Illustrated Textbook of Paediatrics

579 Pages·2021·39.374 MB·English

by  Tom Lissauer, Will Carroll

Illustrated Textbook of
Paediatrics
Illustrated Textbook of
Paediatrics
SIXTH EDITION
Tom Lissauer, MB, BChir, FRCPCH
Honorary Consultant Neonatologist,
Imperial College Healthcare Trust, London, UK;
Centre for Paediatrics and Child Health, Imperial College London, UK
Will Carroll, MD, MRCPCH, BM BCh, MA
Consultant Paediatrician, Department of Paediatrics, Children's Hospital at Royal Stoke,
Stoke-on-Trent, UK; Honorary Reader in Child Health, School of Medicine,
Keele University, Keele, UK
Associate Editor
Keir Alexander Shiels, MA, MB, BChir, MRCPCH, FAcadMed
Consultant General Paediatrician, Great Ormond Street Hospital,
London, UK
Forewords by
Dr Ranj Singh
Consultant Emergency Paediatrician, London, UK
Professor Sir Alan Craft
Emeritus Professor of Child Health, Newcastle University;
Past President of the Royal College of Paediatrics and Child Health
ELSEVIER
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First edition 1997
Second edition 2001
Third edition 2007
Fourth edition 2012
Fifth edition 2018
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ISBN: 978-0-7020-8180-4
978-0-7020-8181-1
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Contents
Foreword by Dr Ranj Singh vi
Foreword by Professor Sir Alan Craft vii
Why paediatrics is such a great speciality viii
Preface ix
List of Contributors x
1. Paediatrics and child health 1
2. History and examination 13
3. Normal child development, hearing and vision 37
4. Developmental problems and the child with special needs 52
5. Care of the ill child and young person 71
6. Paediatric emergencies 85
7. Accidents and poisoning 99
8. Maltreatment of children and young people 113
9. Genetics 125
10. Perinatal medicine 145
11. Neonatal medicine 170
12. Growth and puberty 198
13. Nutrition 214
14. Gastroenterology 236
15. Infection and immunity 259
16. Allergy 292
17. Respiratory disorders 299
18. Cardiac disorders 323
19. Kidney and urinary tract disorders 347
20. Genital disorders 370
21. Liver disorders 377
22. Malignant disease 387
23. Haematological disorders 403
24. Child and adolescent mental health 424
25. Dermatological disorders 444
26. Diabetes mellitus and endocrinology 455
27. Inborn errors of metabolism 474
28. Musculoskeletal disorders 483
29. Neurological disorders 502
30. Adolescent medicine 526
31. Global child health 535
Appendix 545
Index 567
Foreword by
Dr Ranj Singh
I can still remember how I felt when I started my paediatrics Any doctor will tell you that there are key texts that you
rotation at medical school: terrified. I had no idea about children, will remember and refer to throughout your career. Written by
especially sick ones. They were a complete mystery to me. A bit legends from the medical world, and trusted by countless stu-
like when I first encountered the Krebs Cycle… only a little bit dents and professionals across the globe. For me, this is one of
cuter. them. And it will continue to have pride of place on my bookshelf
However, I wanted to be as prepared as possible. The word on for a long time to come.
the street was that you had to get yourself a copy of this book.
It’ll see you through all your exams and beyond, they said. It was
this book that got me through that rotation with flying colours.
This wonderful text helped me turn that initial terror into a
keen interest in the health and wellbeing of children and young
people. Little did I know that one day that same interest would
lead to a career that I love and cherish so much.
And those people were right. This book did serve me for a
very long time: for my medical school finals, during my elective
placement overseas, and even when I was sitting my MRCPCH
exams. It covers everything that a medical student, and budding
paediatrician, needs to know and does it in a way that is engag-
ing as well as relevant to what you will see in practice. The clear
diagrams, pop-out boxes filled with useful information, and the
incredible clinical images ensure that you get a detailed insight Dr Ranj Singh
into so many topics and conditions. It’s just so easy to pick up Consultant Emergency Paediatrician
and read… and that comes from someone who gets anxiety at Author and TV Presenter, including the CBeebies series
the thought of picking up a textbook. Get Well Soon, and resident doctor on ITV’s This Morning.
I still dip into it now and again. Sometimes to find out a key He appeared as a celebrity dancer on the BBC’s
piece of information quickly, and sometimes to remind myself of Strictly Come Dancing.
why I do what I do.
Foreword by
Professor Sir Alan Craft
When the late Frank A. Oski wrote the foreword for the first updated and has many new contributors, all of whom are experts
edition of this book in 1997, he gave it generous praise and in their field and have been chosen because of their ability to
predicted that it would become a ‘standard by which all other impart the important principles in a non­ specialist way. The book
medical textbooks will be judged’. He was a great man and a won­ continues to focus on the key topics in the undergraduate cur­
derful writer, so his prediction was no doubt welcomed by the riculum, and in keeping with this aim there are new, expanded
editors, Tom Lissauer and Graham Clayden, both well known for chapters on child maltreatment, genetics and global child health.
their contributions to undergraduate and postgraduate medical There are now countless doctors throughout the world for
education and assessment. whom this textbook has been their introduction to the fascinat­
I have a much easier task in writing the foreword for the sixth ing and rewarding world of paediatrics.
edition. The mere fact that there is a sixth edition is testimony For students, it is all they need to know and a bit more. For
in itself, but there is also the fact that this book has become the postgraduates, it provides the majority of information needed to
recommended paediatric textbook in countless medical schools get through postgraduate examinations. It stimulates and guides
throughout the world and has been translated into more than the reader into the world of clinical paediatrics, built on the sound
12 languages. I have travelled the world over the last 20 years and foundation of the know ledge base provided by this book.
wherever I have been in a paediatric department, the distinctive The editors are to be congratulated on the continuing success
sunflower cover of Lissauer's Illustrated Textbook of Paediatrics has of this book. I can only echo what Frank Oski said in his preface
been there with me. Whether it is Hong Kong, Malaysia, Oman, or to the first edition: ‘I wish I had written this book’!
South Shields, it is there!
It is not surprising that it has won major awards for innov­
ation and excellence at the British Medical Association and
Royal Society of Medicine book awards. The book is well
established and widely read for the simple reason that it is
an excellent book. Medicine is now so complex and infor­
mation so vast that students are no longer expected to
know all there is to know about medicine. What they need are
the core principles, and guidance as to where to find out more.
This book not only gives the core principles, but it also provides
a great deal more for the student who wishes to extend his or
her knowledge. It is in a very accessible form and has a style and
layout which facilitates learning. There are many diagrams, illus­
trations and case histories to bring the subject to life and to impart
important messages. This new edition includes summaries to help
revision and there is also a companion book for self­assessment.
Will Carroll has succeeded Graham Clayden as co­editor; he
is also a paediatrician with great expertise in medical education
and assessment, and has helped ensure that the book continues
to provide the paediatric information medical students need. The Professor Sir Alan Craft
editing team has been further strengthened for this edition by Emeritus Professor of Child Health, Newcastle University
Keir Shiels as an Associate Editor. The book has been thoroughly Past President of the Royal College of Paediatrics and Child Health
Why paediatrics is
such a great speciality

Quotes from Dr Ranj Singh
“Most of us go into medicine to help people. There is no other specialty where you can make a
bigger difference to someone’s life overall than paediatrics. Even if you can’t cure someone (and
as doctors we soon learn that we can’t fix everything), you can have such a massive impact on
a child or young person’s life that it helps them for years to come. That’s what being a doctor is
all about. Plus, working with kids can be so much fun!”
“I could go on about how interesting and varied paediatrics is as a specialty, or how no two
days at work are the same, or how there’s huge potential to do exciting research. But everyone
knows that. That’s not what got me interested. Children have this amazing ability to bring you
back down to earth, teach you what really matters, and show you how to be a better doctor.
Plus, seeing how resilient they are and how much joy they can bring makes going to work so
much better. I mean, how many jobs are there where you can blow bubbles and watch Frozen
on a ward round?!”
“When a student, I know paediatrics is scary, but just throw yourself in. The more you get involved
in things – teaching, ward rounds, sitting in clinic, spending time in A&E – the more you will get
out of it. You don’t have to know it all – that’s our job to teach you. My top tip: show that you
care and join in.”
Quotes from Professor Sir Alan Craft
“Paediatrics spans tiny premature babies to 2 metre high teenagers; everything from health to
serious illness; an opportunity with chronic illness to see a child develop. And it all takes place in
a family whom you will get to know well.”
“When I started in paediatric oncology, fewer than one in five children could be cured. Now
it is over 80% in high-income countries. Adapting treatment to be economically possible and
worthwhile for those in low- and middle-income countries has been an exciting and rewarding
challenge.”
“All doctors, whatever their speciality, need to have an understanding of children’s development
and illness as well as their place in the life of a family and society. Children are the future, and
whatever help you give today will be seen in generations to come.”
Preface
This textbook provides the knowledge required for the paediat- importance in paediatric practice. There is also a companion book
rics and child health curriculum of most undergraduate medical of self-assessment questions.
schools and for the Medical Licensing Assessment (MLA) in the We would like to thank Graham Clayden, editor for the first
UK. It also covers a high proportion of the knowledge needed four editions, for the inspiration he brought to the book, and all
to prepare for postgraduate examinations such as the Diploma our contributors, both to this and to previous editions, without
of Child Health (DCH) and Membership of the Royal College of whom this book could not have been be produced. We are also
Paediatrics and Child Health (MRCPCH). We are delighted that pleased to welcome Keir Shiels as an Associate Editor, who has
our “sunflower book” is widely used in many countries outside brought fresh ideas to improve the book. Thanks also to our
the UK, including northern Europe, India, Pakistan, Australia, and families – in particular Ann Goldman, Rachel and David and Sam
South Africa, and that there have been numerous translations. We Lissauer, and Lisa Carroll, Daniel, Steven, Natasha, and Belinda
are also pleased that many nurses, therapists and other health Carroll – for their ideas and assistance, and for their understand-
professionals who care for children are using the book. ing of the time taken away in the preparation of this book. We
Whilst the real appreciation of why paediatrics is such a great would also like to thank Hannah Lissauer, aged 7 years, for the
specialty comes from encountering children and young people lovely picture of the sunflower for the cover, helping to maintain
and their families in clinical practice, this book aims to provide its reputation as “the sunflower book”.
what is required for the 6 to 10 weeks usually allocated to paedi- We welcome feedback on the book.
atrics and child health in undergraduate training. In recognition
of the short time available, we have tried to facilitate learning by
using a lecture-note style, by incorporating numerous diagrams
and flow charts, and by including illustrations or images to help
in the recognition of important signs or clinical features. To make
the topics more interesting and memorable, there are key learn-
ing points and clinical case histories. Summary boxes of impor-
tant facts have been provided to help with revision.
The huge amount of positive feedback we have received on
the first five editions of the book from medical students, post-
graduate doctors, tutors, nurses and allied health professionals
in the UK and abroad has spurred us on to produce this new
edition. The book has been fully updated, with many sections
rewritten, new diagrams created and illustrations redone. There
are new, separate or expanded chapters on child maltreatment, Tom Lissauer Will Carroll
genetics and global child health to accommodate their increasing
List of Contributors
The editors would like to acknowledge and offer grateful thanks for the input of all previous editions’ contributors, without
whom this new edition would not have been possible.
Mark Anderson, BM, BS, BSc, BMedSci, William D. Carroll, BM BCh, MA, MD,
MRCPCH MRCPCH, BM BCh, MA
Consultant Paediatrician Consultant Paediatrician
Great North Children's Hospital Department of Paediatrics
Newcastle upon Tyne Hospitals NHS Foundation Trust Children's Hospital at Royal Stoke
Newcastle upon Tyne, UK Stoke-on-Trent, UK;
Chapter 5. Care of the ill child and young person Honorary Reader in Child Health
Chapter 7. Accidents and poisoning School of Medicine
Keele University
Keele, UK
Harriet Barraclough, MBChB, MSc, MRCPCH
Chapter 2. History and examination
Chapter 17. Respiratory disorders
Paediatric Specialist Registrar
Paediatric Gastroenterology
Sheffield Children’s Hospital Subarna Chakravorty, MBBS, PhD, MRCPCH,
Sheffield, UK
FRCPath
Chapter 14. Gastroenterology
Consultant Paediatric Haematologist
Robert Boyle, MB ChB, BSc, PhD, MRCPCH Paediatric Haematology
King's College Hospital
Clinical Reader in Paediatric Allergy London, UK
National Heart and Lung Institute Chapter 23. Haematological disorders
Imperial College London
London, UK
Chapter 16. Allergy Ronny Cheung, BMBCh, MA, MRCPCH,
PGDipMedEd, FHEA
Katherine Burke, MA, MB BS, PhD, MRCPCH
Consultant in General Paediatrics
Evelina London Children’s Hospital
Consultant Neonatologist
Guy’s and St Thomas’ NHS Foundation Trust
Newborn Intensive Care Unit
St Thomas's Hospital
Singleton Hospital
London, UK;
Swansea Bay University Health Board
Honorary Senior Lecturer
Swansea, UK
King's College London
Chapter 9. Genetics
London, UK
Chapter 1. Paediatrics and child health
Orlaith Byrne, MB, BCh, BAO, DCH, MRCPI,
Dip Medical Management, MSc, FRCPCH
Angus J. Clarke, DM, MA, FRCP, FRCPCH
Consultant Paediatrician
Department of Child Health, Children and Families Division Professor
Birmingham Community Healthcare NHS Foundation Trust Institute of Medical Genetics
Birmingham, UK Cardiff University
Cardiff, UK
Chapter 4. Developmental problems and the child with
special needs Chapter 9. Genetics