Signs and Symptoms in Pediatrics

1054 Pages·2015·9.62 MB·English

by  Henry M. Adam MD FAAP

Signs
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Signs & Symptoms in Pediatrics i
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Editors

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Henry M. Adam, MD, FAAP
Jane Meschan Foy, MD, FAAP
Symptoms
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raditionally, medical textbooks have been organized by areas of m
specialty: infectious diseases, cardiology, pulmonary medicine,
p
and so on. For the practicing physician, however, this presentation has
t
its limits. Very few parents or children come to their pediatrician’s office o I N P E D I A T R I C S
m
with a chief complaint of nephrosis, for instance, or of psoriasis. Rather,
they will say, “My son’s feet and face are swollen,” “My daughter has a s
rash,” or even, “My child has been struggling in school.”
i
n
Signs and Symptoms in Pediatrics organizes information to reflect the

way practice really happens. It is a comprehensive guide to the evalua- P
e
tion and treatment of more than 80 signs and symptoms—physical
d
and behavioral—including
i
a
• Abdominal pain
t
• Disruptive behavior and aggression r
i
• Facial dysmorphism c
s
• Fever of unknown origin

• Learning difficulty
• Speech and language concerns
• Vomiting
• Weight loss A
D
Each chapter begins with contextual information on areas like patho- A
M
physiology and epidemiology and provides a guide to the history, physical

examination, and laboratory and imaging studies that generate an appro- •

F
priate differential diagnosis. Next are approaches to initial management O
Y
and suggestions about when to refer or admit.
Signs and Symptoms in Pediatrics is an ideal resource for pediatricians,
family physicians, residents, residency program directors, pediatric nurse
practitioners, physician assistants, medical students, and nurses.
EDITORS
For other pediatric resources, visit the American Academy of Pediatrics at
Henry M. Adam, MD, FAAP
shop.aap.org.
Jane Meschan Foy, MD, FAAP
AAP
American Academy of Pediatrics
Signs & Symptoms
I N P E D I A T R I C S
Editors
Henry M. Adam, MD, FAAP
Jane Meschan Foy, MD, FAAP
American Academy of Pediatrics Publishing Staff
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Published by the American Academy of Pediatrics
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Library of Congress Control Number: 2013949735
ISBN: 978-1-58110-850-7
eBook: 978-1-58110-855-2
MA0703
Th is book has been developed by the American Academy of Pediatrics. Th e authors, editors, and contribu-
tors are expert authorities in the fi eld of pediatrics. No commercial involvement of any kind has been solic-
ited or accepted in the development of this publication.
Th e recommendations in this publication do not indicate an exclusive course of treatment or serve as a
standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
Every eff ort has been made to ensure that the drug selection and dosage set forth in this text are in accor-
dance with the current recommendations and practice at the time of publication. It is the responsibility of
the health care provider to check the package insert of each drug for any change in indications and dosage
and for added warnings and precautions.
Th e mention of product names in this publication is for informational purposes only and does not imply
endorsement by the American Academy of Pediatrics.
Th e American Academy of Pediatrics is not responsible for the content of the resources mentioned in this
publication. Web site addresses are as current as possible but may change at any time.
Th e publishers have made every eff ort to trace the copyright holders for borrowed material. If they have
inadvertently overlooked any, they will be pleased to make the necessary arrangements at the fi rst opportunity.
© 2015 by the American Academy of Pediatrics. All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical,
photocopying, recording, or otherwise, without prior permission from the publisher.
Printed in the United States of America
9-349/0215
1 2 3 4 5 6 7 8 9 10
Editors
Henry M. Adam, MD, FAAP Jane Meschan Foy, MD, FAAP
Bronx, New York Professor of Pediatrics
Wake Forest University School of
Medicine
Winston-Salem, North Carolina
Tools Editors
Rebecca Baum, MD, FAAP Kelly J. Kelleher, MD, MPH, FAAP
Department of Pediatrics Professor of Pediatrics, Psychiatry, and
Th e Ohio State University Public Health
Nationwide Children’s Hospital Th e Ohio State University
Columbus, Ohio Nationwide Children’s Hospital
Columbus, Ohio
Contributors
Jeff rey R. Avner, MD, FAAP Department of Dermatology
Professor of Clinical Pediatrics Boston, Massachusetts
Codirector, Medical Student Education in 3: Alopecia and Hair Shaft Anomalies
Pediatrics 43: Hyperhidrosis
Albert Einstein College of Medicine 61: Pruritus
Chief, Pediatric Emergency Medicine
Th e Children’s Hospital at Montefi ore Rebecca Baum, MD, FAAP
Bronx, New York Department of Pediatrics
32: Gastrointestinal Hemorrhage Th e Ohio State University
Nationwide Children’s Hospital
Sarah Bagley, MD Columbus, Ohio
Addiction Medicine Fellow 54: Medically Unexplained Symptoms
Boston University Medical Center
Boston, Massachusetts Peter F. Belamarich, MD, FAAP
75: Substance Use: Initial Approach in Director, Division of General Pediatrics
Primary Care Th e Children’s Hospital at Montefi ore
Associate Professor of Clinical Pediatrics
Nancy K. Barnett, MD, FAAP Albert Einstein College of Medicine
Dermatology of Cape Cod Bronx, New York
Falmouth, Massachusetts 1: Abdominal Distention
Affi liate, Tufts Medical Center 11: Constipation
iii
iv Contributors
John P. Bent, MD Department of Psychiatry and Behavioral
Director, Pediatric Otolaryngology-Head Health
and Neck Surgery Columbus, Ohio
Professor, Albert Einstein College of 54: Medically Unexplained Symptoms
Medicine
Th e Children’s Hospital at Montefi ore Jayanthi Chandar, MD
Bronx, New York Associate Professor of Clinical Pediatrics
74: Stridor University of Miami Miller School of
Medicine
Robert J. Bidwell, MD Medical Director, Pediatric Kidney
Associate Clinical Professor of Pediatrics Transplant Program
University of Hawai`i John A. Burns Miami Transplant Institute
School of Medicine Miami, Florida
Honolulu, Hawai`i 40: High Blood Pressure
33: Gender Expression and Identity Issues
Marcela Del Rio, MD
Diane E. Bloomfi eld, MD, FAAP Department of Pediatrics
Department of Pediatrics Montefi ore Medical Center
Th e Children’s Hospital at Montefi ore Bronx, New York
Bronx, New York 37: Hematuria
84: Weight Loss
Linda M. Dinerman, MD, PC
Joel S. Brenner, MD, MPH, FAAP Adolescent and Young Adult Medicine
Director, Sports Medicine and Adolescent Private Practice
Medicine Huntsville, Alabama
Children’s Hospital of Th e King’s 18: Dysmenorrhea
Daughters 82: Vaginal Discharge
Associate Professor of Pediatrics
Eastern Virginia Medical School Elaine A. Dinolfo, MD, MS, FAAP
Norfolk, Virginia Assistant Clinical Professor of Pediatrics
8: Back Pain Columbia University College of Physicians
and Surgeons
Michael G. Burke, MD, MBA, FHM, Attending Physician, Department of
FAAP Pediatrics
Department of Pediatrics Harlem Hospital Center
Johns Hopkins University School of New York, New York
Medicine 84: Weight Loss
Saint Agnes Hospital
Baltimore, Maryland Mary Iftner Dobbins, MD, FAAP
24: Extremity Pain Department of Family and Community
Medicine
John Campo, MD Southern Illinois University School of
Professor and Chair Medicine
Ohio State University Wexner Medical Carbondale, Illinois
Center 27: Family Dysfunction
Contributors v
Sarah Edwards, DO Jack Gladstein, MD
Assistant Professor Professor of Pediatrics and Neurology
Director of Training, Child and Adoles- University of Maryland School of
cent Psychiatry Fellowship Medicine
Medical Director of Child and Adolescent Baltimore, Maryland
Psychiatry Hospital Services 34: Headache
Division of Child and Adolescent
Psychiatry Mary Margaret Gleason, MD, FAAP
University of Maryland School of Associate Professor
Medicine Child Psychiatry and Pediatrics
Baltimore, Maryland Tulane University School of Medicine
69: Self-stimulating Behaviors New Orleans, Louisiana
76: Symptoms of Emotional Disturbance in
Mohammad F. El-Baba, MD Young Children
Division Chief, Pediatric Gastroenterology
Fellowship Program Director Beatrice Goilav, MD
Children’s Hospital of Michigan Assistant Professor of Pediatrics
Wayne State University Director, Pediatric Nephrology Training
Detroit, Michigan Program
19: Dysphagia Division of Pediatric Nephrology
Th e Children’s Hospital at Montefi ore
Lisa Figueiredo, MD Albert Einstein College of Medicine
Division of Pediatric Hematology/ Bronx, New York
Oncology 21: Dysuria
Th e Children’s Hospital at Montefi ore
Bronx, New York David L. Goldman, MD
58: Petechiae and Purpura Associate Professor of Pediatrics
Assistant Professor of Microbiology
Barbara L. Frankowski, MD, MPH, Th e Children’s Hospital at Montefi ore
FAAP Albert Einstein College of Medicine
Department of Primary Care Pediatrics Bronx, New York
University of Vermont Children’s Hospital 64: Recurrent Infections
Burlington, Vermont
49: Learning Diffi culty Waseem Hafeez, MBBS, FAAP
Associate Professor of Clinical Pediatrics
Mariam Gangat, MD Albert Einstein College of Medicine
Department of Pediatrics Attending Physician
Division of Pediatric Endocrinology Division of Pediatric Emergency
Rutgers Robert Wood Johnson Medical Medicine
School Th e Children’s Hospital at Montefi ore
New Brunswick, New Jersey Bronx, New York
41: Hirsutism, Hypertrichosis, and 46: Irritability and Fussiness
Precocious Sexual Hair Development
vi Contributors
Caroline Breese Hall, MD† Alain Joff e, MD, MPH, FAAP
52: Lymphadenopathy Director, Student Health and Wellness
Center
David C. Hanson, MD
Johns Hopkins University
Assistant Professor
Associate Professor of Pediatrics
Divison of General Pediatrics
Johns Hopkins University School of
Department of Pediatrics
Medicine
University of Minnesota Masonic
Baltimore, Maryland
Children’s Hospital
4: Amenorrhea
Minneapolis, Minnesota
81: Vaginal Bleeding
24: Extremity Pain
82: Vaginal Discharge
J. Peter Harris, MD
Paul Kaplowitz, MD, PhD, FAAP
Professor Emeritus
Division of Endocrinology
Department of Pediatrics
Children’s National Medical Center
University of Rochester Medical Center
George Washington University School of
Rochester, New York
Medicine and Health Sciences
9: Cardiac Arrhythmias
Washington, DC
Nancy Heath, PhD 70: Short Stature
Department of Educational and
Counselling Psychology Frederick J. Kaskel, MD, PhD
McGill University Professor and Vice Chair of Pediatrics
Montreal, Quebec Albert Einstein College of Medicine
68: Self-harm Director, Division and Training Program
in Pediatric Nephrology
Sebastian Heersink, MD, FACS Th e Children’s Hospital at Montefi ore
Eye Center South Bronx, New York
Dothan, Alabama 21: Dysuria
65: Red Eye/Pink Eye
Diana King, MD, FAAP
Norman T. Ilowite, MD
Assistant Professor of Clinical Pediatrics
Professor of Pediatrics
Albert Einstein College of Medicine
Albert Einstein College of Medicine
Attending Physician
Department of Pediatrics
Division of Pediatric Emergency Medicine
Division of Rheumatology
Children’s Hospital at Montefi ore
Th e Children’s Hospital at Montefi ore
Th e Bronx, New York
Bronx, New York
46: Irritability and Fussiness
50: Limp
Robert A. King, MD
Ginger Janow, MD
Professor of Child Psychiatry
Department of Pediatrics
Yale Child Study Center
Division of Rheumatology
Yale University School of Medicine
Joseph M. Sanzari Children’s Hospital
New Haven, Connecticut
Hackensack, New Jersey
79: Tics
50: Limp
†Deceased.
Contributors vii
Genna W. Klein, MD Bronx, New York
Division of Pediatric Endocrinology 5: Anemia and Pallor
Joseph M. Sanzari Children’s Hospital 58: Petechiae and Purpura
Hackensack University Medical Center
Hackensack, New Jersey Paul A. Levy, MD, FACMG, FAAP
41: Hirsutism, Hypertrichosis, and Attending Geneticist
Precocious Sexual Hair Development Assistant Professor of Pediatrics and
Pathology
Robert K. Kritzler, MD Th e Children’s Hospital at Montefi ore
Deputy Chief Medical Offi cer Bronx, New York
Johns Hopkins HealthCare LLC 22: Edema
Assistant Professor, Johns Hopkins
University Sharon Levy, MD, MPH, FAAP
Glen Burnie, Maryland Director, Adolescent Substance Abuse
62: Puberty: Normal and Abnormal Program
Boston Children’s Hospital
Daniel Krowchuk, MD, FAAP Assistant Professor of Pediatrics
Department of Pediatrics Harvard Medical School
Wake Forest School of Medicine Boston, Massachusetts
Winston-Salem, North Carolina 75: Substance Use: Initial Approach in
63: Rash Primary Care
Erik Langenau, DO, MS, FACOP, Samuel M. Libber, MD, FAAP
FAAP Department of Pediatrics
Department of Learning Technologies Johns Hopkins University School of
Philadelphia College of Osteopathic Medicine
Medicine Baltimore, Maryland
Philadelphia, Pennsylvania 59: Polyuria
57: Odor (Unusual Urine and Body)
Steven E. Lipshultz, MD, FAHA, FAAP
Judith B. Lavrich, MD Schotanus Professor of Pediatrics and Chair
Associate Surgeon Carman and Ann Adams Department
Department of Pediatric Ophthalmology of Pediatrics
and Ocular Genetics Wayne State University School
Wills Eye Hospital of Medicine
Clinical Instructor Pediatrician-in-Chief
Sidney Kimmel Medical College Children’s Hospital of Michigan
Th omas Jeff erson University President, University Pediatricians
Philadelphia, Pennsylvania Detroit, Michigan
65: Red Eye/Pink Eye 40: High Blood Pressure
Adam S. Levy, MD Anthony M. Loizides, MD
Associate Professor of Clinical Pediatrics Assistant Professor of Pediatrics
Th e Children’s Hospital at Montefi ore Albert Einstein College of Medicine
Albert Einstein College of Medicine Attending Physician
viii Contributors
Division of Pediatric Gastroenterology Bethany Marston, MD
and Nutrition Department of Pediatrics and Medicine
Th e Children’s Hospital at Montefi ore University of Rochester
Bronx, New York Rochester, New York
2: Abdominal Pain 48: Joint Pain
Dominique Long, MD Anne May, MD, FAAP
Division of Pediatric Endocrinology Assistant Professor of Clinical Pediatrics
Department of Pediatrics Th e Ohio State University
Johns Hopkins Children’s Center Nationwide Children’s Hospital
Baltimore, Maryland Columbus, Ohio
62: Puberty: Normal and Abnormal 71: Sleep Disturbances (Nonspecifi c)
Michael G. Marcus, MD Jay H. Mayefsky, MD, MPH, FAAP
Vice Chair, Pediatric Ambulatory Network Professor of Pediatrics and Family and
Director, Division of Pulmonary Medicine Preventive Medicine
and Pediatric Allergy and Immunology Rosalind Franklin University of Medicine
Maimonides Infants and Children’s and Science
Hospital Associate Medical Director
Brooklyn, New York School Based Health Centers
12: Cough Heartland Health Centers
Chicago, Illinois
Ronald V. Marino, DO, MPH, FAAP 20: Dyspnea
Professor of Pediatrics
Stony Brook University Medical School Alicia K. McFarren, MD, FAAP
College of Osteopathic Medicine at the Department of Pediatric Hematology,
New York Institute of Technology Oncology, and Blood and Marrow
Associate Chairman, Department Transplantation
of Pediatrics Children’s Hospital Los Angeles
Winthrop University Hospital Los Angeles, California
Mineola, New York 5: Anemia and Pallor
Pediatric Residency Director
Good Samaritan Hospital Medical Center Nancy McGreal, MD
West Islip, New York Assistant Professor of Medicine and
66: School Absenteeism and School Refusal Pediatrics
Divisions of Adult and Pediatric
Robert W. Marion, MD Gastroenterology
Chief, Division of Genetics Duke University Medical Center
Professor of Pediatrics and Obstetrics and Durham, North Carolina
Gynecology and Women’s Health 51: Loss of Appetite
Th e Children’s Hospital at Montefi ore 83: Vomiting
Albert Einstein College of Medicine
Bronx, New York
25: Facial Dysmorphism
Contributors ix
Sarah E. Messiah, PhD, MPH Philip O. Ozuah, MD, PhD, FAAP
Research Associate Professor Professor of Pediatrics
Perinatal/Pediatric Epidemiologist Professor of Epidemiology and Population
University of Miami Miller School of Health
Medicine Albert Einstein College of Medicine
Department of Pediatrics President
Division of Pediatric Clinical Research Montefi ore Health System
Batchelor Children’s Research Institute Bronx, New York
Miami, Florida 28: Fatigue and Weakness
40: High Blood Pressure 39: Hepatomegaly
73: Splenomegaly
Ryan S. Miller, MD 80: Torticollis
Division of Pediatric Endocrinology
Department of Pediatrics Lane S. Palmer, MD, FACS, FAAP
Johns Hopkins University School of Division of Pediatric Urology
Medicine Cohen Children’s Medical Center of
Baltimore, Maryland New York
59: Polyuria Hofstra North Shore-LIJ School of
Medicine
Timothy R. Moore, PhD, LP, BCBA-D Long Island, New York
Clinical Director 67: Scrotal Swelling and Pain
Minnesota Life Bridge
Debra H. Pan, MD
Cambridge, Minnesota
Assistant Professor of Pediatrics
68: Self-harm
Albert Einstein College of Medicine
Attending Physician
Joshua P. Needleman, MD, FAAP
Division of Pediatric Gastroenterology
Pediatric Pulmonary Medicine
and Nutrition
Maimonides Medical Center
Th e Children’s Hospital at Montefi ore
Brooklyn, New York
Bronx, New York
85: Wheezing
47: Jaundice
Katherine Atienza Orellana, DO
Sanjay R. Parikh, MD, FACS
Pediatric Gastroenterology
Division of Pediatric Otolaryngology
Valley Medical Group
Seattle Children’s Hospital
Ramsey, New Jersey
Associate Professor
2: Abdominal Pain
Department of Otolaryngology–Head and
Neck Surgery
Philip Overby, MD, DABPN
University of Washington
Department of Pediatrics and Neurology
Seattle, Washington
New York Medical College
42: Hoarseness
Valhalla, NY
7: Ataxia