Table Of Contenta LANGE medical book
CURRENT
Diagnosis & Treatment
Pediatrics
TWENTY-FOURTH EDITION
Edited by
William W. Hay, Jr., MD Robin R. Deterding, MD
Professor, Department of Pediatrics Professor, Department of Pediatrics
Section of Neonatology and Chief, Section of Pediatric Pulmonary Medicine
Division of Perinatal Medicine
University of Colorado School of Medicine and
University of Colorado School of Medicine Children’s Hospital Colorado
and Children’s Hospital Colorado
Medical Director, Breathing Institute Children’s
Hospital Colorado
Myron J. Levin, MD
Professor, Departments of Pediatrics and Medicine Mark J. Abzug, MD
Section of Pediatric Infectious Diseases Professor, Department of Pediatrics
University of Colorado School of Medicine Section of Pediatric Infectious Diseases
and Children’s Hospital Colorado
Associate Vice Chair for Academic Affairs,
Department of Pediatrics
University of Colorado School of Medicine and
Children’s Hospital Colorado
and Associate Authors
The Department of Pediatrics at the University of Colorado School of Medicine
is affiliated with Children’s Hospital Colorado.
New York Chicago San Francisco Athens London Madrid Mexico City Milan
New Delhi Singapore Sydney Toronto
Hay_FM_pi-xxxii.indd 1 30/03/18 11:40 AM
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Contents
Authors xix Esophageal Atresia & Tracheoesophageal
Preface xxix Fistula 48
Selected Highlighted Topics in the Intestinal Obstruction 49
24th Edition of CDT-P xxxi Abdominal Wall Defects 50
Diaphragmatic Hernia 51
1. Advancing the Quality Gastrointestinal Bleeding 51
& Safety of Care 1 Gastroesophageal Reflux 51
Infections in the Newborn Infant 52
Daniel Hyman, MD
Bacterial Infections 52
Introduction 1 Fungal Sepsis 55
Current Context 1 Congenital Infections 56
Strategies & Models for Perinatally Acquired Infections 58
Quality Improvement (QI) 4 Hematologic Disorders in the Newborn Infant 59
Principles of Patient Safety Bleeding Disorders 59
(Incident Reporting, Just Culture, Anemia 60
Disclosure, FMEA, RCA, Polycythemia 61
Reliability, Checklists) 7 Renal Disorders in the Newborn Infant 62
Renal Failure 62
2. The Newborn Infant 10 Urinary Tract Anomalies 62
Renal Vein Thrombosis 63
Danielle Smith, MD
Neurologic Problems in the Newborn Infant 63
Theresa Grover, MD
Seizures 63
Introduction 10 Intracranial Hemorrhage 64
The Neonatal History 10 Metabolic Disorders in the Newborn Infant 65
Assessment of Growth & Gestational Age 10 Hyperglycemia 65
Examination at Birth 12 Hypocalcemia 65
Examination in the Nursery 13 Inborn Errors of Metabolism 66
Care of the Well Neonate 15 Quality Assessment & Improvement
Feeding the Well Neonate 15 in the Newborn Nursery & NICU 66
Early Discharge of the Newborn Infant 17
Hearing Screening 18 3. Child Development & Behavior 67
Common Problems in the Term Newborn 18
Edward Goldson, MD
Neonatal Jaundice 18
Ann Reynolds, MD
Hypoglycemia 25
Respiratory Distress in the Term Introduction 67
Newborn Infant 26 Normal Development 67
Heart Murmurs 28 The First 2 Years 67
Birth Trauma 28 Ages 2–4 Years 73
Infants of Mothers Who Abuse Drugs 29 Early School Years: Ages 5–7 Years 74
Multiple Births 31 Middle Childhood: Ages 7–11 Years 74
Neonatal Intensive Care 32 Behavioral & Developmental Variations 74
Perinatal Resuscitation 32 Normality & Temperament 74
The Preterm Infant 36 Enuresis & Encopresis 75
The Late Preterm Infant 45 Enuresis 75
Cardiac Problems in the Newborn Infant 46 Encopresis 76
Structural Heart Disease 46 Common Developmental Concerns 77
Persistent Pulmonary Hypertension 47 Colic 77
Arrhythmias 48 Feeding Disorders in Infants &
Gastrointestinal & Abdominal Surgical Young Children 79
Conditions in the Newborn Infant 48 Sleep Disorders 80
iii
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iv Contents
Parasomnias 81 Predicting the Progression from
Insomnia 81 use to Abuse 148
Sleep-Disordered Breathing 82 Evaluation of Substance Abuse 149
Restless Legs Syndrome & Periodic Treatment & Referral 152
Limb Movement Disorder 82 Prevention 154
Temper Tantrums & Breath-Holding Spells 83 References 155
Well-Child Surveillance & Screening 85
Developmental Disorders 85 6. Eating Disorders 156
Attention-Deficit/Hyperactivity Disorder 87
Eric J. Sigel, MD
Autism Spectrum Disorders 89
Intellectual Disability 93 Introduction 156
Specific Forms of Intellectual Disability & Etiology 156
Associated Treatment Issues 95 Incidence 157
References 97 Predisposing Factors & Clinical Profiles 157
Anorexia Nervosa 157
4. Adolescence 98 Bulimia Nervosa 163
Binge-Eating Disorder 165
Amy E. Sass, MD, MPH
Avoidant/Restrictive Food Intake Disorder 166
Molly J. Richards, MD
Prognosis, Quality Assessment,
Introduction 98 & Outcomes Metrics 166
Epidemiology 98 Resources for Practitioners & Families 167
Mortality Data 98
Morbidity Data 98 7. Child & Adolescent Psychiatric
Providing a Medical Home for Adolescents 99 Disorders & Psychosocial Aspects
Relating to the Adolescent Patient 100 of Pediatrics 168
The Structure of the Visit 101
Adam Burstein, DO
Guidelines for Adolescent Preventive Services 107
Kimberly Kelsay, MD
Adolescent Screening 107
Ayelet Talmi, PhD
Promoting Healthy Behaviors 108
Transition to Adult Care 112 Introduction 168
Growth & Development 114 Models of Care Encompassing
Puberty 114 Behavioral Health in the
Physical Growth 114 Primary Care Setting 169
Sexual Maturation 114 Prevention, Early Identification, &
Psychosocial Development 115 Developmental Context 170
Adolescent Gynecology & Lifestyle Recommendations 171
Reproductive Health 117 Identification & Assessment During Health
Breast Examination 117 Supervision Visits 171
Breast Masses 118 Psychiatric Disorders of Childhood
Nipple Discharge & Galactorrhea 119 & Adolescence 180
Gynecomastia 120 Anxiety Disorders 181
Gynecologic Disorders in Adolescence 122 Obsessive-Compulsive & Related Disorders 189
Contraception 132 Attention-Deficit/Hyperactivity Disorder 192
Pregnancy 139 Mood Disorders 196
Suicide in Children & Adolescents 202
5. Adolescent Substance Abuse 142 Disruptive, Impulse-Control
& Conduct Disorders 204
Paritosh Kaul, MD
High-Risk Patients & Homicide 205
Scope of the Problem 142 Somatic Symptom & Related Disorders 207
Morbidity Data 147 Adjustment Disorders 209
Psychotic Disorders 209
Other Psychiatric Conditions 212
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Contents v
8. Child Abuse & Neglect 213 Vaccination in Special Circumstances 254
Hepatitis B Vaccination 255
Antonia Chiesa, MD
Rotavirus Vaccination 258
Andrew P. Sirotnak, MD
Diphtheria-Tetanus-Acellular
Introduction 213 Pertussis Vaccination 259
Prevention 214 Haemophilus Influenzae Type B
Clinical Findings 214 Vaccination 261
Differential Diagnosis 220 Pneumococcal Vaccination 262
Treatment 220 Poliomyelitis Vaccination 264
Prognosis 221 Influenza Vaccination 265
Measles, Mumps, & Rubella Vaccination 266
9. Ambulatory & Office Pediatrics 222 Varicella Vaccination 268
Hepatitis A Vaccination 270
Meghan Treitz, MD
Meningococcal Vaccination 271
Daniel Nicklas, MD
Tetanus-Reduced Diphtheria-Acellular
Maya Bunik, MD, MSPH
Pertussis Vaccination
David Fox, MD
(Adolescents & Adults) 273
Introduction 222 Human Papillomavirus Vaccination 273
Pediatric History 222 Vaccinations for Special Situations 274
Pediatric Physical Examination 224 Rabies Vaccination 274
Health Supervision Visits 225 Typhoid Fever Vaccination 276
Developmental & Behavioral Assessment 225 Cholera Vaccination 277
Growth Parameters 228 Japanese Encephalitis Vaccination 277
Blood Pressure 229 Tuberculosis Vaccination 277
Vision & Hearing Screening 230 Yellow Fever Vaccination 278
Anticipatory Guidance 234 Passive Prophylaxis 278
Nutrition Counseling 235
Counseling About Television & 11. Normal Childhood Nutrition
Other Media 236 & Its Disorders 280
Immunizations 237
Acute-Care Visits 237 Matthew A. Haemer, MD, MPH
Prenatal Visits 238 Laura E. Primak, RD, CNSD
Sports Physicals 238 Nancy F. Krebs, MD, MS
Chronic Disease Management 238 Nutritional Requirements 280
Medical Home 239 Nutrition & Growth 280
Mental & Behavioral Health 239 Energy 280
Telephone Management & Web-Based Protein 281
Information 240 Lipids 282
Advocacy & Community Pediatrics 240 Carbohydrates 283
Common General Pediatric Issues 241 Major Minerals 284
Fever 241 Trace Elements 284
Growth Deficiency 243 Vitamins 284
Infant Feeding 288
10. Immunization 245 Breast-Feeding 288
Special Dietary Products for Infants 295
Matthew F. Daley, MD
Nutrition for Children 2 Years & Older 296
Sean T. O’Leary, MD, MPH
Pediatric Undernutrition 297
Ann-Christine Nyquist, MD, MSPH
Pediatric Overweight & Obesity 298
Standards for Pediatric Immunization Nutrition Support 302
Practices 246 Enteral 302
Routine Childhood & Adolescent Immunization Parenteral Nutrition 303
Schedules 247 Nutrient Requirements & Delivery 304
Vaccine Safety 247
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vi Contents
12. Emergencies & Injuries 309 Barbiturates & Benzodiazepines 342
Belladonna Alkaloids (Atropine, Jimsonweed,
Kevin P. Carney, MD
Potato Leaves, Scopolamine, Stramonium) 342
Kelley Roswell, MD
b-Blockers & Calcium Channel Blockers 343
Introduction to Pediatric Carbon Monoxide 343
Emergencies & Injuries 309 Caustics 344
Initial Approach to the Acutely Ill Central a-Adrenergic Agonist 344
2
Infant or Child 309 Cocaine 345
The ABCs of Resuscitation 310 Cosmetics & Related Products 345
Management of Shock 314 Cyclic Antidepressants 345
Summary of Initial Approach to the Digitalis & Other Cardiac Glycosides 346
Acutely Ill Infant or Child 315 Diphenoxylate with Atropine
Emergency Pediatric Drugs 316 (Lomotil) & Loperamide (Imodium) 346
Approach to the Pediatric Trauma Patient 316 Disinfectants & Deodorizers 347
Mechanism of Injury 317 Disk-Shaped “Button” Batteries 347
Initial Assessment & Management 317 Ethylene Glycol & Methanol 348
Primary Survey 317 g-Hydroxybutyrate, g-Butyrolactone,
Secondary Survey 319 Butanediol, Flunitrazepam, & Ketamine 348
Head Injury 321 Hydrocarbons (Benzene, Charcoal
Burns 323 Lighter Fluid, Gasoline, Kerosene,
Thermal Burns 323 Petroleum Distillates, Turpentine) 349
Electrical Burns 325 Ibuprofen 349
Disorders due to Extremes of Environment 326 Insect Stings (Bee, Wasp, & Hornet) 349
Heat-Related Illnesses & Heat Stroke 326 Insecticides 349
Hypothermia 326 Iron 350
Submersion Injuries 327 Lead 351
Lacerations 328 Magnets 352
Animal & Human Bites 329 Marijuana 352
Dog Bites 329 Mushrooms 352
Cat Bites 330 Nitrites, Nitrates, Aniline,
Human Bites 330 Pentachlorophenol, & Dinitrophenol 353
Pain Management & Procedural Sedation 330 Opioids & Opiates 353
Oral Anti-Diabetics
13. Poisoning 332 (Sulfonylureas, Metformin) 354
Antipsychotics (Typical & Atypical) 355
Richard C. Dart, MD, PhD
Plants 355
Barry H. Rumack, MD
Psychotropic Drugs 355
George Sam Wang, MD
Salicylates 357
Introduction 332 Scorpion Stings 358
Pharmacologic Principles of Toxicology 332 Serotonin Reuptake Inhibitors 358
Preventing Childhood Poisonings 333 Snakebite 358
General Treatment of Poisoning 333 Soaps & Detergents 359
Initial Telephone Contact 333 Spider Bites 360
Initial Emergency Department Contact 336 Vitamins 360
Definitive Therapy of Poisoning 336 Warfarin (Coumadin) & Newer Oral
Management of Specific Common Poisonings 337 Anticoagulants (NOAC) 361
Acetaminophen (Paracetamol) 337
Alcohol, Ethyl (Ethanol) 339
Amphetamines & Related Drugs
(Stimulants, Methamphetamine, MDMA) 340
Anesthetics, Local 340
Antihistamines & Cough & Cold
Preparations 341
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Contents vii
14. Critical Care 362 Fungal Infections of the Skin 409
Viral Infections of the Skin 410
Todd C. Carpenter, MD
Virus-Induced Tumors 411
Amy Clevenger, MD, PhD
Insect Infestations 412
Angela S. Czaja, MD, MSc
Dermatitis (Eczema) 412
Eva N. Grayck, MD
Common Skin Tumors 415
Cameron F. Gunville, DO
Papulosquamous Eruptions 416
Leslie Ridall, DO
Hair Loss (Alopecia) 417
Carleen Zebuhr, MD
Reactive Erythemas 418
Introduction 362 Miscellaneous Skin Disorders Seen
Respiratory Critical Care 362 in Pediatric Practice 418
Acute Respiratory Failure 362
Conventional Mechanical Ventilation 366 16. Eye 420
Other Modes of Respiratory Support 369
Jennifer Lee Jung, MD
Major Respiratory Diseases in the
Rebecca Sands Braverman, MD
Pediatric ICU 370
Acute Respiratory Distress Syndrome 370 Introduction 420
Status Asthmaticus 373 Common Nonspecific Signs & Symptoms 420
Cardiovascular Critical Care 376 Red Eye 420
Shock 376 Tearing 420
Sepsis 379 Discharge 420
Neurocritical Care 383 Pain & Foreign Body Sensation 420
Traumatic Brain Injury 383 Photophobia 420
Hypoxic-Ischemic Encephalopathy 387 Leukocoria 421
Acute Kidney Injury & Renal Replacement Refractive Errors 421
Therapy 388 Myopia (Nearsightedness) 422
Fluid Management & Nutritional Support Hyperopia (Farsightedness) 422
of the Critically Ill Child 389 Astigmatism 422
Sedation & Analgesia in the Pediatric ICU 391 Ophthalmic Examination 422
End-of-Life Care & Death in the PICU 395 History 422
Quality Improvement Initiatives Visual Acuity 422
in the PICU 398 External Examination 423
Pupils 424
15. Skin 399 Alignment & Motility Evaluation 424
Ophthalmoscopic Examination 425
Lori D. Prok, MD
Ocular Trauma 426
Carla X. Torres-Zegarra, MD
Ocular Foreign Bodies 426
General Principles 399 Corneal Abrasion 427
Diagnosis of Skin Disorders 399 Intraocular Foreign Bodies & Perforating
Treatment of Skin Disorders 399 Ocular Injuries 428
Disorders of the Skin in Newborns 401 Blunt Orbital Trauma 429
Transient Diseases in Newborns 401 Lacerations 429
Pigment Cell Birthmarks, Nevi, Burns 430
& Melanoma 402 Hyphema 431
Melanocytic Nevi 402 Abusive Head Trauma & Nonaccidental
Vascular Birthmarks 403 Trauma 432
Epidermal Birthmarks 404 Prevention of Ocular Injuries 432
Connective Tissue Birthmarks Disorders of the Ocular Structures 433
(Juvenile Elastoma, Collagenoma) 404 Diseases of the Eyelids 433
Hereditary Skin Disorders 405 Viral Eyelid Disease 434
Common Skin Diseases in Infants, Miscellaneous Eyelid Infections 435
Children, & Adolescents 406 Eyelid Ptosis 435
Acne 406 Horner Syndrome 436
Bacterial Infections of the Skin 408 Eyelid Tics 437
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viii Contents
Disorders of the Nasolacrimal System 437 17. Oral Medicine & Dentistry 466
Nasolacrimal Duct Obstruction 437
Ulrich Klein, DMD, DDS, MS
Congenital Dacryocystocele 438
Roopa P. Gandhi, BDS, MSD
Dacryocystitis 438
Camille V. Gannam, DMD, MS
Diseases of the Conjunctiva 439
Ophthalmia Neonatorum 439 Issues in Pediatric Oral Health 466
Bacterial Conjunctivitis 440 Oral Examination of Children 467
Viral Conjunctivitis 440 Eruption of the Teeth 469
Allergic Conjunctivitis 441 Dental Caries 471
Mucocutaneous Diseases 442 Periodontal Disease 473
Disorders of the Iris 443 Dental Emergencies 474
Iris Coloboma 443 Special Patient Populations 475
Aniridia 444 Orthodontic Referral 477
Albinism 444
Miscellaneous Iris Conditions 445 18. Ear, Nose, & Throat 478
Glaucoma 445
Patricia J. Yoon, MD
Uveitis 445
Melissa A. Scholes, MD
Anterior Uveitis/Iridocyclitis/Iritis 446
Norman R. Friedman, MD
Posterior Uveitis 446
Intermediate Uveitis 447 The Ear 478
Disorders of the Cornea 448 Infections of the Ear 478
Cloudy Cornea 448 Acute Trauma to the Middle Ear 488
Viral Keratitis 448 Ear Canal Foreign Body &
Corneal Ulcers 449 Cerumen Impaction 488
Disorders of the Lens 450 Auricular Hematoma 489
Cataracts 450 Congenital Ear Malformations 489
Dislocated Lenses/Ectopia Lentis 450 Identification & Management of
Disorders of the Retina 451 Hearing Loss 489
Retinal Hemorrhages in the Newborn 451 The Nose & Paranasal Sinuses 492
Retinopathy of Prematurity 451 Acute Viral Rhinitis 492
Retinoblastoma 452 Rhinosinusitis 493
Retinal Detachment 453 Choanal Atresia 495
Diabetic Retinopathy 454 Recurrent Rhinitis 495
Diseases of the Optic Nerve 454 Epistaxis 496
Optic Neuropathy 454 Nasal Infection 497
Optic Nerve Hypoplasia 455 Nasal Trauma 497
Papilledema 456 Foreign Bodies in the Nose 497
Optic Neuritis 457 The Throat & Oral Cavity 497
Optic Atrophy 458 Acute Stomatitis 497
Diseases of the Orbit 458 Pharyngitis 498
Periorbital & Orbital Cellulitis 458 Peritonsillar Cellulitis or Abscess (Quinsy) 501
Craniofacial Anomalies 459 Retropharyngeal Abscess 501
Orbital Tumors 459 Ludwig Angina 501
Nystagmus 460 Acute Cervical Adenitis 502
Amblyopia 461 Snoring, Mouth Breathing, & Upper Airway
Strabismus 462 Obstruction 503
Unexplained Decreased Vision Tonsillectomy & Adenoidectomy 505
in Infants & Children 464 Disorders of the Lips 506
Learning Disabilities & Dyslexia 464 Disorders of the Tongue 506
Halitosis 506
Salivary Gland Disorders 507
Congenital Oral Malformations 507
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Contents ix
19. Respiratory Tract & Mediastinum 509 Congenital Malformations
of the Lung Parenchyma 529
Monica J. Federico, MD
Pulmonary Agenesis & Hypoplasia 529
Christopher D. Baker, MD
Pulmonary Sequestration 530
Emily M. Deboer, MD
Congenital Lobar Overinflation 531
Ann C. Halbower, MD
Congenital Pulmonary Airway Malformation
Oren Kupfer, MD
(Cystic Adenomatoid Malformation) 532
Stacey L. Martiniano, MD
Acquired Abnormalities of the Lung
Scott D. Sagel, MD
Parenchyma 533
Paul Stillwell, MD
Bronchopulmonary Dysplasia 533
Edith T. Zemanick, MD
Community-Acquired Bacterial Pneumonia 534
Michelle Caraballo, MD
Parapneumonic Effusion & Empyema 536
Stephen Hawkins, MD, DO
Atypical Pneumonias 537
Respiratory Tract 509 Viral Pneumonia 537
Growth & Development 509 Bronchiolitis 538
Diagnostic Aids 510 Mycoplasma Pneumonia 539
Physical Examination of the Aspiration Pneumonia 540
Respiratory Tract 510 Pneumonia in the Immunocompromised
Pulmonary Function Tests 510 Host 541
Assessment of Oxygenation & Ventilation 511 Lung Abscess 542
Diagnosis of Respiratory Tract Infections 512 Bronchiolitis Obliterans 543
Imaging of the Respiratory Tract 514 Children’s Interstitial Lung Disease
Laryngoscopy & Bronchoscopy 515 Syndrome 544
General Therapy for Pediatric Lung Diseases 515 Hypersensitivity Pneumonitis 545
Oxygen Therapy 515 Diseases of the Pulmonary Circulation 546
Inhalation of Medications 516 Pulmonary Hemorrhage 546
Airway Clearance Therapy 516 Pulmonary Embolism 548
Avoidance of Environmental Hazards 517 Pulmonary Edema 549
Disorders of the Conducting Airways 517 Congenital Pulmonary Lymphangiectasia 549
Laryngomalacia & Congenital Disorders Disorders of the Chest Wall 550
of the Extrathoracic Airway 518 Scoliosis 550
Laryngomalacia 518 Pectus Carinatum 550
Other Causes of Congenital Extrathoracic Pectus Excavatum 550
Obstruction 518 Neuromuscular Disorders & Lung Disease 551
Acquired Disorders of the Disorders of the Pleura & Pleural Cavity 551
Extrathoracic Airway 519 Hemothorax 552
Foreign Body Aspiration in the Chylothorax 552
Extrathoracic Airway 519 Pneumothorax & Related Air Leak
Croup Syndromes 520 Syndromes 552
Vocal Fold Immobility 522 Mediastinum 553
Subglottic Stenosis 522 Mediastinal Masses 553
Congenital Causes of Intrathoracic Airway Sleep-Disordered Breathing 554
Obstruction 523 Obstructive & Central Sleep Apnea 554
Malacia of Airways 523 Apparent Life-Threatening Events 555
Vascular Rings & Slings 524 Sudden Unexpected Infant Death &
Bronchogenic Cysts 524 Sudden Infant Death Syndrome 558
Acquired Causes of Intrathoracic Quality Assessment & Outcomes Metrics 559
Airway Obstruction 525
Foreign Body Aspiration in the
Intrathoracic Airway 525
Disorders of Mucociliary Clearance 525
Cystic Fibrosis 526
Primary Ciliary Dyskinesia 527
Bronchiectasis 528
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