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PERVEZ AKBAR KHAN
BASIS OF
PEDIATRIC
TENTH ES ITION
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Pervez Akbar Khan
MBBS, FCPS
Formerly, Professor ofPediatrics
Nishtar Medical College
Multan
i
NISHTAR
PUBLICATIONS
Ry’
Model Town, Multan Tel: 0334-6344400 0321-2066562
|
©
Nishter Publications (Pvt.) Ltd.
BasisofPediatrics
by
PervezAkbar Khan
All rights reserved. No partofthis publication may be reproduced, stored in a retrieval system, ortransmitted in anyform or by
anymeans,electronic,mechanical,photocopying,recordingorotherwise,withoutthepriorpermissionoftheCopyrightHolders.
Thisbookissoldsubjecttotheconditionthatitshallnot,bywayoftradeorotherwise,belent,resold,hiredoutorotherwisecirculated
without the publisher's priorconsent in anyform ofbinding or cover other than that in which it is published and without a similar
conditionincludingthisconditionbeingimposedonthesubsequentpurchaser.
Medicalknowledgeisconstantlychanging.Asnewinformation becomesavailable,changesintreatment,procedures,equipment
and the use ofdrugs become necessary.Theeditors, contributors and the publishers have, as far as it is possible, taken care to
ensurethatthe information given in this text is accurate and up-to-date. However, readers are strongly advised to confirm that
the information, especiallywith regard to drug usage, complieswiththe latest legislation and standards ofpractice. Neitherthe
publishernorthe authorsassume any responsibilityforanyloss orinjuryand/ordamageto person or propertyarising outofor
relatedtoanyuseofthematerialcontained inthishandbook.
Copyright© 2018
All Rights Reserved
First Edition 1985 Sixth Edition 2002
Second Edition 1986 Seventh Edition 2008
Third Edition 1989 Eighth Edition 2011
Fourth Edition 1992 Ninth Edition 2018
Fifth Edition 1997 Tenth Edition 2020
(8 NISHTAR
WR PUBLICATIONS
Model Town, Multan Tel: 0334-6344400 0321-2066562
|
ISBN: 978-969-791-631-3
Printed in Pakistan
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Thisbookiswritten forundergraduates keeping in view theirspecial requirements and theirdire need ofasmall book
onPediatrics.ThemainobjectofthisbookistointroducethestudentswiththeelementaryknowledgeofPediatricsand
to enable themto prepare forthe examination. It may also be useful for internee doctors who optto work in Pediatric
hospitals.
It is not meant to replace the standard textbooks ofPediatrics. Its topics have been carefully selected to include only
thoseaspects,whichare eithernottoucheduponordiscussedindetail in Medicine. Thishas greatlyhelpedmetolimit
thevolumeofthisbook.Valuable suggestions andcriticism willbe greatlyappreciatedtothisend.
Iam greatly indebted to my learned teachers, Prof. Shaukat Raza Khan, Prof. S. M. Haneef, Prof. Tariq Iqbal Bhutta,
Prof.AbdulWaheedQureshi,andProf. FehmidaJaleel,whohadgreatinfluenceonmeduringmy formativeyears.This
bookreflects the salientfeatures oftheknowledge impartedto meduringtheseyears.
MygratitudeisduetoDr.M.M.ZafarullahKundiandDr.ShukarElahiforprovidingmethematerialandencouragement
inwritingofthis book. I amthankfulto Dr. MuhammadBakhshMalik,forproofreadingofthismanual.
Intheend,thanksareduetoMr. KarimUllahMazhar, fortypingofthismanuscriptandMesser’sCaravan BookCenter
forpublishingit.
Prof. Dr. PervezAkbarKhan
Jan. 1985
lii71VHOS FOGIIMONY (sruebqi - sisouey Avesgi] - WSIA Syood 404) IZOsYpP
lam greatly indebted tostudentsof Medical colleges and doctorsworking in children wardsofdifferenthospi-
tals who continue to look for a book which fulfill their partial needs and at time they have to refer to textbook
forfurther details. still feel the students complain of studying such a large bookfor preparation oftheirexam
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and they require a brief version. The knowledge of pediatrics is ever expanding and have tried to limits its
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volume to manageable size. For this have curtailed many detailed explanation of different aspects and
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omitted many diagrams to limit its size.
In this edition have included the recent national statistics which were available from year 2017. In addition it
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was a great pleasure to get help from Dr Athar Abdul Razzaq to review neonatal section and include ail the
recent updates available and give it a complete newer look. Similarly Dr Muhammad Imran took immense
interest in updating Nephrology section and almostcompletely help us rewritethesection and including ail the
recent updates and brief essential new topics. It was a great effort on his part. |am also indebted to Dr Ghazi
Khosa who spared his precious time to revise the Gastroenterology and liver diseases section. {t will be
pleasure to get his help in future edition also. am extremely thankful to Dr Muhmmad Idrees who worked
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meticulously to read the book and brought necessary changes from scrap and added almost more then fifty
paragraphs and cancel many diagrams which were unnecessary to limit the size of the book. He was also
responsible to bring all the necessary changes in this new edition. It was kind of him to spare his valuable time
from family life and medical profession. shall be failing in my duty if don’t mention the name of Dr Talat
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Pervaiz for valuable suggestion and Dr Asif Qamar Rana to taking the responsibility to draw the diagram of
growth and development and taking the responsibility to publish the book to international standards. hope
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they won't let me down in this endeavor.
i shall be looking forward to students and doctors for valuable suggestion and necessary ratifications of our
shortfalls. Nobody is perfect except ALLAH almighty.
Prof. Dr. PervezAkber Khan
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fn
Prof AbdulBari. @ Prof Khawie am
Taceba
Bolan MedicalCollege, Quetta Lahore
Prof Jamal Rave:
LahoreGeneral Hospital DeanJPMC, Karachi
Prof
Iqtadar Kh
Dean MotherandChild Health.Aga Khan Hospital,
Karachi
KingEdwardMedicalCollege Lahore
ProfFazal.
Gomal MedicalCollege, Dera Ismail Khan
PunjabM.C Faisalabad
Peshawer
MMDC., Multan
ProfSalman
/
ProfQasim |a — ArmyMedical College, Rawalpindi.
oe
Quaid-i-Azam MedicalCollege, Bahawalpur
ProfFouziaZa
NMC, Multan
DeanChildrenHospital Multan
ProfSamiaNat
ProfMubarik Rawalpindi Medical College, Rawalpindi
ShaikhZayedRahimYarKhanMedical College
ProfTahir
Maso
ProfHuma Arshad Children Hospital & instituteofChild Health, Lahore.
Children’sHospital, Lahore
ProfTipu Sultan it LahoreGeneral Hospital, Lahore
Children’s Hospital, Lahore
Prof
Ayesha:
ProfShazia
Mai
Dr
Muhammad’
ChildrenHospital, Lahore
ProfWagarRabb
Sahiwal Medical College
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3133 History Taking and Physical {es Behavioral and Psychiatric Disorders 70
Examination
1 Pica 70
Nocturnal enuresis 70
History 1
Encopresis 72
Physical examination 3
Attention Deficit Hyperactivity Disorder
Neonatal! reflexes 11
(ADHD) 73
(ey, Growth and Development 15 Autism spectrum disorder (pervasive develop-
Growth 15 mental disorder) 74
Tic disorder 75
Development 17
Red flags in development 24 Anorexia nervosa and bulimia nervosa........... 76
Puberty and the tanner stages 24
Pediatric Nutrition and Nutritional
Growth charts 26
Disorders 77
Immunization 35
Nutritional requirements 77
Definition 35
Infant feeding 78
Vaccine 35
Breastfeeding 79
Immunglobulins 35
Artificial feeding 82
Vaccination schedule 35
Weaning 83
Precautions and recommendations 36
Micro-nutrients and Macro-nutrients 84
Conditionswhich arenotcontraindicated to
Vitamin A 84
immunization 36
Vitamin D 86
BCG vaccine 36
Vitamin E 87
Poliomyelitis vaccine 37
Vitamin K 87
Diphtheria, Tetnus, and Pertussis(DTaP)
Vitamin Br 88
vaccine 37
Folic acid 88
Measles, Mumps, Rubella (MMR) vaccine 38
Vitamin C 88
Measles immunization 38
lron 89
Hepatitis B vaccine 38 Zinc 90
Meningococcal vaccine 39
lodine 90
Haemophilus influenza type B vaccine 39
Malnutrition 90
Pneumococcal vaccine 40
Classifications 92
Typhoid vaccine 40
Marasmus 94
Cholera vaccine 40
Kwashiorkor 95
Hepatitis A vaccine 41
Obesity and overweight 101
Rotavirus vaccine 41
Influenza vaccine 4) Fluid and Electrolyte Disorder 103
Varicella vaccine 41 Maintenance fluid therapy 103
Rabies immunization 42
Dehydration and replacement therapy 103
Social and Preventive Pediatrics 44 Sodium disorders 104
4)
Pakistan statistical data 44 Potassium disorders 106
Acid-base disorders 107
Child rights 45
Child abuse 45
Acutely ill Child 111
Child neglect 47
Child labor 47 Anaphylaxis 1m
Shock N2
IMCI (Integrated Management of Childhood
48 Burn injuries N13
lllness)
IMCI_ tables 51 Foreign body inhalation and choking 115
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Drowning (submersion injury) 117 4 Infecti.ous Diseases 180
Head trauma (injury) 117 he+ Acute diarrhea 180
Cholera 186
Bal Neonatology 119
Shigellosis (bacillary dysentery) 188
Definitions nig Presistent diarrhea 189
History and examination of newborn infant... 119 Giardiasis 190
Neonatal resuscitation 121 Amebiasis 190
Care of the normal newborn infant 125 Typhoid (enteric) fever 191
Temperature regulation in newborn infant 125 Poliomyelitis 195
Hypothermia 126 Diphtheria 198
Hyperthermia 126 Pertussis (whooping cough) 202
Nutritional management ofthe newborn Tetanus
205
infant 127 Botulism 208
Total parenteral nutrition (TPN) 129 Measles 208
Birth asphyxia/Perinatal asphyxia 130 Mumps 212
Prematurity 133 Chickenpox (Varicella) 213
Causes of respiratory distress in the newborn infectious mononucleosis 216
infant 137 Malaria 217
Respiratory distress Syndrome (RDS) 138 Tuberculosis 221
Necrotizing Enterocolitis (NEC) 140 Rheumatic fever 229
Intraventricular Hemorrhage (IVH) 142 Dengue fever 234
Apnea 144 Leishmaniasis 236
Neonatal sepsis 145 Rabies 237
TORCH infections 148 Primary amebic meningoencephalitis
Toxoplasmosis 148 (Naegleria) 239
Rube a 149 Worm infestation (Helminthiasis) 240
Cytomegalovirus (CMV) 150
wi
Herpes Simplex Virus (HSV) 150 Respiratory Disorders 243
Tuberculosis 151 Choanal atresia 243
Hepatitis B virus 151 Acute Respiratory Infections (ARI) 243
Jaundice neonatorum 152 Acute pharyngitis 244
Unconjugated (indirect) Tonsils and adenoids 245
Hyperbilirubinemia 152 Acute epiglottitis 246
Conjugated (direct) Croup 247
Hyperbilirubinemia 159 Laryngomalacia 248
Post-term infant 160 Otitis media 248
Large for Gestational Age (LGA) infant 160 Bronchiolitis 250
Small for Gestational age infant (SGA) 161 Pneumonia 252
Meconium aspiration syndrome 162 Pleural effusion 256
Transient Tachypnea ofthe Newborn Bronchiecatasis 257
(TTN) 164 Pulmonary abscess 259
Hypoglycemia 165 Pneumothorax 259
Hypocalcemia 166 Asthma 260
Infant of Diabetic Mother (IDM) 167 Cystic fibrosis 266
Neonatal seizures 169
pea
Hemorrhagic disease of the newborn infant.. 171 te Gastrointestinal and Liver Disorders . 270
Anemia in newborn infant 172 Evaluation of a child with vomiting 270
Polycythemia in newborn infant 174 Gastroesophageal reflux disease 271
Neonatal thrombocytopenic purpura 175 Chronic diarrhea 272
Birth (trauma) injuries 177 Constipation 276
Neonatal conjunctivitis 178 Approach to abdominal pain 277
Peptic ulcer disease 278
Celiac disease 280
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inflammatory Bowel Disease (IBD) 282 Generalized Seizures 347
Hepatomegaly 284 Partial Seizures 349
Acute hepatitis 285 Epileptic Syndromes 351
Acute viral hepatitis 285 Management of Epilepsy 351
Hepatitis A 285 Status epilepticus 354
Hepatitis B 286 Headaches 356
Hepatitis C 288 Migraine 356
Hepatitis D 290 Tension headache 356
Hepatitis 290 Headacheswith increased intracranial
Hepatitis G 290 pressure 356
Fulminant hepatic failure 290 coma 356
Hepatic encephalopathy 291 Hydrocephalus 359
Autoimmune hepatitis 294 Dandy-Walkersyndrome
Cirrhosis 295 (malformation) 362
Portal hypertension and varices 296 Intracranial SpaceOccupying Lesion
Liver abscess 297 (SOL) 362
Ascites 298 Intracranial tumors 362
Wilson’s disease 299 Brain abscess 363
Cholecystitis 301 Pediatric stroke 365
Acute pancreatitis 301 Cerebral Palsy (CP) 366
Acute peritonitis 302 Mental retardation 370
it Microcephaly 372
Cardiovascular Disorders 305
Ataxia 373
Fetal and neonatal circulation 305 Neurofibromatosis (NF) 374
Congenital heart disease 305 Tuberous Sclerosis 375
Cyanotic heart disease 307 Sturge-Weber Syndrome (SWS) 375
Tetralogy of Fallot (TOF) 307 Multiple sclerosis 377
Transposition ofGreatArteries (TGA) 309
Ebstein anomaly 3i Neuro-Muscular Disorders 378
Total Anomalous Pulmonary Venous Duchenne muscular dystrophy 378
Drainage or Connections (TAPVC) 312 Myasthenia gravis 379
Truncus arteriosus 313 Fioppy infant 382
Tricuspid atresia 313 Spinal Muscular Atrophy (SMA) 383
Hypoplastic left heart syndrome 314 Degenerative disorders of CNS 383
Acyanotic heart disease 314 Sphingolipidoses 384
Ventricular Septal Defect (VSD) 314 Adreno-leukodystrophy 386
Patent Ductus Arteriosus (PDA) 316 Guillain-Barre Syndrome (GBS) 387
Atrial Septal Defect (ASD) 318 Bell's palsy 391
Aortic stenosis 319 Myotonic muscular dystrophy 392
Coarctation of aorta 319 Syringomyelia 393
Supraventriculartachycardia 320 Transverse myelitis 394
Congestive Cardiac Failure (CCF) 322
Hematologic Disorders 396
Infective endocarditis 325
Anemia 396
Cardiomyopathy 327
Myocarditis 328 Congenital Hypoplastic anemia 397
Diamond-Blackfan anemia 397
Neurologic Disorders 330 Transient erythroblastopenia of childhood 398
Pyogenic meningitis 330 Microcytic anemia 398
Tuberculous meningitis 336 (ron deficiency anemia 398
Beta-thalassemia 400
Encephaiitis 339
Cerebral malaria 342 Hereditary spherocytosis 403
Sickle cell anemia 404
Febrile convulsions 344
Epilepsy 346 Macrocytic megaloblastic anemia 405
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