Nelson essentials of pediatrics , 7th edition

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Nelson
Essentials
of Pediatrics

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Nelson
Essentials
of Pediatrics
7
th
Edition
Karen J. Marcdante, MD
Professor
Department of Pediatrics
Medical College of Wisconsin
Children’s Hospital of Wisconsin
Milwaukee, Wisconsin
Robert M. Kliegman, MD
Professor and Chairman Emeritus
Department of Pediatrics
Medical College of Wisconsin
Children’s Hospital of Wisconsin
Milwaukee, Wisconsin
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899

NELSON ESSENTIALS OF PEDIATRICS, SEVENTH EDITION ISBN: 978-1-4557-5980-4
INTERNATIONAL EDITION ISBN: 978-0-323-22700-1
Copyright © 2015, 2011, 2006, 2002, 1998, 1994, 1990 by Saunders, an imprint of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and retrieval system,
without permission in writing from the publisher. Details on how to seek permission, further information about
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Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
is book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).
Notices
Knowledge and best practice in this eld are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information or
methods they should be mindful of their own safety and the safety of others, including parties for whom they
have a professional responsibility.
With respect to any drug or pharmaceutical products identied, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and
to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any
liability for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.
Library of Congress Cataloging-in-Publication Data
Nelson essentials of pediatrics / [edited by] Karen J. Marcdante, Robert M. Kliegman Seventh edition.

p. ; cm.
Essentials of pediatrics
Includes bibliographical references and index.
ISBN 978-1-4557-5980-4 (paperback : alk. paper)
I. Marcdante, Karen J., editor of compilation. II. Kliegman, Robert, editor of compilation. III. Title:
Essentials of pediatrics.
[DNLM: 1. Pediatrics. WS 100]
RJ45
618.92 dc23 2013044668
Senior Content Strategist: James Merritt
Senior Content Development Specialist: Jennifer Shreiner
Publishing Services Manager: Patricia Tannian
Project Manager: Amanda Mincher
Manager, Art and Design: Steven Stave
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
is book is dedicated to all of our colleagues (faculty, residents, and medical students)
who demonstrate a passion for learning, a curiosity that drives advancement in
the care of children, and an amazing dedication to the patients and families
we are honored to serve.

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ix
Lisa M. Allen, MD
Associate Professor
Department of Obstetrics and Gynecology
University of Toronto
e Hospital for Sick Children
Mount Sinai Hospital
Toronto, Ontario

Canada
Adolescent Medicine
Warren P. Bishop, MD
Professor
Department of Pediatrics
University of Iowa Carver College of Medicine
Director, Division of Gastroenterology
University of Iowa Children’s Hospital
Iowa City, Iowa
e Digestive System
Kim Blake, MD, MRCP, FRCPC
Professor of General Pediatrics
IWK Health Centre
Division of Medical Education
Dalhousie University
Halifax, Nova Scotia
Canada
Adolescent Medicine
Nathan J. Blum, MD
Professor
Department of Pediatrics
e Perelman School of Medicine at the University
of Pennsylvania
Director, Leadership Education in Neurodevelopmental
Disabilities
Program Director, Developmental-Behavioral Pediatrics
Fellowship Program
Division of Child Development and Metabolic Disease
e Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania

Psychosocial Issues
Raed Bou-Matar, MD
Associate Sta
Center for Pediatric Nephrology
Cleveland Clinic Foundation
Cleveland, Ohio
Fluids and Electrolytes
Scott J. Brown, MD
Developmental-Behavioral Pediatric Fellow
Department of Pediatrics
University of California, San Diego
La Jolla, California
Behavioral Disorders
April O. Buchanan, MD
Associate Professor
Department of Pediatrics
Academic Director, Years 3 and 4
University of South Carolina School of Medicine Greenville
Pediatric Hospitalist
Children’s Hospital, Greenville Health System
Greenville, South Carolina
Pediatric Nutrition and Nutritional Disorders
Asriani M. Chiu, MD
Associate Professor of Pediatrics
Division of Pediatric Allergy and Immunology
Director, Asthma and Allergy
Director, Allergy and Immunology Fellowship Program
Medical College of Wisconsin
Milwaukee, Wisconsin
Allergy

Yvonne E. Chiu, MD
Assistant Professor
Department of Dermatology
Medical College of Wisconsin
Milwaukee, Wisconsin
Dermatology
Cindy W. Christian, MD
Professor
Department of Pediatrics
e Perelman School of Medicine at the University
of Pennsylvania
Director, Safe Place
e Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania
Psychosocial Issues
David Dimmock, MD
Assistant Professor
Department of Pediatrics
Division of Pediatric Genetics
Medical College of Wisconsin
Milwaukee, Wisconsin
Metabolic Disorders
Contributors
x Contributors
Dawn R. Ebach, MD
Clinical Associate Professor
Department of Pediatrics
University of Iowa Carver College of Medicine
Iowa City, Iowa
e Digestive System

Sheila Gahagan, MD, MPH
Professor and Chief
Academic General Pediatrics, Child Development and
Community Health
Martin Stein Endowed Chair, Developmental-Behavioral
Pediatrics
University of California, San Diego
La Jolla, California
Behavioral Disorders
Clarence W. Gowen, Jr., MD, FAAP
Associate Professor and Interim Chair
Department of Pediatrics
Eastern Virginia Medical School
Interim Senior Vice President for Academic Aairs
Director of Medical Education
Director of Pediatric Residency Program
Children’s Hospital of e King’s Daughters
Norfolk, Virginia
Fetal and Neonatal Medicine
Larry A. Greenbaum, MD, PhD
Marcus Professor of Pediatrics
Director, Division of Pediatric Nephrology
Emory University School of Medicine
Chief, Pediatric Nephrology
Emory-Children’s Center
Atlanta, Georgia
Fluids and Electrolytes
Hilary M. Haftel, MD, MHPE
Clinical Associate Professor
Departments of Pediatrics and Communicable Diseases

and Internal Medicine
Director of Pediatric Education
Pediatric Residency Director
University of Michigan Medical School
Ann Arbor, Michigan
Rheumatic Diseases of Childhood
MaryKathleen Heneghan, MD
Attending Physician
Division of Pediatric Endocrinology
Advocate Lutheran General Children’s Hospital
Park Ridge, Illinois
Endocrinology
Matthew P. Kronman, MD, MSCE
Assistant Professor of Pediatrics
University of Washington School of Medicine
Division of Pediatric Infectious Diseases
Seattle Children’s Hospital
Seattle, Washington
Infectious Diseases
K. Jane Lee, MD
Assistant Professor of Pediatrics, Bioethics, and Medical
Humanities
Program Director, Pediatric Critical Care Fellowship
Medical College of Wisconsin
Institute for Health and Society
Milwaukee, Wisconsin
e Acutely Ill or Injured Child
David A. Levine, MD
Professor
Department of Pediatrics

Chief, Division of Pre-doctoral Education
Morehouse School of Medicine
Atlanta, Georgia
Growth and Development
Paul A. Levy, MD, FACMG
Assistant Professor
Departments of Pediatrics and Pathology
Albert Einstein College of Medicine of Yeshiva University
Attending Geneticist
Children’s Hospital at Monteore
Bronx, New York
Human Genetics and Dysmorphology
Yi Hui Liu, MD, MPH
Assistant Professor
Department of Pediatrics
University of California, San Diego
La Jolla, California
Behavioral Disorders
John D. Mahan, MD
Professor, Department of Pediatrics
Program Director, Pediatric Residency Program
Program Director, Pediatric Nephrology Fellowship Program
Vice-Chair for Education
e Ohio State University College of Medicine
Nationwide Children’s Hospital
Columbus, Ohio
Nephrology and Urology
Robert W. Marion, MD
Professor
Department of Pediatrics

Department of Obstetrics and Gynecology and Women’s
Health
Ruth L. Gottesman Chair in Developmental Pediatrics
Chief, Section of Child Development
Chief, Section of Genetics
Department of Pediatrics
Albert Einstein College of Medicine of Yeshiva University
Bronx, New York
Human Genetics and Dysmorphology
Maria L. Marquez, MD
Associate Professor
Department of Pediatrics
Georgetown University School of Medicine
Director, Medical Student Education
Georgetown University Hospital
Washington, DC
Pediatric Nutrition and Nutritional Disorders
Contributors xi
Susan G. Marshall, MD
Professor
Department of Pediatrics
University of Washington School of Medicine
Attending Physician
Pulmonary Division
Seattle Children’s Hospital
Seattle, Washington
e Respiratory System
Thomas W. McLean, MD
Associate Professor
Department of Pediatrics

Wake Forest University Baptist Medical Center
Winston-Salem, North Carolina
Oncology
Thida Ong, MD
Assistant Professor
Department of Pediatrics
University of Washington School of Medicine
Attending Physician
Pulmonary Division
Seattle Children’s Hospital
Seattle, Washington
e Respiratory System
Julie A. Panepinto, MD, MSPH
Professor
Department of Pediatrics
Medical College of Wisconsin
Division of Pediatric Hematology
e Children’s Research Institute of the Children’s Hospital
of Wisconsin
Milwaukee, Wisconsin
Hematology
Hiren P. Patel, MD
Clinical Associate Professor
Department of Pediatrics
e Ohio State University College of Medicine
Chief, Section of Nephrology
Medical Director, Renal Dialysis Unit
Nationwide Children’s Hospital
Columbus, Ohio
Nephrology and Urology

Rowena C. Punzalan, MD
Assistant Professor
Department of Pediatrics
Medical College of Wisconsin
Division of Pediatric Hematology
e Children’s Research Institute of the Children’s Hospital
of Wisconsin
Milwaukee, Wisconsin
Hematology
Russell Scheffer, MD
Chair and Professor
Department of Psychiatry and Behavioral Sciences
Professor
Department of Pediatrics
University of Kansas School of Medicine–Wichita
Wichita, Kansas
Psychiatric Disorders
Jocelyn Huang Schiller, MD
Clinical Assistant Professor
Department of Pediatrics
University of Michigan Medical School
Division of Pediatric Neurology
C.S. Mott Children’s Hospital
Ann Arbor, Michigan
Neurology
Daniel S. Schneider, MD
Associate Professor
Department of Pediatrics
University of Virginia School of Medicine
Charlottesville, Virginia

e Cardiovascular System
J. Paul Scott, MD
Professor
Department of Pediatrics
Medical College of Wisconsin
Medical Director, Wisconsin Sickle Cell Center
e Children’s Research Institute of the Children’s Hospital
of Wisconsin
Milwaukee, Wisconsin
Hematology
Renée A. Shellhaas, MD, MS
Clinical Assistant Professor
Department of Pediatrics
University of Michigan Medical School
Division of Pediatric Neurology
C.S. Mott Children’s Hospital
Ann Arbor, Michigan
Neurology
Benjamin S. Siegel, MD
Director, Medical Student Education in Pediatrics
Professor
Department of Pediatrics
Boston University School of Medicine
Boston, Massachusetts
e Profession of Pediatrics
Paola A. Palma Sisto, MD
Associate Professor
Department of Pediatrics
University of Connecticut School of Medicine
Director, Endocrinology Program

Division of Pediatric Endocrinology
Connecticut Children’s Medical Center
Hartford, Connecticut
Endocrinology
Sherilyn Smith, MD
Professor of Pediatrics
Fellowship Director, Pediatric Infectious Disease
University of Washington School of Medicine
Associate Clerkship Director
Seattle Children’s Hospital
Seattle, Washington
Infectious Diseases
xii Contributors
Amanda Striegl, MD, MS
Assistant Professor
Department of Pediatrics
University of Washington School of Medicine
Attending Physician
Pulmonary Division
Seattle Children’s Hospital
Seattle, Washington
e Respiratory System
J. Channing Tassone, MD
Associate Professor
Departments of Orthopedic Surgery and Pediatrics
Medical College of Wisconsin
Division of Pediatric Orthopedic Surgery
Children’s Hospital of Wisconsin
Milwaukee, Wisconsin
Orthopedics

Aveekshit Tripathi, MD
Senior Psychiatry Resident
Department of Psychiatry and Behavioral Sciences
University of Kansas School of Medicine–Wichita
Wichita, Kansas
Psychiatric Disorders
James W. Verbsky, MD, PhD
Assistant Professor
Department of Pediatrics
Department of Microbiology and Molecular Genetics
Division of Pediatric Rheumatology
Medical College of Wisconsin
Children’s Hospital of Wisconsin
Milwaukee, Wisconsin
Immunology
Kevin D. Walter, MD, FAAP
Assistant Professor
Departments of Orthopedic Surgery and Pediatrics
Medical College of Wisconsin
Program Director, Primary Care Sports Medicine
Children’s Hospital of Wisconsin
Milwaukee, Wisconsin
Orthopedics
Marcia M. Wofford, MD
Associate Professor
Department of Pediatrics
Wake Forest University Baptist Medical Center
Winston-Salem, North Carolina
Oncology
xiii

Medicine and technology just don’t stop! e amazing
advancements we hear about as our scientist colleagues further
delineate the pathophysiology and mechanisms of diseases
must eventually be translated to our daily care of patients. Our
goal, as the editors and authors of this textbook, is not only to
provide the classic, foundational knowledge we use every day
but to include these advances in a readable and concise text for
medical students and residents.
is new edition has been updated with the advances that
have occurred since the last edition. We have also incorpo-
rated technology by linking this book to the second edition
of Pediatric Decision Making Strategies by Pomeranz, Busey,
Sabnis, and Kliegman. is will allow you to read about the
medical issues and then follow a link to an algorithm to facilitate
ecient and eective evaluations.
We believe this integration will help you investigate the
common and classic pediatric disorders in a time-honored,
logical format to both acquire knowledge and apply knowledge
to your patients. We have also once again asked our colleagues
who serve as clerkship directors to write many of the sections
so that you can gain the knowledge and skills necessary to
succeed both in caring for patients and in preparing for clerkship
or in-service examinations.
We are honored to be part of the journey of thousands
of learners who rotate through pediatrics as well as those
who will become new providers of pediatric care in the years
to come.
Karen J. Marcdante, MD
Robert M. Kliegman, MD
Preface

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xv
e editors could never have published this edition without
the assistance and attention to detail of James Merritt and
Jennifer Shreiner. We also couldn’t have accomplished this
without Carolyn Redman, whose prompting, organizing, and
overseeing of the process helped us create this new edition.
Acknowledgments

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xvii
SECTION
1
The Profession of Pediatrics 1
Karen J. Marcdante and Benjamin S. Siegel
Chapter 1 POPULATION AND CULTURE: THE
CARE OF CHILDREN IN SOCIETY 1
Chapter 2 PROFESSIONALISM 4
Chapter 3 ETHICS AND LEGAL ISSUES 5
Chapter 4 PALLIATIVE CARE AND END-OF-
LIFE ISSUES 7
SECTION
2
Growth and Development 10
David A. Levine
Chapter 5 NORMAL GROWTH 10
Chapter 6 DISORDERS OF GROWTH 12
Chapter 7 NORMAL DEVELOPMENT 13
Chapter 8 DISORDERS OF DEVELOPMENT 15

Chapter 9 EVALUATION OF THE WELL
CHILD 20
Chapter 10 EVALUATION OF THE CHILD WITH
SPECIAL NEEDS 26
SECTION
3
Behavioral Disorders 37
Sheila Gahagan, Yi Hui Liu, and Scott J. Brown
Chapter 11 CRYING AND COLIC 37
Chapter 12 TEMPER TANTRUMS 39
Chapter 13 ATTENTION-DEFICIT/
HYPERACTIVITY DISORDER 41
Chapter 14 CONTROL OF ELIMINATION 43
Chapter 15 NORMAL SLEEP AND PEDIATRIC
SLEEP DISORDERS 47
SECTION
4
Psychiatric Disorders 51
Russell Scheffer and Aveekshit Tripathi
Chapter 16 SOMATOFORM DISORDERS,
FACTITIOUS DISORDERS, AND
MALINGERING 51
Chapter 17 ANXIETY AND PHOBIAS 55
Chapter 18 DEPRESSION AND BIPOLAR
DISORDERS 59
Chapter 19 OBSESSIVE-COMPULSIVE
DISORDER 62
Chapter 20 PERVASIVE DEVELOPMENTAL
DISORDERS AND PSYCHOSES 63
SECTION

5
Psychosocial Issues 67
Cindy W. Christian and Nathan J. Blum
Chapter 21 FAILURE TO THRIVE 67
Chapter 22 CHILD ABUSE AND NEGLECT 70
Chapter 23 HOMOSEXUALITY AND GENDER
IDENTITY 75
Chapter 24 FAMILY STRUCTURE AND
FUNCTION 76
Contents
xviii Contents
Chapter 25 VIOLENCE 79
Chapter 26 DIVORCE, SEPARATION, AND
BEREAVEMENT 82
SECTION
6
Pediatric Nutrition and Nutritional
Disorders
86
April O. Buchanan and Maria L. Marquez
Chapter 27 DIET OF THE NORMAL INFANT 86
Chapter 28 DIET OF THE NORMAL CHILD AND
ADOLESCENT 89
Chapter 29 OBESITY 90
Chapter 30 PEDIATRIC UNDERNUTRITION 93
Chapter 31 VITAMIN AND MINERAL
DEFICIENCIES 96
SECTION
7
Fluids and Electrolytes 106

Larry A. Greenbaum and Raed Bou-Matar
Chapter 32 MAINTENANCE FLUID
THERAPY 106
Chapter 33 DEHYDRATION AND
REPLACEMENT THERAPY 107
Chapter 34 PARENTERAL NUTRITION 111
Chapter 35 SODIUM DISORDERS 112
Chapter 36 POTASSIUM DISORDERS 116
Chapter 37 ACID-BASE DISORDERS 119
SECTION
8
The Acutely Ill or Injured Child 124
K. Jane Lee
Chapter 38 ASSESSMENT AND
RESUSCITATION 124
Chapter 39 RESPIRATORY FAILURE 128
Chapter 40 SHOCK 129
Chapter 41 INJURY PREVENTION 133
Chapter 42 MAJOR TRAUMA 133
Chapter 43 DROWNING 136
Chapter 44 BURNS 137
Chapter 45 POISONING 139
Chapter 46 SEDATION AND ANALGESIA 144
SECTION
9
Human Genetics and
Dysmorphology
146
Paul A. Levy and Robert W. Marion
Chapter 47 PATTERNS OF INHERITANCE 146

Chapter 48 GENETIC ASSESSMENT 154
Chapter 49 CHROMOSOMAL DISORDERS 156
Chapter 50 THE APPROACH TO THE
DYSMORPHIC CHILD 160
SECTION
10
Metabolic Disorders 164
David Dimmock
Chapter 51 METABOLIC ASSESSMENT 164
Chapter 52 CARBOHYDRATE DISORDERS 172
Chapter 53 AMINO ACID DISORDERS 174
Chapter 54 ORGANIC ACID DISORDERS 177
Chapter 55 FAT METABOLIC DISORDERS 179
Chapter 56 LYSOSOMAL AND PEROXISOMAL
DISORDERS 180
Chapter 57 MITOCHONDRIAL DISORDERS 183
Contents xix
SECTION
11
Fetal and Neonatal Medicine 186
Clarence W. Gowen, Jr.
Chapter 58 ASSESSMENT OF THE MOTHER,
FETUS, AND NEWBORN 186
Chapter 59 MATERNAL DISEASES AFFECTING
THE NEWBORN 204
Chapter 60 DISEASES OF THE FETUS 208
Chapter 61 RESPIRATORY DISEASES OF THE
NEWBORN 209
Chapter 62 ANEMIA AND
HYPERBILIRUBINEMIA 216

Chapter 63 NECROTIZING
ENTEROCOLITIS 223
Chapter 64 HYPOXIC-ISCHEMIC
ENCEPHALOPATHY,
INTRACRANIAL HEMORRHAGE,
AND SEIZURES 224
Chapter 65 SEPSIS AND MENINGITIS 227
Chapter 66 CONGENITAL INFECTIONS 229
SECTION
12
Adolescent Medicine 234
Kim Blake and Lisa M. Allen
Chapter 67 OVERVIEW AND ASSESSMENT OF
ADOLESCENTS 234
Chapter 68 WELL-ADOLESCENT CARE 240
Chapter 69 ADOLESCENT GYNECOLOGY 242
Chapter 70 EATING DISORDERS 248
Chapter 71 SUBSTANCE ABUSE 250
SECTION
13
Immunology 252
James W. Verbsky
Chapter 72 ASSESSMENT 252
Chapter 73 LYMPHOCYTE DISORDERS 256
Chapter 74 NEUTROPHIL DISORDERS 263
Chapter 75 COMPLEMENT SYSTEM 266
Chapter 76 HEMATOPOIETIC STEM CELL
TRANSPLANTATION 269
SECTION
14

Allergy 271
Asriani M. Chiu
Chapter 77 ASSESSMENT 271
Chapter 78 ASTHMA 273
Chapter 79 ALLERGIC RHINITIS 282
Chapter 80 ATOPIC DERMATITIS 285
Chapter 81 URTICARIA, ANGIOEDEMA, AND
ANAPHYLAXIS 288
Chapter 82 SERUM SICKNESS 292
Chapter 83 INSECT ALLERGIES 293
Chapter 84 ADVERSE REACTIONS TO
FOODS 294
Chapter 85 ADVERSE REACTIONS TO
DRUGS 296
SECTION
15
Rheumatic Diseases
of Childhood 299
Hilary M. Haftel
Chapter 86 ASSESSMENT 299
Chapter 87 HENOCH-SCHÖNLEIN
PURPURA 301
Chapter 88 KAWASAKI DISEASE 303
Chapter 89 JUVENILE IDIOPATHIC
ARTHRITIS 305
Chapter 90 SYSTEMIC LUPUS
ERYTHEMATOSUS 309
Chapter 91 JUVENILE
DERMATOMYOSITIS 311
Chapter 92 MUSCULOSKELETAL PAIN

SYNDROMES 312
xx Contents
SECTION
16
Infectious Diseases 315
Matthew P. Kronman and Sherilyn Smith
Chapter 93 ASSESSMENT 315
Chapter 94 IMMUNIZATION AND
PROPHYLAXIS 317
Chapter 95 ANTI-INFECTIVE THERAPY 323
Chapter 96 FEVER WITHOUT A FOCUS 324
Chapter 97 INFECTIONS CHARACTERIZED BY
FEVER AND RASH 329
Chapter 98 CUTANEOUS INFECTIONS 335
Chapter 99 LYMPHADENOPATHY 338
Chapter 100 MENINGITIS 342
Chapter 101 ENCEPHALITIS 344
Chapter 102 THE COMMON COLD 346
Chapter 103 PHARYNGITIS 347
Chapter 104 SINUSITIS 350
Chapter 105 OTITIS MEDIA 351
Chapter 106 OTITIS EXTERNA 353
Chapter 107 CROUP
(LARYNGOTRACHEOBRONCHITIS)
354
Chapter 108 PERTUSSIS 356
Chapter 109 BRONCHIOLITIS 357
Chapter 110 PNEUMONIA 358
Chapter 111 INFECTIVE ENDOCARDITIS 364
Chapter 112 ACUTE GASTROENTERITIS 366

Chapter 113 VIRAL HEPATITIS 369
Chapter 114 URINARY TRACT INFECTION 372
Chapter 115 VULVOVAGINITIS 374
Chapter 116 SEXUALLY TRANSMITTED
INFECTIONS 376
Chapter 117 OSTEOMYELITIS 381
Chapter 118 INFECTIOUS ARTHRITIS 384
Chapter 119 OCULAR INFECTIONS 386
Chapter 120 INFECTION IN THE
IMMUNOCOMPROMISED
PERSON 390
Chapter 121 INFECTIONS ASSOCIATED WITH
MEDICAL DEVICES 394
Chapter 122 ZOONOSES 396
Chapter 123 PARASITIC DISEASES 402
Chapter 124 TUBERCULOSIS 407
Chapter 125 HIV AND AIDS 412
SECTION
17
The Digestive System 417
Warren P. Bishop and Dawn R. Ebach
Chapter 126 ASSESSMENT 417
Chapter 127 ORAL CAVITY 429
Chapter 128 ESOPHAGUS AND STOMACH 430
Chapter 129 INTESTINAL TRACT 437
Chapter 130 LIVER DISEASE 444
Chapter 131 PANCREATIC DISEASE 450
Chapter 132 PERITONITIS 453
SECTION
18

The Respiratory System 455
Thida Ong, Amanda Striegl, and Susan G. Marshall
Chapter 133 RESPIRATORY SYSTEM
ASSESSMENT 455
Chapter 134 CONTROL OF BREATHING 461
Chapter 135 UPPER AIRWAY OBSTRUCTION 464
Chapter 136 LOWER AIRWAY, PARENCHYMAL,
AND PULMONARY VASCULAR
DISEASES 469
Chapter 137 CYSTIC FIBROSIS 475
Chapter 138 CHEST WALL AND PLEURA 478
Contents xxi
SECTION
19
The Cardiovascular System 481
Daniel S. Schneider
Chapter 139 CARDIOVASCULAR SYSTEM
ASSESSMENT 481
Chapter 140 SYNCOPE 486
Chapter 141 CHEST PAIN 487
Chapter 142 DYSRHYTHMIAS 488
Chapter 143 ACYANOTIC CONGENITAL HEART
DISEASE 491
Chapter 144 CYANOTIC CONGENITAL HEART
DISEASE 495
Chapter 145 HEART FAILURE 499
Chapter 146 RHEUMATIC FEVER 501
Chapter 147 CARDIOMYOPATHIES 502
Chapter 148 PERICARDITIS 504
SECTION

20
Hematology 506
Julie A. Panepinto, Rowena C. Punzalan, and J. Paul
Scott
Chapter 149 HEMATOLOGY ASSESSMENT 506
Chapter 150 ANEMIA 509
Chapter 151 HEMOSTATIC DISORDERS 523
Chapter 152 BLOOD COMPONENT
THERAPY 532
SECTION
21
Oncology 534
Thomas W. McLean and Marcia M. Wofford
Chapter 153 ONCOLOGY ASSESSMENT 534
Chapter 154 PRINCIPLES OF CANCER
TREATMENT 538
Chapter 155 LEUKEMIA 542
Chapter 156 LYMPHOMA 544
Chapter 157 CENTRAL NERVOUS SYSTEM
TUMORS 546
Chapter 158 NEUROBLASTOMA 548
Chapter 159 WILMS TUMOR 550
Chapter 160 SARCOMAS 551
SECTION
22
Nephrology and Urology 553
John D. Mahan and Hiren P. Patel
Chapter 161 NEPHROLOGY AND UROLOGY
ASSESSMENT 553
Chapter 162 NEPHROTIC SYNDROME AND

PROTEINURIA 556
Chapter 163 GLOMERULONEPHRITIS AND
HEMATURIA 558
Chapter 164 HEMOLYTIC UREMIC
SYNDROME 560
Chapter 165 ACUTE AND CHRONIC RENAL
FAILURE 561
Chapter 166 HYPERTENSION 563
Chapter 167 VESICOURETERAL REFLUX 564
Chapter 168 CONGENITAL AND
DEVELOPMENTAL ABNORMALITIES
OF THE URINARY TRACT 565
Chapter 169 OTHER URINARY TRACT AND
GENITAL DISORDERS 567
SECTION
23
Endocrinology 570
Paola A. Palma Sisto and MaryKathleen Heneghan
Chapter 170 ENDOCRINOLOGY
ASSESSMENT 570
Chapter 171 DIABETES MELLITUS 572
Chapter 172 HYPOGLYCEMIA 579
xxii Contents
Chapter 173 SHORT STATURE 583
Chapter 174 DISORDERS OF PUBERTY 589
Chapter 175 THYROID DISEASE 596
Chapter 176 DISORDERS OF PARATHYROID
BONE AND MINERAL
ENDOCRINOLOGY 602
Chapter 177 DISORDERS OF SEXUAL

DEVELOPMENT 604
Chapter 178 ADRENAL GLAND
DYSFUNCTION 607
SECTION
24
Neurology 612
Jocelyn Huang Schiller and Renée A. Shellhaas
Chapter 179 NEUROLOGY ASSESSMENT 612
Chapter 180 HEADACHE AND MIGRAINE 616
Chapter 181 SEIZURES (PAROXYSMAL
DISORDERS) 618
Chapter 182 WEAKNESS AND
HYPOTONIA 623
Chapter 183 ATAXIA AND MOVEMENT
DISORDERS 631
Chapter 184 ALTERED MENTAL STATUS 634
Chapter 185 NEURODEGENERATIVE
DISORDERS 642
Chapter 186 NEUROCUTANEOUS
DISORDERS 645
Chapter 187 CONGENITAL MALFORMATIONS
OF THE CENTRAL NERVOUS
SYSTEM 647
SECTION
25
Dermatology 650
Yvonne E. Chiu
Chapter 188 ASSESSMENT 650
Chapter 189 ACNE 652
Chapter 190 ATOPIC DERMATITIS 653

Chapter 191 CONTACT DERMATITIS 656
Chapter 192 SEBORRHEIC DERMATITIS 657
Chapter 193 PIGMENTED LESIONS 659
Chapter 194 VASCULAR ANOMALIES 661
Chapter 195 ERYTHEMA MULTIFORME,
STEVENS-JOHNSON SYNDROME,
AND TOXIC EPIDERMAL
NECROLYSIS 662
Chapter 196 CUTANEOUS INFESTATIONS 664
SECTION
26
Orthopedics 667
Kevin D. Walter and J. Channing Tassone
Chapter 197 ORTHOPEDICS ASSESSMENT 667
Chapter 198 FRACTURES 670
Chapter 199 HIP 672
Chapter 200 LOWER EXTREMITY AND
KNEE 676
Chapter 201 FOOT 681
Chapter 202 SPINE 684
Chapter 203 UPPER EXTREMITY 691
Chapter 204 BENIGN BONE TUMORS AND
CYSTIC LESIONS 693
1
Chapter
1
POPULATION AND
CULTURE: THE CARE
OF CHILDREN IN
SOCIETY

Health care professionals need to appreciate the interactions
between medical conditions and social, economic, and envi-
ronmental inuences associated with the provision of pediatric
care. New technologies and treatments help improve morbidity,
mortality, and the quality of life for children and their families,
but the costs may exacerbate disparities in medical care. e
challenge for pediatricians is to deliver care that is socially equi-
table; integrates psychosocial, cultural, and ethical issues into
practice; and ensures that health care is available to all children.
CURRENT CHALLENGES
Many challenges aect children’s health outcomes. ese
include access to health care; health disparities; supporting
their social, cognitive, and emotional lives in the context of
families and communities; and addressing environmental fac-
tors, especially poverty. Early experiences and environmental
stresses interact with the genetic predisposition of every child
and, ultimately, may lead to the development of diseases seen
in adulthood. us, pediatricians have the unique opportunity
to address not only acute and chronic illnesses but also the
aforementioned issues and toxic stressors to promote wellness
and health maintenance in children.
Many scientic advances have an impact on the growing
role of pediatricians. Incorporating the use of newer genetic
technologies allows the diagnosis of diseases at the molecu-
lar level, aids in the selection of medications and therapies,
and provides information on the prognosis of some diseases.
Prenatal diagnosis and newborn screening improve the accu-
racy of early diagnosis of a variety of conditions, allowing for
earlier treatment even when a cure is impossible. Functional
magnetic resonance imaging allows a greater understanding

of psychiatric and neurologic problems, such as dyslexia and
attention-decit/hyperactivity disorder.
Challenges persist with the incidence and prevalence of
chronic illness having increased in recent decades. Chronic
illness is now the most common reason for hospital admis-
sions among children (excluding trauma and newborn admis-
sions). From middle school and beyond, mental illness is the
main non–childbirth-related reason for hospitalization among
children. Pediatricians must also address the increasing con-
cern about environmental toxins and the prevalence of physi-
cal, emotional, and sexual abuse, as well as violence. Since the
September 11, 2001, destruction of the World Trade Center
in New York City, fear of terrorism in the United States has
increased the level of anxiety for many families and children.
To address these ongoing challenges, pediatricians must
practice as part of a health care team. Many pediatricians
already practice collaboratively with psychiatrists, psychol-
ogists, nurses, and social workers. Team composition can
change, depending on location and patient needs. Although
school health and school-based health clinics have improved
access and outcomes for many common childhood and ado-
lescent conditions, the shortage of available general pedia-
tricians and family physicians has led to the development of
retail medical facilities in pharmacies and retail stores.
Childhood antecedents of adult health conditions, such as
alcoholism, depression, obesity, hypertension, and hyperlip-
idemias, are increasingly being recognized. Maternal health
status can aect the fetus. Infants who are a smaller size and
relatively underweight at birth because of maternal malnu-
trition have increased rates of coronary heart disease, stroke,

type 2 diabetes mellitus, obesity, metabolic syndrome, and
osteoporosis in later life. Because of improved neonatal care,
a greater percentage of preterm, low birth weight, or very low
birth weight newborns survive, increasing the number of
children with chronic medical conditions and developmental
delays with lifelong implications.
LANDSCAPE OF HEALTH CARE FOR
CHILDREN IN THE UNITED STATES
Complex health, economic, and psychosocial challenges greatly
inuence the well-being and health out comes of children.
National reports from the Centers for Disease Control and
Prevention (CDC) (e.g.,
hus11.pdf#102) provide information about many of these issues.
Some of the key issues include the following:
• Health insurance coverage. In 2010 over eight million
children in the United States had no health insurance
coverage. In addition, 10 to 20 million were underinsured.
Many children, despite public sector insurance, do
not receive recommended immunizations. Although
The Profession of
Pediatrics
Karen J. Marcdante and Benjamin S. Siegel
SECTION
1