Table Of ContentOXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
Paediatrics
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Published and forthcoming Oxford Handbooks
Oxford Handbook for the Foundation Programme 3e
Oxford Handbook of Acute Medicine 3e
Oxford Handbook of Anaesthesia 3e
Oxford Handbook of Applied Dental Sciences
Oxford Handbook of Cardiology 2e
Oxford Handbook of Clinical and Laboratory Investigation 3e
Oxford Handbook of Clinical Dentistry 5e
Oxford Handbook of Clinical Diagnosis 2e
Oxford Handbook of Clinical Examination and Practical Skills
Oxford Handbook of Clinical Haematology 3e
Oxford Handbook of Clinical Immunology and Allergy 3e
Oxford Handbook of Clinical Medicine – Mini Edition 8e
Oxford Handbook of Clinical Medicine 8e
Oxford Handbook of Clinical Pathology
Oxford Handbook of Clinical Pharmacy 2e
Oxford Handbook of Clinical Rehabilitation 2e
Oxford Handbook of Clinical Specialties 9e
Oxford Handbook of Clinical Surgery 4e
Oxford Handbook of Complementary Medicine
Oxford Handbook of Critical Care 3e
Oxford Handbook of Dental Patient Care 2e
Oxford Handbook of Dialysis 3e
Oxford Handbook of Emergency Medicine 4e
Oxford Handbook of Endocrinology and Diabetes 2e
Oxford Handbook of ENT and Head and Neck Surgery
Oxford Handbook of Epidemiology for Clinicians
Oxford Handbook of Expedition and Wilderness Medicine
Oxford Handbook of Gastroenterology & Hepatology 2e
Oxford Handbook of General Practice 3e
Oxford Handbook of Genetics
Oxford Handbook of Genitourinary Medicine, HIV and AIDS 2e
Oxford Handbook of Geriatric Medicine
Oxford Handbook of Infectious Diseases and Microbiology
Oxford Handbook of Key Clinical Evidence
Oxford Handbook of Medical Dermatology
Oxford Handbook of Medical Imaging
Oxford Handbook of Medical Sciences 2e
Oxford Handbook of Medical Statistics
Oxford Handbook of Nephrology and Hypertension
Oxford Handbook of Neurology
Oxford Handbook of Nutrition and Dietetics 2e
Oxford Handbook of Obstetrics and Gynaecology 2e
Oxford Handbook of Occupational Health 2e
Oxford Handbook of Oncology 3e
Oxford Handbook of Ophthalmology 2e
Oxford Handbook of Oral and Maxillofacial Surgery
Oxford Handbook of Paediatrics 2e
Oxford Handbook of Pain Management
Oxford Handbook of Palliative Care 2e
Oxford Handbook of Practical Drug Therapy 2e
Oxford Handbook of Pre-Hospital Care
Oxford Handbook of Psychiatry 3e
Oxford Handbook of Public Health Practice 2e
Oxford Handbook of Reproductive Medicine & Family Planning
Oxford Handbook of Respiratory Medicine 2e
Oxford Handbook of Rheumatology 3e
Oxford Handbook of Sport and Exercise Medicine
Oxford Handbook of Tropical Medicine 3e
Oxford Handbook of Urology 3e
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1
Oxford Handbook of
Paediatrics
Second Edition
Edited by
Robert C. Tasker
Professor of Neurology and Anaesthesia (Pediatrics),
Harvard Medical School; Chair in Neurocritical Care,
Children’s Hospital, Boston, USA
Robert J. McClure
Neonatologist, Paediatrician and Anatomical Pathologist
Queen Elizabeth Medical Centre, Nedlands,
Perth, Western Australia
Carlo L. Acerini
University Senior Lecturer,
Cambridge University Clinical School,
Cambridge, UK
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3
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press, 2013
The moral rights of the author have been asserted
First edition published 2008
Second edition published 2013
Impression: 1
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,
without the prior permission in writing of Oxford University Press,
or as expressly permitted by law, or under terms agreed with the appropriate
reprographics rights organization. Enquiries concerning reproduction
outside the scope of the above should be sent to the Rights Department,
Oxford University Press, at the address above
You must not circulate this book in any other binding or cover and you must
impose the same condition on any acquirer
British Library Cataloguing in Publication Data
Data available
ISBN 978–0–19–960830–0 (fl exicover: alk.paper)
Printed in China by
C&C Offset Printing Co. Ltd.
Oxford University Press makes no representation, express or implied, that the drug
dosages in this book are correct. Readers must therefore always check the product
information and clinical procedures with the most up-to-date published product
information and data sheets provided by the manufacturers and the most recent
codes of conduct and safety regulations. The authors and the publishers do not
accept responsibility or legal liability for any errors in the text or for the misuse or
misapplication of material in this work. Except where otherwise stated, drug dosages
and recommendations are for the non-pregnant adult who is not breastfeeding.
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v
Foreword to the fi rst
edition
Textbooks have been the mainstay of medical education for centuries.
Clearly, the development of the information superhighway via the Internet
has changed how we learn, fi nd information, and communicate. What does
yet another paediatric textbook add to the current long list of titles?
Drs Tasker, McClure, and Acerini have conceived of and edited a new
book. It is a handbook of paediatrics that joins a stable of similar publica-
tions from Oxford University Press. There are 23 contributing editors.
Using a well-tested format for presentation, the handbook consists of 31
chapters, ranging from sections on epidemiology, evidence, and practice,
through the more traditional topics, such as nephrology and neurology,
and concluding with international health and travel, and paediatrics, eth-
ics, and the law. Each chapter follows the same format, 5–40 sections, fol-
lowed by bulleted points. Both signs and symptoms of illness, as well as
specifi c diseases are covered. Virtually all topics are limited to 1–2 pages
of important information. Tables are carefully inserted, and complement the
text. Doses of important drugs are included in the text and/or the tables.
There are a limited number of fi gures, but like the tables, they supplement
the text and have been carefully chosen to add clarity.
The Oxford Handbook of Paediatrics is a worthy addition to your library.
It will be particularly appealing to medical students and younger physicians,
who have learned to digest a great deal of information quickly and in an
abbreviated format. Its availability on a CD-ROM is an added and neces-
sary benefi t. Drs Tasker, McClure, and Acerini have done a wonderful job
in ensuring consistency, clarity, and completeness.
Professor Howard Bauchner,
Boston University School of Medicine/Boston Medical Center,
Vice-Chair, Academic Affairs,
Editor in Chief, Archives of Disease in Childhood,
January 2008
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vi
Preface
The fi rst ‘boke’ of paediatrics printed in English was written by Thomas
Phaire (1510–1560), a man from East Anglia who studied medicine at
Oxford University. The book had 56 pages, measured 3 7/8 inches (9.8cm)
by 2 5/8 inches (6.7cm), and covered ‘. . . innumerable passions & diseases,
wherunto the bodye of man is subiecte, and as well moste commonly
the tender age of chyldren is chefely vexed and greued with these dis-
eases folowyng. Apostume of the brayne, swellyng of the head . . .’.1 In
1553, the ‘innumerable passions & diseases’ came to 39 presenting clini-
cal problems. As clinicians, we fi rst met and worked in the heart of East
Anglia (Cambridge University) and have now collaborated with Oxford
University Press in this venture, a new handbook of paediatrics. Our simi-
larity with Thomas Phaire has not escaped us, particularly as we see the
importance of basing a text on common presenting clinical problems.
Our principal aim is to provide a compact source of information and
clinical thinking that can be used in the clinic or hospital ward, at a time
when the child is being seen. The challenge, therefore, was to distil the
content of information found in several textbooks into a conveniently
sized handbook without the loss of important information. We easily
reached the limit in pages given to us, and so we have had to be strict in
sifting out key facts crucial to clinical practice. Our intention is that the
handbook be used from the start of one’s education in paediatrics all the
way through to higher general training in the fi eld.
We have kept with the tradition of providing content and text that
often exceeds that required by the generalist—we believe it important
for learners and readers to see the full landscape. There are spaces where
more notes can be added from lectures, other reading, and personal expe-
rience. This is intended. It means that the handbook can be made personal,
develop with you, and be used in whatever your chosen practice—
hospitalist, generalist, or community and family practice. Above all, we
hope that the handbook will give you confi dence to manage paediatric
clinical problems effectively and safely.
RCT
RJM
CLA
April 2012
Reference
1 Phaire T (1553). The boke of chyldren. [Reprint edited by Neale AV,
Wallis HRE (1965). Edinburgh: E&S Livingstone Ltd, Edinburgh.
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vii
Authors’ disclaimer
All reasonable efforts have been undertaken in order to ensure the accu-
racy of drug doses in this book. UK readers are advised to also consult
the British National Formulary for children (2012; see http://www.bnf.
org/bnf/index.htm)). Other readers should refer to their own regional
or national guidelines. The authors cannot be held responsible for any
errors here in.
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viii
Acknowledgements
We would like to extend our thanks and gratitude to all the contributors.
We would also like to thank our colleagues who reviewed and advised
on the content of our chapters, in particular Dr Robert Ross-Russell,
Dr Roddy O’Donnell, Jenny Pool, Amy Stewart, Clare Bradley Stevenson,
and Liesje Cornwell for their helpful comments. We are also indebted to
Dr Stephan Sanders for his comments and criticisms of our draft manu-
script. We would also like to thank Drs Kim Jones and Tony Jaffa, Profs
Deirdre Kelly and Brett McDermott, and Ms Julia Smith, Kelly Lamour, and
Lynne Radbone for their contribution to the last edition. We are especially
grateful to Beth Womack and Elizabeth Reeve at OUP for their help and
assistance, and for their patience with us. Finally, but not least, a special
thanks goes to our respective families for their encouragement, support,
and understanding throughout the preparation of this book.
Robert C. Tasker
Robert J. McClure
Carlo L. Acerini
RJM is indebted to Marge, Hannah, and Thomas, for their endless love,
support, and sacrifi ce.
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ix
Contributors
Mr David Albert
Consultant Otolaryngologist,
Great Ormond Street Hospital for
Children NHS Foundation Trust,
London
Miss Louise Allen
Consultant Paediatric
Ophthalmologist
Cambridge University Hospitals
NHS Foundation Trust,
Cambridge, and
Associate Lecturer, University of
Cambridge, UK
Dr R Mark Beattie
Consultant Paediatric
Gastroenterologist
University Hospital Southampton
Southampton, UK
Mr Yogesh Bajaj
Consultant Paediatric
Otolaryngologist
Barts, and the London Children’s
Hospital, London
Dr Ian Balfour-Lynn
Consultant in Respiratory
Paediatrics
Royal Brompton Hospital, London
Dr Tony Caccetta
Dermatology Registrar
Princess Margaret Hospital, Perth,
Western Australia
Professor Imti Choonara
Professor in Child Health,
Academic Division of Child
Health, University of Nottingham,
Derbyshire Children’s Hospital
Derby, UK
Dr David Coghill
Ninewells Hospital and
Medical School,
Dundee, UK
Mr David Crabbe
Consultant Paediatric Surgeon
Leeds Teaching Hospitals NHS
Trust and Bradford Teaching
Hospitals NHS Foundation Trust,
UK
Dr Saul N Faust
Reader in Paediatric Immunology
and Infectious Diseases and
Director, NIHR Wellcome
Trust Clinical Research Facility,
University of Southampton, UK
Dr Rob Freeman
Consultant Orthopaedic Surgeon,
Robert Jones and Agnes
Hunt Orthopaedic Hospital NHS
Trust, Shropshire, UK
Dr Georgina Hall
Consultant, Paediatric
Haematology/Oncology Unit, John
Radcliffe Hospital, Oxford, UK
Dr Peter Heinz
Consultant Paediatrician
Cambridge University Hospitals
NHS Foundation Trust,
Cambridge, UK
Dr Ewen D Johnston
Consultant Neonatologist
Simpson Centre for Reproductive
Health, Royal Infi rmary of
Edinburgh,
UK
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x
CONTRIBUTORS
Dr Samir Latifi
Consultant in Paediatric Intensive
Care, Akron Children’s Hospital
Akron, Ohio, USA
Dr Elaine Lewis
Consultant Community
Paediatrician, Cambridge
University Hospitals NHS
Foundation Trust,
Cambridge, UK
Dr James C Nicholson
Consultant Paediatric Oncologist
Cambridge University Hospitals
NHS Foundation Trust,
Cambridge, UK
Dr Roddy O’Donnell
Consultant in Paediatric Intensive
Care, Cambridge University
Hospitals NHS Foundation Trust,
Cambridge, UK
Dr Alasdair Parker
Consultant Paediatric Neurologist,
Cambridge University Hospitals
NHS Foundation Trust,
Cambridge, UK
Dr Willie Reardon
Consultant Clinical Geneticist,
Our Lady’s Hospital for Sick
Children, Dublin, Ireland
Dr Lesley Rees
Consultant Paediatric
Nephrologist
Great Ormond Street Hospital for
Children Foundation Trust,
London
Professor Benjamin J
Stenson
Consultant Neonatologist
Simpson Centre for Reproductive
Health, Royal Infi rmary of
Edinburgh, UK
Dr Robert M R Tulloh
Consultant in Paediatric
Cardiology, Bristol Royal Hospital
for Children and Bristol Royal
Infi rmary, UK
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CONTENTS
xi
Contents
Detailed contents xiii
Symbols and abbreviations xxxii
1 Practising paediatrics
1
2 Epidemiology, evidence, and practice
9
3 Clinical assessment
19
4 Resuscitation
35
5 Emergency and high dependency care
45
6 Neonatology
107
7 Practical procedures
201
8 Cardiovascular
225
9 Respiratory medicine
253
10 Gastroenterology and nutrition
297
11 Nephrology
349
12 Endocrinology and diabetes
399
13 Growth and puberty
455
14 Neurology
495
15 Child development
555
16 Child and family psychiatry
567
17 Haematology
607
18 Oncology
651
19 Infectious diseases
693
20 Bones and joints
731
21 Adolescent health
793
22 Dermatology
805
23 Paediatric surgery
843
24 Special senses
893
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CONTENTS
xii
CONTENTS
25 Genetics
925
26 Inherited metabolic disease
953
27 Community child health
979
28 Child protection
997
29 Pharmacology and therapeutics
1011
30 International health and travel
1021
31 Paediatrics, ethics, and the law
1029
Index 1047
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xiii
Detailed contents
1
Practising paediatrics
1
Reading and learning paediatrics 2
Professional conduct and attitudes 3
Professional skills 4
Knowledge 6
2
Epidemiology, evidence, and practice
9
Introduction 10
Descriptions in populations 10
Summary of study designs 11
Levels of evidence 12
Basics of statistics 14
Training and special knowledge skills 16
Useful websites and resources 18
References 18
3
Clinical assessment
19
Communication skills 20
Taking a paediatric history: introduction 21
The presenting complaint 22
History of present illness 24
Past health history 25
Symptom review 26
Family history 28
Examining a child: introduction 28
General condition 29
Vital signs 30
Respiratory system 31
Cardiovascular system 32
Gastrointestinal system 33
Genitourinary system 34
Musculoskeletal system 34
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xiv
DETAILED CONTENTS
4
Resuscitation
35
Cardiopulmonary arrest 36
Rapid cardiopulmonary assessment 36
Paediatric basic life support 38
Choking children 39
Paediatric advanced life support 40
Rhythm disturbances 42
Treating supraventricular tachycardia 43
Following unsuccessful resuscitation 44
5
Emergency and high dependency care
45
The ABC of high dependency 46
Respiratory distress 48
Respiratory distress: management 50
Foreign-body inhalation 51
Drowning 52
Circulation: cardiovascular diffi culty 53
Cardiovascular system diffi culty: assessment 54
Cardiovascular system diffi culty: therapy—1 56
Cardiovascular system diffi culty: therapy—2 58
Cyanosis: assessment 60
Cyanosis: management 62
Anaphylaxis 64
Hypovolaemic shock 65
Burns 66
Burns: treatment 68
Sepsis 70
Altered level of consciousness 72
Altered level of consciousness: clinical assessment 74
Altered level of consciousness: Glasgow coma scale 76
Altered level of consciousness: management 78
Status epilepticus 80
Poisoning 82
Poisoning: management 84
Poisoning: antidotes and substrates 86
Fluid and electrolytes 89
Fluid and electrolytes: dehydration 90
Fluid and electrolytes: abnormalities 92
Renal insuffi ciency 94
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