Table Of Contenta 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.
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DOI: 10.1036/007154433X
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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
