antihistamines & Cough & Cold Preparations
Barbiturates & Benzodiazepines
Belladonna Alkaloids (Atropine, Jimsonweed, Potato Leaves, Scopolamine, Stramonium)
β-Blockers & Calcium Channel Blockers
Carbon Monoxide
Caustics
Central α2-Adrenergic Agonist
Cocaine
Cosmetics & Related Products
Cyclic Antidepressants
Digitalis & Other Cardiac Glycosides
Diphenoxylate with Atropine (Lomotil) & Loperamide (Imodium)
Disinfectants & Deodorizers
Disk-Shaped “Button” Batteries
Ethylene Glycol & Methanol
γ-Hydroxybutyrate, γ-Butyrolactone, Butanediol, Flunitrazepam, & Ketamine
Hydrocarbons (Benzene, Charcoal Lighter Fluid, Gasoline, Kerosene, Petroleum Distillates, Turpentine)
Ibuprofen
Insect Stings (Bee, Wasp, & Hornet)
Insecticides
Iron
Lead
Magnets
Marijuana
Mushrooms
Nitrites, Nitrates, Aniline, Pentachlorophenol, & Dinitrophenol
Opioids & Opiates
Oral Anti-Diabetics (Sulfonylureas, Metformin)
Antipsychotics (Typical & Atypical)
Plants
Psychotropic Drugs
Salicylates
Scorpion Stings
Serotonin Reuptake Inhibitors
Snakebite
Soaps & Detergents
Spider Bites
Vitamins
Warfarin (Coumadin) & Newer Oral Anticoagulants (NOAC)


14. Critical Care

Introduction
Respiratory Critical Care
Major Respiratory Diseases in the Pediatric ICU
Cardiovascular Critical Care
Neurocritical Care
Acute Kidney Injury & Renal Replacement Therapy
Fluid Management & Nutritional Support of the Critically Ill Child
Sedation & Analgesia in the Pediatric ICU
End-of-Life Care & Death in the PICU
Quality Improvement Initiatives in the PICU


15. Skin

General Principles
Disorders of the Skin in Newborns
Common Skin Diseases in Infants, Children, & Adolescents


16. Eye

Introduction
Common Nonspecific Signs & Symptoms
Refractive Errors
Ophthalmic Examination
Ocular Trauma
Disorders of the Ocular Structures
Disorders of the Nasolacrimal System
Diseases of the Conjunctiva
Disorders of the Iris
Glaucoma
Uveitis
Disorders of the Cornea
Disorders of the Lens
Disorders of the Retina
Diseases of the Optic Nerve
Diseases of the Orbit
Esotropia (Crossed Eyes)
Exotropia (Wall-Eyed, Drifting of Eyes)


17. Oral Medicine & Dentistry

Pediatric Oral Health
Oral Examination of Children
Dental Caries
Periodontal Disease
Dental Emergencies
Special Patient Populations
Orthodontic Referral


18. Ear, Nose, & Throat

The Ear
The Nose & Paranasal Sinuses
The Throat & Oral Cavity


19. Respiratory Tract & Mediastinum

Respiratory Tract
Growth & Development
Diagnostic Aids
General Therapy for Pediatric Lung Diseases
Disorders of the Conducting Airways
Laryngomalacia & Congenital Disorders of the Extrathoracic Airway
Acquired Disorders of the Extrathoracic Airway
Congenital Causes of Intrathoracic Airway Obstruction
Acquired Causes of Intrathoracic Airway Obstruction
Disorders of Mucociliary Clearance
Congenital Malformations of the Lung Parenchyma
Acquired Abnormalities of the Lung Parenchyma
Atypical Pneumonias
Bronchiolitis Obliterans
Diseases of the Pulmonary Circulation
Disorders of the Chest Wall
Neuromuscular Disorders & Lung Disease
Disorders of the Pleura & Pleural Cavity
Mediastinum
Sleep-Disordered Breathing
Primary Snoring & Obstructive Sleep Apnea
Periodic Breathing & Central Sleep Apn
ea
Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events)


20. Cardiovascular Diseases

Introduction
Diagnostic Evaluation
Perinatal & Neonatal Circulation
Heart Failure
Genetic Basis of Congenital Heart Disease
Acyanotic Congenital Heart Disease
Cyanotic Congenital Heart Disease
Quality Improvement in Congenital Heart Disease
Acquired Heart Disease
Preventive Cardiology
Chest Pain
Cardiac Transplantation
Quality Improvement for Pediatric Heart Transplantation
Pulmonary Hypertension
Disorders of Rate & Rhythm
Syncope (Fainting)


21. Gastrointestinal Tract

Disorders of the Esophagus
Disorders of the Stomach & Duodenum
Disorders of the Small Intestine
Disorders of the Colon
Disorders of the Peritoneal Cavity
Gastrointestinal Tumors & Malignancies
Major Gastrointestinal Symptoms & Signs


22. Liver & Pancreas

Liver Disorders
Pancreatic Disorders


23. Fluid, Electrolyte, & Acid–Base Disorders & Therapy

Regulation of Body Fluids, Electrolytes, & Tonicity
Acid–Base Balance
Fluid & Electrolyte Management
Acid–Base Disturbances


24. Kidney & Urinary Tract

Evaluation of the Kidney & Urinary Tract
Congenital Anomalies of the Urinary Tract
Hematuria & Glomerular Disease
Tubulointerstitial Disease
Proteinuria & Renal Disease
Diseases of the Renal Vessels
Renal Failure
Hypertension
Inherited or Developmental Defects of the Kidneys
Urinary Tract Infections
QA/QI in Pediatric Nephrology


25. Neurologic & Muscular Disorders

Neurologic Assessment & Neurodiagnostics
Disorders Affecting the Nervous System in Infants & Children
Ataxias of Childhood
Infections & Inflammatory Disorders of the Central Nervous System
Syndromes Presenting as Acute Flaccid Weakness
Motor Neuron Disorders
Miscellaneous Neuromuscular Disorders


26. Orthopedics

Introduction
Disturbances of Prenatal Origin
Deformities of the Extremities
Common Spine Conditions
Inflammatory Conditions
Syndromes with Musculoskeletal Involvement
Neurologic Disorders Involving the Musculoskeletal System
Trauma
Fractures
Infections of the Bones & Joints
Vascular Lesions & Avascular Necrosis (Osteochondroses)
Neoplasia of the Musculoskeletal System
Miscellaneous Diseases of Bone & Joint
Quality Assurance/Improvement Initiatives in Orthopedics


27. Sports Medicine

Basic Principles
Common Sports Medicine Issues & Injuries
Prevention


28. Rehabilitation Medicine

Pediatric Brain Injury
Spinal Cord Injury
Brachial Plexus Lesions & Typical Features
Common Rehabilitation Problems
Quality Assurance/Improvement Initiatives in Rehabilitation Medicine


29. Rheumatic Diseases

Juvenile Idiopathic Arthritis
Systemic Lupus Erythematosus
Dermatomyositis
Vasculitis
Raynaud Phenomenon
Noninflammatory Pain Syndromes


30. Hematologic Disorders

Normal Hematologic Values
Bone Marrow Failure
Constitutional Aplastic Anemia (Fanconi Anemia)
Acquired Aplastic Anemia
Anemias
Polycythemia & Methemoglobinemia
Disorders of Leukocytes
Splenic Abnormalities
Transfusion Medicine


31. Neoplastic Disease

Major Pediatric Neoplastic Diseases
Blood & Marrow Transplant & Cellular Therapeutics
Late Effects of Pediatric Cancer Therapy


32. Pain Management & Pediatric Palliative & End-of-Life Care

Introduction
Pain Assessment
Acute Pain
Chronic Pain Management
Pediatric Palliative & End-of-Life Care


33. Immunodeficiency

Introduction
Immunodeficiency Evaluation: Primary Considerations
Severe Combined Immunodeficiency Diseases
SCID Classification
Other Combined Immunodeficiencies
Antibody Deficiency Syndromes
Phagocyte Disorders
Deficiencies of the Innate Immune System
Immunodeficiency Diseases That Present with Autoimmunity
Immunodeficiency Diseases That Overlap with Allergy


34. Endocrine Disorders

General Concepts
Disturbances of Growth
Disorders of the Posterior Pituitary Gland
Thyroid Gland
Disorders of Calcium & Phosphorus Metabolism
Gonads (Ovaries & Testes)
Abnormalities in Female Pubertal Development & Ovarian Function
Polycystic Ovarian Syndrome
Abnormalities in Male Pubertal Development & Testicular Function
Adrenal Cortex


35. Diabetes Mellitus

Quality Assessment & Outcomes Metrics
Associated Autoimmune Diseases in Type 1 Diabetes
Associated Conditions with Type 2 Diabetes
References


36. Inborn Errors of Metabolism

Introduction
Diagnosis
Management of Metabolic Emergencies
Newborn Screening
Disorders of Carbohydrate Metabolism
Disorders of Energy Metabolism
Disorders of Amino Acid Metabolism
Organic Acidemias
Disorders of Fatty Acid Oxidation & Carnitine
Purine Metabolism Disorders
Lysosomal Diseases
Peroxisomal Diseases
Congenital Disorders of Glycosylation
Smith-Lemli-Opitz Syndrome & Disorders of Cholesterol Synthesis
Disorders of Brain Specific Metabolism: Neurotransmitters, Synthesis of Amino Acids & Glucose Transport
Creatine Synthesis Disorders
Quality Initiatives in the Field of Metabolic Disease


37. Genetics & Dysmorphology

Foundations of Genetic Diagnosis
Principles of Inherited Human Disorders
Dysmorphology & Human Embryology
Chromosomal Disorders: Abnormal Number
Chromosomal Abnormalities: Abnormal Structure
Chromosome Deletion Disorders
Contiguous Gene Disorders
Mendelian Disorders
Nonmendelian Disorders
Disorders of Multifactorial Inheritance
Common Recognizable Disorders with Variable or Unknown Cause
Genetic Evaluation of the Child with Developmental Disabilities
Perinatal Genetics


38. Allergic Disorders

Introduction
Asthma
Allergic Rhinoconjunctivitis
Atopic Dermatitis
Urticaria & Angioedema
Anaphylaxis
Adverse Reactions to Drugs & Biologicals
Food Allergy
Insect Allergy


39. Antimicrobial Therapy

Principles of Antimicrobial Therapy
Concepts for Judicious Use of Antimicrobials
Susceptibility Testing & Drug Dosing Properties
Pharmacodynamic Concepts
Use of Antimicrobial Agents to Prevent Disease
Choice of Antimicrobial Agents
Specific Antimicrobial Agents


40. Infections: Viral & Rickettsial

Viral Infections
Respiratory Infections
Infections Due to Enteroviruses & Parechoviruses
Infections Due to Herpesviruses
Viral Infections Spread by Insect Vectors
Other Major Viral Childhood Exanthems
Infections Due to Other Viruses
Rickettsial Infections and Q Fever


41. Human Immunodeficiency Virus Infection

Pathogenesis & Epidemiology
Prevention
Perinatally HIV-Exposed Infant
Adolescents & Youth with HIV Exposure
Progressive HIV Disease
Treatment
Quality Assurance & Outcome Metrics


42. Infections: Bacterial & Spirochetal

Bacterial Infections
Spirochetal Infections


43. Infections: Parasitic & Mycotic

Parasitic Infections
Protozoal Infections
Metazoal Infections
Mycotic Infections


44. Sexually Transmitted Infections

Introduction
Adolescent Sexuality
Risk Factors
Prevention of Sexually Transmitted Infections
Screening for Sexually Transmitted Infections
Signs & Symptoms
The Most Common Antibiotic-Responsive Sexually Transmitted Infections
The Spectrum of Signs & Symptoms of Sexually Transmitted Infections


45. Travel Medicine

Introduction
Preparing Children & Infants for Travel
Vaccinations—Routine Childhood Vaccines Modified for Travel
Va
ccinations—Travel-Specific
Traveler’s Diarrhea
Malaria Prophylaxis & Prevention
Visits to Friends & Relatives (VFR) in High-Risk Areas
HIV & Sexually Transmitted Diseases
Fever in the Returned Traveler
References


46. Chemistry & Hematology Reference Intervals

Challenges in Determining & Interpreting Pediatric Reference Intervals
Guidelines for Use of Data in a Reference Range Study
Statistical Computation of Reference Intervals
Why Reference Intervals Vary
Sensitivity, Specificity, & Predicitive Values
Pediatric Reference Intervals


Index