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a LANGE medical book CURRENT Diagnosis & Treatment Pediatrics NINETEENTH EDITION Edited by William W. Hay, Jr., MD Professor, Department of Pediatrics Section of Neonatology and the Division of Perinatal Medicine University of Colorado School of Medicine and The Children’s Hospital, Denver Myron J. Levin, MD Professor, Departments of Pediatrics and Medicine Section of Pediatric Infectious Diseases University of Colorado School of Medicine and The Children’s Hospital, Denver Judith M. Sondheimer, MD Professor Emeritus, Department of Pediatrics Section of Pediatric Gastroenterology, Hepatology, and Nutrition University of Colorado School of Medicine and The Children’s Hospital, Denver Robin R. Deterding, MD Professor, Department of Pediatrics Section of Pediatric Pulmonary Medicine University of Colorado School of Medicine and The Children’s Hospital, Denver and Associate Authors The Department of Pediatrics at the University of Colorado School of Medicine is affiliated with The Children’s Hospital of Denver. New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. 0-07-164136-X The material in this eBook also appears in the print version of this title: 0- 07-154433-X. All trademarks are trademarks of their respective owners. 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If you’d like more information about this book, its author, or related books and websites, please click here. For more information about this title, click here Contents Authors x 4. Adolescent Substance Abuse 137 Preface xviii Paritosh Kaul, MD 1. The Newborn Infant 1 Scope of the Problem 137 Morbidity Data 141 Elizabeth H. Thilo, MD, & Adam A. Rosenberg, MD Supplement Use & Abuse 142 The Neonatal History 1 Response to the Problem 143 Care of the Well Neonate 7 Predicting the Progression from Use to Abuse 143 Common Problems in the Term Newborn 10 Management of Substance Abuse 144 Neonatal Intensive Care 25 Treatment & Referral 147 Cardiac Problems in the Newborn Infant 41 Prevention 150 Gastrointestinal & Abdominal Surgical Conditions in the Newborn Infant 43 5. Eating Disorders 152 Infections in the Newborn Infant 46 Eric J. Sigel, MD Hematologic Disorders in the Newborn Infant 55 Renal Disorders in the Newborn Infant 57 Etiology 152 Neurologic Problems in the Newborn Infant 59 Incidence 153 Metabolic Disorders in the Newborn Infant 60 Predisposing Factors 153 Anorexia Nervosa 154 2. Child Development & Behavior 63 Bulimia Nervosa 159 Eating Disorder Not Otherwise Specified 162 Edward Goldson, MD, & Ann Reynolds, MD Prognosis 162 Normal Development 63 The First 2 Years 63 6. Child & Adolescent Psychiatric Disorders Ages 2–4 Years 80 & Psychosocial Aspects of Pediatrics 163 Early School Years: Ages 5–7 Years 81 Brian Stafford, MD, MPH, Jennifer Hagman, MD, Middle Childhood: Ages 7–11 Years 81 & Bert Dech, MD Behavioral & Developmental Variations 81 Normality & Temperament 82 Mental Health in the Primary Care Setting 163 Common Developmental Concerns 83 Early Identification & Prevention of Colic 83 Developmental & Socioemotional Feeding Disorders 84 Problems 164 Sleep Disorders 85 Identification & Assessment during Health Temper Tantrums & Breath-holding Spells 88 Maintenance Visits 165 Well Child Surveillance & Screening 89 Consultation-Liaison Psychiatry 172 Developmental Disorders 90 Psychiatric Disorders of Childhood Attention-Deficit/Hyperactivity Disorder 91 & Adolescence 176 Autism Spectrum Disorders 93 Pervasive Developmental Disorders Intellectual Disability/Mental Retardation 95 & Autism 177 Mood Disorders 180 3. Adolescence 101 Suicide 184 Adjustment Disorders 185 David W. Kaplan, MD, MPH, Schizophrenia 186 & Kathryn A. Love-Osborne, MD Conduct Disorders 187 Guidelines for Adolescent Preventive Services 103 Anxiety Disorders 189 Growth & Development 109 Obsessive-Compulsive Disorder 191 Behavior & Psychological Health 113 Post-Traumatic Stress Disorder 192 Breast Disorders 118 Somatoform Disorders 194 Gynecologic Disorders in Adolescence 120 Elimination Disorders 195 iii iv (cid:2) CONTENTS Overview of Pediatric Psychopharmacology 197 Burns 307 ADHD Medications 198 Disorders Due to Altered Environmental Antidepressents 200 Temperature 308 Mood Stabilizers & Atypical Antipsychotics 203 Submersion Injuries 310 Antipsychotics 205 Animal & Human Bites 311 Adrenergic Agonists 207 Procedural Sedation & Analgesia (PSA) 311 7. Child Abuse & Neglect 209 12. Poisoning 313 Andrew P. Sirotnak, MD, Richard D. Krugman, MD, Barry H. Rumack, MD, & Richard C. Dart, MD, PhD & Antonia Chiesa, MD Pharmacologic Principles of Toxicology 313 Forms of Child Maltreatment 209 Preventing Childhood Poisonings 314 Recognition of Abuse & Neglect 210 General Treatment of Poisoning 314 Management & Reporting 213 Management of Specific Common Poisonings 318 Prevention 214 Acetaminophen (Paracetamol) 318 Alcohol, Ethyl (Ethanol) 319 8. Ambulatory & Community Pediatrics 216 Amphetamines & Related Drugs 321 Anesthetics, Local 321 Robert M. Brayden, MD, Maya Bunik MD, MSPH, Antihistamines 321 Jeffrey M. Brown, MD, MPH, CPE, Arsenic 322 & Matthew F. Daley, MD Barbiturates 322 Pediatric History 216 Belladonna Alkaloids 322 Pediatric Physical Examination 217 Carbon Monoxide 323 Health Supervision Visits 219 Caustics 323 Other Types of General Pediatric Services 229 Cocaine 324 Common General Pediatric Issues 232 Contraceptive Pills 324 Cosmetics & Related Products 324 9. Immunization 236 Cyclic Antidepressants 325 Digitalis & Other Cardiac Glycosides 325 Matthew F. Daley, MD, Diphenoxylate with Atropine (Lomotil) Eric A. F. Simoes, MB, BS, DCH, MD, & Loperamide (Imodium) 325 & Ann-Christine Nyquist, MD, MSPH Disinfectants & Deodorizers 326 Standards for Pediatric Immunization Practices 236 Disk-Shaped Batteries 326 Routine Childhood & Adolescent Ethylene Glycol & Methanol 327 Immunizations 238 Gamma-Hydroxybutyrate, Gamma- Safe Handling of Vaccines 238 Butyrolactone, & Butanediol 327 Vaccinations for Special Situations 263 Hydrocarbons (Benzene, Charcoal Passive Prophylaxis 266 Lighter Fluid, Gasoline, Kerosene, Petroleum Distillates, Turpentine) 327 10. Normal Childhood Nutrition Ibuprofen 328 & Its Disorders 268 Insect Stings (Bee, Wasp, & Hornet) 328 Nancy F. Krebs, MD, MS, Insecticides 328 & Laura E. Primak, RD, CNSD, CSP Iron 329 Nutritional Requirements 268 Lead 330 Infant Feeding 275 Magnets 330 Nutrition for the Older Child 282 Mushrooms 330 Pediatric Under- & Overnutrition 283 Nitrites, Nitrates, Aniline, Nutrition Support 286 Pentachlorophenol, & Dinitrophenol 331 Opioids (Codeine, Heroin, Methadone, 11. Emergencies & Injuries 294 Morphine, Propoxyphene) 331 Phenothiazines (Chlorpromazine, Maria J. Mandt, MD, & Glenn Faries, MD Prochlorperazine, Trifluoperazine) 332 Advanced Life Support for Infants & Children 294 Plants 332 Approach to the Seriously Ill Child 299 Psychotropic Drugs 332 Approach to the Pediatric Trauma Patient 301 Salicylates 334 Head Injury 306 Scorpion Stings 335 CONTENTS (cid:2) v Serotonin Reuptake Inhibitors 335 Diseases of the Conjunctiva 408 Snakebite 335 Disorders of the Iris 411 Soaps & Detergents 336 Glaucoma 412 Spider Bites 337 Uveitis 413 Thyroid Preparations (Thyroid Dessicated, Ocular Manifestations of Acquired Sodium Levothyroxine) 337 Immunodeficiency Syndrome 414 Vitamins 337 Disorders of the Cornea 415 Warfarin 337 Disorders of the Lens 416 Disorders of the Retina 417 13. Critical Care 339 Diseases of the Optic Nerve 419 Diseases of the Orbit 421 Todd C. Carpenter, MD, Emily L. Dobyns, MD, Nystagmus 422 Eva N. Grayck, MD, Peter M. Mourani, MD, Amblyopia & Strabismus 423 & Kurt R. Stenmark, MD Unexplained Decreased Vision in Infants Acute Respiratory Failure 339 & Children 425 Mechanical Ventilation 343 The Blind Child 425 Acute Respiratory Distress Syndrome 345 Learning Disabilities & Dyslexia 426 Indications for Central Venous & Arterial Cannulation 350 16. Oral Medicine & Dentistry 427 Brain Injury & Cerebral Edema 353 Ulrich Klein, DMD, DDS, MS Ethical Deliberation & End-of-Life Care in the PICU 355 Issues in Pediatric Oral Health 427 Nutritional Support of the Critically Ill Child 357 Oral Examination of the Newborn & Infant 428 Asthma (Life-Threatening) 361 Eruption of the Teeth 430 Shock 364 Dental Caries 431 Pain & Anxiety Control 371 Periodontal Disease 432 Orofacial Trauma 433 14. Skin 375 Dental Emergencies 434 Antibiotics in Pediatric Dentistry 434 Joseph G. Morelli, MD, & Joanna M. Burch, MD Special Patient Populations 434 General Principles 375 Maternal-Fetal Relationship 435 Disorders of the Skin in Newborns 376 Dental & Orthodontic Referral 435 Transient Diseases 376 17. Ear, Nose, & Throat 437 Birthmarks, Nevi, & Melanoma 378 Common Skin Diseases in Infants, Children, Peggy E. Kelley, MD, Norman R. Friedman, MD, & Adolescents 381 & Patricia J. Yoon, MD Acne 381 The Ear 437 Bacterial Infections 383 The Nose & Paranasal Sinuses 453 Fungal Infections 384 The Throat & Oral Cavity 459 Viral Infections 385 Insect Infestations 387 18. Respiratory Tract & Mediastinum 471 Dermatitis (Eczema) 388 Common Skin Tumors 390 Gwendolyn S. Kerby, MD, Robin R. Deterding, MD, Papulosquamous Eruptions 391 Vivek Balasubramaniam, MD, Scott D. Sagel, MD, Hair Loss 392 Keith L. Cavanaugh, MD, & Monica J. Federico, MD Reactive Erythemas 393 Respiratory Tract 471 Growth & Development 471 15. Eye 395 Diagnostic Aids 472 General Therapy of Pediatric Lung Diseases 475 Rebecca Sands Braverman, MD Disorders of the Conducting Airways 476 Common Nonspecific Signs & Symptoms 395 Stridor & Noisy Breathing from Congenital Refractive Errors 396 Disorders of the Extrathoracic Airway 477 Ophthalmic Examination 397 Stridor & Noisy Breathing from Acquired Ocular Trauma 400 Disorders of the Extrathoracic Airway 478 Disorders of the Ocular Structures 404 Congenital Disorders of the Intrathoracic Airways 481 Disorders of the Nasolacrimal System 407 Acquired Disorders of the Intrathoracic Airways 482 vi (cid:2) CONTENTS Disorders of Mucociliary Clearance 485 α-Antitrypsin Deficiency Liver Disease 630 1 Congenital Malformations of the Lung 491 Wilson Disease (Hepatolenticular Degeneration) 631 Acquired Disorders Involving Alveoli 494 Cirrhosis 633 Diseases of the Pulmonary Circulation 506 Portal Hypertension 634 Disorders of the Chest Wall 509 Biliary Tract Disease 637 Sleep-Disordered Breathing 513 Pyogenic & Amebic Liver Abscess 641 Apparent Life-Threatening Events in Infancy 514 Hepatoma 642 Mediastinum 517 Liver Transplantation 644 Pancreatic Disorders 644 19. Cardiovascular Diseases 519 Acute Pancreatitis 644 Chronic Pancreatitis 645 Henry M. Sondheimer, MD, Jeffrey R. Darst, MD, Gastrointestinal & Hepatobiliary Elizabeth M. Shaffer, MD, & Shelley D. Miyamoto, MD Manifestations of Cystic Fibrosis 646 Diagnostic Evaluation 519 Syndromes with Pancreatic Exocrine Perinatal & Neonatal Circulation 528 Insufficiency 649 Heart Failure 529 Isolated Exocrine Pancreatic Enyme Defect 649 Acyanotic Congenital Heart Disease 531 Pancreatic Tumors 649 Cyanotic Congenital Heart Disease 545 Acquired Heart Disease 554 22. Kidney & Urinary Tract 651 Cardiac Transplantation 564 Primary Pulmonary Hypertension 566 Gary M. Lum, MD Disorders of Rate & Rhythm 567 Evaluation of the Kidney & Urinary Tract 651 Congenital Anomalies of the Urinary Tract 655 20. Gastrointestinal Tract 577 Hematuria & Glomerular Disease 656 Proteinuria & Renal Disease 658 Judith M. Sondheimer, MD, Diseases of the Renal Vessels 660 & Shikha Sundaram, MD, MSCI Renal Failure 661 Disorders of the Esophagus 577 Inherited or Developmental Defects of the Kidney 667 Disorders of the Stomach & Duodenum 580 Urinary Tract Infections 670 Disorders of the Small Intestine 583 Disorders of the Colon 587 23. Neurologic & Muscular Disorders 673 Disorders of the Peritoneal Cavity 591 Paul G. Moe, MD, Timothy A. Benke, MD, PhD, Gastrointestinal Tumors & Malignancies 592 Tim J. Bernard, MD, & Paul Levisohn, MD Major Gastrointestinal Symptoms & Signs 593 Malabsorption Syndromes 600 Neurologic Assessment & Neurodiagnostic Inflammatory Bowel Disease 605 Procedures 673 Disorders Affecting the Nervous System 21. Liver & Pancreas 609 in Infants & Children 679 Infections & Inflammatory Disorders of the Ronald J. Sokol, MD, & Michael R. Narkewicz, MD Central Nervous System 728 Liver Disorders 609 Disorders of Childhood Affecting Muscles 736 Prolonged Neonatal Cholestatic Jaundice 609 Miscellaneous Neuromuscular Disorders 745 Intrahepatic Cholestasis 609 Progressive Familial Intrahepatic Cholestasis 24. Orthopedics 750 (Byler Disease) 617 Extrahepatic Neonatal Cholestasis 617 John D. Polousky, MD, & Robert E. Eilert, MD Other Neonatal Hyperbilirubinemic Conditions Disturbances of Prenatal Origin 750 (Noncholestatic Nonhemolytic) 619 Growth Disturbances of the Musculoskeletal Hepatitis A 621 System 754 Hepatitis B 623 Degenerative Problems (Arthritis, Bursitis, Hepatitis C 625 & Tenosynovitis) 757 Hepatitis D (Delta Agent) 626 Trauma 757 Hepatitis E 626 Infections of the Bones & Joints 760 Other Hepatitis Viruses 626 Vascular Lesions & Avascular Necrosis Acute Liver Failure (Fulminant Hepatic Failure) 627 (Osteochondroses) 762 Autoimmune Hepatitis 628 Neurologic Disorders Involving the Nonalcoholic Fatty Liver Disease 629 Musculoskeletal System 764 CONTENTS (cid:2) vii Neoplasia of the Musculoskeletal System 764 29. Neoplastic Disease 853 Miscellaneous Diseases of Bone 765 Kelly Maloney, MD, Brian S. Greffe, MD, 25. Sports Medicine 768 Nicholas K. Foreman, MD, Doug K. Graham, MD, PhD, Roger H. Giller, MD, Ralph R. Quinones, MD, Pamela E. Wilson, MD, & K. Brooke Pengel, MD & Amy K. Keating, MD Basic Principles 768 Major Pediatric Neoplastic Diseases 853 Preparticipation History & Physical Acute Lymphoblastic Leukemia 853 Examination 769 Acute Myeloid Leukemia 856 Rehabilitation of Sports Injuries 773 Myeloproliferative Diseases 858 Common Sports Medicine Issues & Injuries 776 Brain Tumors 860 Infectious Diseases 776 Lymphomas & Lymphoproliferative Disorders 863 Head & Neck Injuries 776 Neuroblastoma 868 Spine Injuries 777 Wilms Tumor (Nephroblastoma) 870 Shoulder Injuries 778 Bone Tumors 871 Elbow & Forearm Injuries 780 Rhabdomyosarcoma 873 Hand & Wrist Injuries 781 Retinoblastoma 875 Hip Injuries 781 Hepatic Tumors 876 Knee Injuries 783 Langerhans Cell Histiocytosis 877 Foot & Ankle Injuries 786 Hematopoietic Stem Cell Transplantation 878 Prevention 787 Late Effects of Pediatric Cancer Therapy 880 26. Rehabilitation Medicine 788 30. Pain Management & Palliative Care 883 Pamela E. Wilson, MD, & Gerald H. Clayton, PhD Brian S. Greffe, MD, Jeffrey L. Galinkin, MD, Pediatric Brain Injury 788 & Nancy A. King, MSN, RN, CPNP Spinal Cord Injury 791 Pain Management 883 Brachial Plexus Lesions 793 Pain Assessment 883 Common Rehabilitation Problems 794 Acute Pain 883 27. Rheumatic Diseases 796 Chronic Pain 884 Pediatric Palliative & End-of-Life Care 886 Jennifer B. Soep, MD, & J. Roger Hollister, MD Pain Management in Palliative Care 888 Juvenile Idiopathic Arthritis 796 Quality-of-Life Adjuncts Enthesitis-Related Arthritis & Symptom Management 888 & Spondyloarthropathy 799 Psychosocial Aspects of Palliative Care 888 Enteropathic Arthritis 799 Spiritual & Cultural Support 888 Systemic Lupus Erythematosus 799 Advance Care Planning 889 Dermatomyositis 801 Polyarteritis Nodosa 802 31. Immunodeficiency 891 Scleroderma 802 Lora J. Stewart, MD, Richard B. Johnston, Jr., MD, Raynaud Phenomenon 802 & Andrew H. Liu, MD Noninflammatory Pain Syndromes 803 Immunodeficiency Evaluation: 28. Hematologic Disorders 804 Primary Considerations 891 Antibody Deficiency Syndromes 895 Daniel R. Ambruso, MD, Taru Hays, MD, Severe Combined Immunodeficiency Diseases 899 & Neil A. Goldenberg, MD Interleukin-7-Receptor-Alpha-Chain Deficiency 901 Normal Hematologic Values 804 Other Combined Immunodeficiency Bone Marrow Failure 804 Disorders 902 Anemias 806 Phagocytic Defects 904 Polycythemia & Methemoglobinemia 824 Complement Defects 906 Disorders of Leukocytes 826 Other Well-Defined Immunodeficiency Bleeding Disorders 830 Syndromes 907 Thrombotic Disorders 842 Genetic Syndromes Associated with Splenic Abnormalities 845 Immunodeficiency 908 Transfusion Medicine 846 Graft-Versus-Host Disease 909 viii (cid:2) CONTENTS 32. Endocrine Disorders 911 Common Recognizable Disorders with Variable or Unknown Cause 1013 Philip S. Zeitler, MD, PhD, Sharon H. Travers, MD, Evaluation of the Developmentally Delayed Child 1014 Francis Hoe, MD, Kristen Nadeau, MD, Perinatal Genetics 1016 & Michael S. Kappy, MD, PhD General Concepts 911 36. Allergic Disorders 1018 Disturbances of Growth 912 Mark Boguniewicz, MD, Ronina A. Covar, MD, Disorders of the Posterior Pituitary Gland 920 & David M. Fleischer, MD Thyroid Gland 921 Asthma 1018 Disorders of Calcium & Phosphorus Metabolism 926 Allergic Rhinoconjunctivitis 1034 Gonads (Ovaries & Testes) 933 Atopic Dermatitis 1037 Adrenal Cortex 940 Urticaria & Angioedema 1041 33. Diabetes Mellitus 949 Adverse Reactions to Drugs & Biologicals 1046 Food Allergy 1050 H. Peter Chase, MD, & George S. Eisenbarth, MD, PhD Insect Allergy 1051 General Considerations 949 Pathogenesis 949 37. Antimicrobial Therapy 1053 Prevention 950 John W. Ogle, MD Clinical Findings 950 Principles of Antimicrobial Therapy 1053 Treatment 950 Antimicrobial Susceptibility Testing 1054 Acute Complications 953 Alteration of Dose & Measurement of Blood Levels 1054 Chronic Complications 955 The Use of New Antimicrobial Agents 1058 34. Inborn Errors of Metabolism 956 Prophylactic Antimicrobial Agents 1058 Initial Empiric Antimicrobial Choices for Janet A. Thomas, MD, Selected Conditions 1062 & Johan L. K. Van Hove, MD, PhD, MBA Specific Antimicrobial Agents 1064 Diagnosis 956 38. Infections: Viral & Rickettsial 1071 Management of Metabolic Emergencies 960 Newborn Screening 960 Myron J. Levin, MD, & Adriana Weinberg, MD Disorders of Carbohydrate Metabolism 961 Viral Infections 1071 Disorders of Energy Metabolism 963 The Common Cold 1071 Disorders of Amino Acid Metabolism 965 Adenoviruses 1074 Organic Acidemias 970 Influenza 1077 Disorders of Fatty Acid Oxidation & Carnitine 973 Parainfluenza 1079 Purine Metabolism Disorders 975 Respiratory Syncytial Virus 1079 Lysosomal Diseases 975 Human Metapneumovirus 1081 Peroxisomal Diseases 978 Enteroviruses 1082 Congenital Disorders of Glycosylation 978 Acute Febrile Illness 1082 Smith-Lemli-Opitz Syndrome Respiratory Tract Illnesses 1082 & Disorders of Cholesterol Synthesis 979 Rashes 1083 Disorders of Neurotransmitter Metabolism 980 Central Nervous System Illnesses 1083 Creatine Synthesis Disorders 980 Herpesviruses 1086 Herpes Simplex Infections 1086 35. Genetics & Dysmorphology 982 Varicella & Herpes Zoster 1088 Ellen R. Elias, MD, Anne Chun-Hui Tsai, MD, MSc, Cytomegalovirus Infections 1091 & David K. Manchester, MD Infectious Mononucleosis Foundations of Genetic Diagnosis 982 (Epstein-Barr Virus) 1094 Principles of Inherited Human Disorders 989 Viral Infections Spread by Insect Vectors 1096 Dysmorphology & Human Embryology 996 Viral Childhood Exanthems 1100 Chromosomal Disorders: Abnormal Number 999 Hantavirus Cardiopulmonary Syndrome 1104 Chromosomal Abnormalities: Mumps 1105 Abnormal Structure 1003 Rabies 1106 Mendelian Disorders 1004 Rickettsial Infections 1107 Nonmedelian Disorders 1008 Ehrlichiosis 1107 Disorders of Multifactorial Inheritance 1011 Rocky Mountain Spotted Fever 1108