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a 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 Copyright © 2018 by McGraw-Hill Education. All rights reserved. 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. 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Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. 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 Hay_FM_pi-xxxii.indd 3 30/03/18 11:40 AM 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 Hay_FM_pi-xxxii.indd 4 30/03/18 11:40 AM 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 Hay_FM_pi-xxxii.indd 5 30/03/18 11:40 AM 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 Hay_FM_pi-xxxii.indd 6 30/03/18 11:40 AM 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 Hay_FM_pi-xxxii.indd 7 30/03/18 11:40 AM 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 Hay_FM_pi-xxxii.indd 8 30/03/18 11:40 AM 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 Hay_FM_pi-xxxii.indd 9 30/03/18 11:40 AM