Authors xix
Preface xxix
Milestone 25th Silver Anniversary Edition xxxi
1. Advancing the Quality• Safety of Care 1
Daniel Hyman, MD
Introduction
Current Context
Strategies & Models for
1
1
Quality Improvement (QI) 4
Principles of Patient Safety
(Incident Reporting, Just Culture, Disclosure,
FMEA, RCA, Reliability, Data, & Checldists) 7
2. The Newborn Infant 10
Danielle Smith, MD
Introduction 10
The Neonatal History 10
Assessment of Growth &
Gestational Age 10
Examination at Birth 12
Examination in the Nursery 12
Care of the Well Neonate 15
Feeding the Well Neonate 15
Early Discharge of the Newborn Infant 16
Hearing Screening 17
Common Problems in the Term Newborn 18
Neonatal Jaundice 18
Hypoglycernia 24
Respiratory Distress in the Term Newborn
Infant 26
Heart Murmurs 28
Birth Trauma 28
Infants of Mothers Who Abuse Drugs 29
Multiple Births 31
Neonatal Intensive Care 31
Perinatal Resuscitation 31
The Preterm Infant 35
The Late Preterm Infant 44
Cardiac Problems in the Newborn Infant 45
Structural Heart Disease 45
Persistent Pulmonary Hypertension 46
Arrhythmias 47
Gastrointestinal & Abdominal Surgical
Conditions in the Newborn Infant 47
Esophageal Atresia & Tracheoesophageal
Fistula 47
Intestinal Obstruction 48
iii
Abdominal Wall Defects
Diaphragmatic Hernia
Gastrointestinal Bleeding
Gastroesophageal Reflux
Infections in the Newborn Infant
Bacterial Infections
Fungal Sepsis
Congenital Infections
Perinatally Acquired Infections
Hematologic Disorders in the Newborn Infant
Bleeding Disorders
Anemia
Polycythemia
Renal Disorders in the Newborn Infant
Renal Failure
49
50
50
51
51
51
54
55
57
58
58
60
60
61
61
Urinary Tract Anomalies 61
Renal Vein Thrombosis 62
Neurologic Problems in the
Newborn Infant 62
Seizures 62
Intracranial Hemorrhage 63
Metabolic Disorders in the Newborn Infant 64
Hyperglycemia 64
Hypocalcemia 64
Inborn Errors of Metabolism 65
Quality Assessment & Improvement in the
Newborn Nursery & NICU 65
3. Chlld DevelopmenUr Behavlor 66
Edward Goldson, MD
Ann Reynolds, MD
Abigail S. Angulo, MD, MPH
Dannah M. Raz, MD
Introduction 66
Normal Development 66
The First 2 Years 66
Ages 2-4 Years 72
Early School Years: Ages 5-7 Years 72
Middle Childhood: Ages 7-11 Years 73
Behavioral & Developmental Variations 73
Normality & Temperament 73
Enuresis & Encopresis 74
Enuresis 74
Encopresis 75
Common Developmental Concerns 76
Colic 76
Feeding Disorders in Infants &
Young Children 77
Sleep Disorders 79
CONTENTS
Parasomnias 80 Treatment & Referral 150
Insomnia 80 Prevention 153
Sleep-Disordered Breathing 81 References 154
Restless Legs Syndrome & Periodic
Limb Movement Disorder 81 6. Eating Disorders 155
Temper Tantrums & Breath-Holding Spells 82
Well-Child Surveillance & Screening 84 Eric J. Sigel MD
Developmental Disorders 84 Introduction 155
Attention-Deficit/Hyperactivity Disorder 85 Etiology 155
Autism Spectrum Disorders 88 Incidence 156
Intellectual Disability 92 Predisposing Factors & Clinical Profiles 156
Specific Forms of Intellectual Disability & Anorexia Nervosa 156
Associated Treatment Issues 94 Bulimia Nervosa 162
References 96 Binge-Eating Disorder 164
Avoidant/Restrictive Food Intake Disorder 165
4. Adolescence 97 Prognosis, Quality Assessment, &
Outcomes Metrics 165
Amy E. Sass, MD, MPH Resources for Practitioners & Families 166
Molly J. Richards, MD
Introduction 97 7. Child & Adolescent Psychiatric
Epidemiology 97 Disorders & Psychosoclal Aspeds of
Mortality Data 97 Pediatrics 167
Morbidity Data 97
Providing A Medical Home for Adolescents 98 Kimberly Kelsay, MD
Relating to the Adolescent Patient 99 Aye/et Ta/mi, PhD
The Structure of the Visit 100 Adam Burstein, DO
Guidelines for Adolescent Preventive Services 106 Introduction 167
Adolescent Screening 106 Models of Care Encompassing Behavioral
Promoting Healthy Behaviors 110 Health in the Primary Care Setting 168
Transition to Adult Care 112 Prevention, Early Identification, &
Growth & Development 112 Developmental Context 168
Puberty 112 Lifestyle Recommendations 170
Physical Growth 113 Identification & Assessment During Health
Sexual Maturation 113 Supervision Visits 170
Psychosocial Development 114 Tools for Mental Health Screening in the
Adolescent Gynecology & Reproductive Health 116 Primary Care Office Setting 171
Breast Examination 116 Psychiatric Disorders of Childhood &
Breast Masses 116 Adolescence 177
Nipple Discharge & Galactorrhea 118 Anxiety Disorders 178
Gynecomastia 119 Obsessive-Compulsive & Related Disorders 184
Gynecologic Care & Gynecologic Disorders in Attention-Deficit/Hyperactivity Disorder 187
Adolescence 120 Mood Disorders 189
Contraception 131 Suicide in Children & Adolescents 195
Pregnancy 137 Disruptive, Impulse-Control,
& Conduct Disorders 196
5. Adolescent Substance Abuse 140 High-Risk Patients & Homicide 198
Paritosh Kaul, MD
Somatic Symptom & Related Disorders 199
Adjustment Disorders 201
Scope of the Problem 140 Psychotic Disorders 201
Morbidity Data 145 Other Psychiatric Conditions 203
Predicting the Progression References 204
From Use to Abuse 146
Evaluation of Substance Abuse 146
CONTENTS
8. Child Abuse 8r Neglect 208 Communicating with Parents About Vaccines 251
Hepatitis B Vaccination 252
Antonia Chiesa, MD Rotavirus Vaccination 254
Andrew P. Sirotnak, MD, FAAP Diphtheria-Tetanus-Acellular Pertussis
Introduction 208 Vaccination 255
Prevention 209 Haemophilus Influenzae Type B Vaccination 257
Clinical Findings 210 Pneumococcal Vaccination 258
Differential Diagnosis 215 Poliomyelitis Vaccination 260
Treatment 215 Influenza Vaccination 261
Prognosis 216 Measles, Mumps, & Rubella Vaccination 262
Varicella Vaccination 265
9. Ambulatory & Office Pediatrics 217 Hepatitis A Vaccination 266
Meningococcal Vaccination 267
Meghan Treitz, MD Tetanus-Reduced Diphtheria-Acellular
Daniel Nicklas, MD Pertussis Vaccination (Adolescents
David Fox, MD &Adults) 269
Introduction 217 Human Papillomavirus Vaccination 270
Pediatric History 217 Vaccinations for Special Situations 271
Pediatric Physical Examination 218 Rabies Vaccination 271
Health Supervision Visits 219 Typhoid Fever Vaccination 272
Developmental & Behavioral Assessment 219 Cholera Vaccination 273
Growth Parameters 222 Japanese Encephalitis Vaccination 273
Blood Pressure 223 Tuberculosis Vaccination 273
Vision & Hearing Screening 224 Yellow Fever Vaccination 274
Anticipatory Guidance 228 Passive Prophylaxis 274
Nutrition Counseling 230
Counseling About Television 11. Normal Childhood Nutrition &
& Other Media 230 Its Disorders 276
Immunizations 231
Acute-Care Visits 232 Matthew A. Haemer, MD, MPH
Prenatal Visits 232 Uliane K. Diab, MD
Sports Physicals 232 Laura E. Primak, RD, CNSD, CSP
Chronic Disease Management 233 Nancy F. Krebs, MD, MS
Medical Home 233 Nutritional Requirements 276
Mental & Behavioral Health 233 Nutrition & Growth 276
Telephone Management & Web-Based Energy 276
Information 234 Protein 277
Advocacy & Community Pediatrics 235 Lipids 278
Toxic Stress 235 Carbohydrates 279
Common General Pediatric Issues 236 Major Minerals 280
Fever 236 Trace Elements 280
Growth Deficiency 237 Vitamins 280
Infant Feeding 284
10. Immunization 240 Breast-Feeding 284
Matthew F. Daley, MD Special Dietary Products for Infants 291
Nutrition for Children 2 Years & Older 292
Sean T. O'leary, MD, MPH
Pediatric Undernutrition 292 Ann-Christine Nyquist, MD, MSPH
Pediatric Overweight & Obesity 294
Jessica R. Cataldi, MD, MSCS
Nutrition Support 297
Standards for Pediatric Immunization Practices 241 Enteral 297
Routine Childhood & Adolescent Immunization Parenteral Nutrition 298
Schedules 242 Nutrient Requirements & Delivery 299
Vaccine Safety 242
Vaccination in Special Circumstances 250
CONTENTS
12. Emergencies&: Injuries 305 Anesthetics, Local 336
Jonathan Orsborn, MD
Antihistamines & Cough &
Cold Preparations 337
Cortney Braund, MD Barbiturates & Benzodiazepines 338
Introduction to Pediatric Emergencies Belladonna Alkaloids (Atropine,
&Injuries 305 Jimsonweed, Potato Leaves, Scopolamine,
Initial Approach to the Acutely Ill Stramonium) 338
Infant or Child 305 ~-Blockers & Calcium Channel Blockers 338
The ABCs of Resuscitation 306 Carbon Monoxide 339
Management of Shock 310 Caustics 339
Summary of Initial Approach to the Central ~-Adrenergic Agonist 340
Acutely Ill Infant or Child 311 Cocaine 340
Emergency Pediatric Drugs 311 Cosmetics & Related Products 341
Approach to the Pediatric Trauma Patient 312 Cyclic Antidepressants 341
Mechanism of Injury 312 Digitalis & Other Cardiac Glycosides 341
Initial Assessment & Management 312 Diphenoxylate with Atropine (Lomotil) &
Primary Survey 313 Loperamide (Imodium) 342
Secondary Survey 315 Disinfectants & Deodorizers 342
Head Injury 317 Disk-Shaped "Button• Batteries 343
Bums 319 Ethylene Glycol & Methanol 343
Thermal Bums 319 y-Hydroxybutyrate, y-Butyrolactone,
Electrical Burns 321 Butanediol, Flunitrazepam, & Ketamine 344
Disorders Due to Extremes of Environment 321 Hydrocarbons (Benzene, Charcoal Lighter
Heat-Related Illnesses & Heat Stroke 321 Fluid. Gasoline, Kerosene, Petroleum
Hypothermia 322 Distillates, Turpentine) 344
Submersion Injuries 323 Ibuprofen 344
Lacerations 324 Insect Stings (Bee, Wasp, & Hornet) 345
Animal & Human Bites 325 Insecticides 345
Dog Bites 325 Iron 346
Cat Bites 326 Lead 346
Human Bites 326 Magnets 347
Pain Management & Marijuana 347
Procedural Sedation 326 Mushrooms 348
Nitrites, Nitrates, Aniline,
13. Poisoning 328 Pentachlorophenol, & Dinitrophenol 348
George Sam Wang, MD
Opioids & Opiates 349
Oral Anti-Diabetics (Sulfonylureas,
Barry H. Rumack, MD Metformin) 349
Richard C. Dart, MD, PhD Anti.psychotics (Typical & Atypical) 350
Introduction 328 Plants 350
Pharmacologic Principles of Toxicology 328 Psychotropic Drugs 351
Preventing Childhood Poisonings 329 Salicylates 352
General Treatment of Poisoning 329 Scorpion Stings 353
Initial Telephone Contact 329 Serotonin Reuptake Inhibitors 353
Initial Emergency Department Contact 332 Snakebite 353
Definitive Therapy of Poisoning 332 Soaps & Detergents 354
Management of Specific Common Poisonings 333 Spider Bites 355
Acetaminophen (Paracetamol) 333 Vitamins 355
Alcohol, Ethyl (Ethanol) 335 Warfarin (Coumadin) & Newer Oral
Amphetamines & Related Drugs (Stimulants, Anticoagulants (NOAC) 356
Methamphetamine, 3,4-Methylenedioxy-
N-Methylamphetamine) 336
CONTENTS vii
14. Critical Care 357 Acne 399
Bacterial Infections of the Skin 402
Amy C. Clevenger, M~ PhD Fungal Infections of the Skin 403
Angela S. Czaja, MD, MSc Viral Infections of the Skin 404
Ryan J. Good, MD Virus-Induced Tumors 405
Cameron F. Gunvil/e, DO Insect Infestations 406
Leslie A Ridall, DO Dermatitis (Eczema) 406
Todd C. Carpenter, MD Common Skin Tumors 409
Eva N. Grayck, MD Papulosquamous Eruptions 410
Carleen Schneiter, MD Hair Loss (Alopecia) 411
Introduction 357 Reactive Erythemas 412
Respiratory Critical Care 357 Miscellaneous Skin Disorders Seen
Acute Respiratory Failure 357 in Pediatric Practice 413
Conventional Mechanical Ventilation 361
Other Modes of Respiratory Support 363 16. Eye 414
Major Respiratory Diseases in the Pediatric ICU 364
Acute Respiratory Distress Syndrome 364 Jennifer Lee Jung, MD
Status Asthmaticus 368 Introduction 414
Cardiovascular Critical Care 370 Common Nonspecific Signs & Symptoms 414
Shock 370 Red Eye 414
Sepsis 373 Tearing 414
Neurocritical Care 377 Discharge 414
Traumatic Brain Injury 377 Pain & Foreign-Body Sensation 414
Hypoxic-Ischemic Encephalopathy 380 Photophobia 414
Status Epilepticus 381 Abnormal Red Reflex 414
Acute Kidney Injury & Renal Replacement Refractive Errors 415
Therapy 382 Myopia (Nearsightedness) 416
Fluid Management & Nutritional Support Hyperopia (Farsightedness) 416
of the Critically ill Child 383 Astigmatism 416
Sedation & Analgesia in the Ophthalmic Examination 416
Pediatric ICU 386 History 416
End-of-Life Care & Death in the PICU 389 Visual Acuity 416
Quality Improvement Initiatives in the PICU 392 External Examination 417
Pupils 418
15. Skin 393 Alignment & Motility Evaluation 418
Ophthalmoscopic Examination 419
Lori D. Prok, MD Ocular Trauma 420
Carla X. Torres-Zegarra, MD Prevention of Ocular Injuries 420
General Principles 393 Corneal Abrasion 420
Diagnosis of Skin Disorders 393 Ocular Foreign Bodies 420
Treatment of Skin Disorders 393 Intraocular Foreign Bodies & Perforating
Disorders of the Skin in Newborns 395 Ocular Injuries 421
Transient Diseases in Newborns 395 Blunt Orbital Trauma 422
Pigment Cell Birthmarks, Lacerations 423
Nevi, & Melanoma 396 Burns 423
Melanocytic Nevi 396 Hyphema 424
Vascular Birthmarks 397 Abusive Head Trauma & N onaccidental
Epidermal Birthmarks 398 Trauma 425
Connective Tissue Birthmarks Disorders of the Ocular Structures 425
(Juvenile Elastoma, Collagenoma) 399 Diseases of the Eyelids 425
Hereditary Skin Disorders 399 Viral Eyelid Disease 428
Common Skin Diseases in Infants, Miscellaneous Eyelid Infections 428
Children, & Adolescents 399 Eyelid Ptosis 428
viii
Homer Syndrome
Eyelid Ties
Disorders of the Nasolacrimal System
Nasolacrimal Duct Obstruction
Congenital Dacryocystocele
Dacryocystitis
Diseases of the Conjunctiva
Ophthalmia Neonatorum
Bacterial Conjunctivitis
Vtral Conjunctivitis
Allergic Conjunctivitis
Mucocutaneous Diseases
Disorders of the Iris
Iris Coloboma
Aniridia
Albinism
Miscellaneous Iris Conditions
Glaucoma
Uveitis
Anterior Uveitis/Iridocyclitis/Iritis
Posterior Uveitis
Intermediate Uveitis
Disorders of the Cornea
Cloudy Cornea
Viral Keratitis
Corneal Ulcers
Disorders of the Lens
Cataracts
Dislocated Lenses/Ectopia Lentis
Disorders of the Retina
Retinal Hemorrhages in the Newborn
Retinopathy of Prematurity (ROP)
Retinoblastoma
Retinal Detachment
Diabetic Retinopathy
Diseases of the Optic Nerve
Optic Neuropathy
Optic Nerve Hypoplasia
Papilledema
Optic Neuritis
Optic Atrophy
Diseases of the Orbit
Periorbital & Orbital Cellulitis
Craniofacial Anomalies
Orbital Tumors
Nystagmus
Amblyopia
Strabismus
Esotropia (Crossed Eyes)
Exotropia (Wall-Eyed, Drifting of Eyes)
Unexplained Decreased Vision in
Infants & Children
Learning Disabilities & Dyslexia
CONTENTS
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430
430
430
431
431
432
432
433
434
435
435
437
437
437
438
438
439
439
439
440
441
442
442
442
443
443
444
444
445
445
445
446
447
447
448
448
448
449
450
451
452
452
452
453
453
454
455
455
456
457
458
17. Oral Medicine a Dentistry 459
Roopo P. Gandhi, BOS, MSD
Choitonya P. Puranik, BOS, MS, MDentSd, PhD
Anne Wilson, DOS, MS
Katherine L Chin, DOS, MS
Pediatric Oral Health 459
Oral Examination of Children 460
Dental Caries 463
Periodontal Disease 466
Dental Emergencies 466
Special Patient Populations 469
Orthodontic Referral 470
18. Ear, Nose, a Throat 471
Patricia J. Yoon, MD
Melissa A Scholes, MD
Brian W. Herrmann, MD
The Ear 471
Infections of the Ear 471
Acute Trauma to the Middle Ear 480
Ear Canal Foreign Body &
Cerwnen Impaction 481
Auricular Hematoma 481
Congenital Ear Malformations 481
Identification & Management
of Hearing Loss 482
The Nose & Paranasal Sinuses 484
Acute Vual Rhinitis 484
Rhinosinusitis 486
Choanal Atresia 488
Recurrent Rhinitis 488
Epistaxis 488
Nasal Infection 489
Nasal Trawna 489
Foreign Bodies in the Nose 489
The Throat & Oral Cavity 490
Acute Stomatitis 490
Pharyngitis 490
Peritonsillar Cellulitis or Abscess (Quinsy) 493
Retropharyngeal Abscess 494
Ludwig Angina 494
Acute Cervical Adenitis 494
Tonsillectomy & Adenoidectomy 495
Disorders of the Lips 496
Disorders of the Tongue 496
Halitosis 497
Salivary Gland Disorders 497
Congenital Oral Malformations 497
19. Respiratory Tract Bi Mediastinum 499
Monica J. Federico, MD
Christopher D. Baker, MD
Emily M. DeBoer, MD
Oren Kupfer, MD
Stacey L. Martiniano, MD
Paul Stillwell, MD
Stephen Hawkins, MD
Deborah Liptzin, MD
Respiratory Tract 499
Growth & Development 499
Diagnostic Aids 499
Physical Examination of the Respiratory Tract 499
Pulmonary Function Tests 500
Assessment of Oxygenation & Ventilation 501
Diagnosis of Respiratory Tract Infections 502
Imaging of the Respiratory Tract 504
Laryngoscopy & Bronchoscopy 504
General Therapy for Pediatric
Lung Diseases 504
Oxygen Therapy 504
Inhalation of Medications 505
Airway Clearance Therapy 506
Avoidance of Environmental Hazards 506
Disorders of the Conducting Airways 506
Laryngomalacia & Congenital Disorders of the
Extrathoracic Airway 507
Laryngomalacia 507
Other Causes of Congenital Extrathoracic
Obstruction 507
Acquired Disorders of the Extrathoracic
Airway 508
Foreign-Body Aspiration in the Extrathoracic
Airway 508
Croup Syndromes 509
Vocal Fold Immobility 511
Subglottic Stenosis 511
Congenital Causes of Intrathoracic Airway
Obstruction 512
Malacia of Airways 512
Vascular Rings & Slings 512
Bronchogenic Cysts 513
Acquired Causes of Intrathoracic Airway
Obstruction 513
Foreign-Body Aspiration in the Intrathoracic
Airway 514
Disorders of Mucociliary Clearance 514
Cystic Fibrosis 514
Primary Ciliary Dyskinesia 516
Bronchiectasis 517
Congenital Malformations of the Lung
Parenchyma 518
CONTENTS
Puhnonary Agenesis & Hypoplasia 518
Puhnonary Sequestration 519
Congenital Lobar Overinflation 519
Congenital Puhnonary Airway Malformation
(Previously Named Cystic
Adenomatoid Malformation) 520
Acquired Abnormalities of the
Lung Parenchyma 521
Bronchopulmonary Dysplasia 521
Community-Acquired Bacterial Pneumonia 523
Parapneumonic Effusion & Empyema 525
Atypical Pneumonias 526
Viral Pneumonia 526
Bronchiolitis 527
Mycoplasma Pneumonia 528
Aspiration Pneumonia 528
Pneumonia in the
Immunocompromised Host 529
Lung Abscess 531
Bronchiolitis Obliterans 532
Children's Interstitial Lung Disease
Syndrome 533
Hypersensitivity Pneumonitis 535
Diseases of the Puhnonary Circulation 535
Puhnonary Hemorrhage 535
Puhnonary Embolism 537
Puhnonary Edema 538
Congenital Puhnonary Lymphangiectasia 539
Disorders of the Chest Wall 539
Scoliosis 539
Pectus Carinatum 539
Pectus Excavatum 540
Neuromuscular Disorders &
Lung Disease 540
Disorders of the Pleura &
Pleural Cavity 540
Hemothorax 541
Chylothorax 541
Pneumothorax & Related Air Leak
Syndromes 542
Mediastinum 542
Mediastinal Masses 542
Sleep-Disordered Breathing 543
Primary Snoring & Obstructive
Sleep Apnea 544
Periodic Breathing & Central
Sleep Apnea 546
Brief Resolved Unexplained Events (Formerly
Apparent Life-Threatening Events) 546
Sudden Unexpected Infant Death &
Sudden Infant Death Syndrome 549
Quality Assessment & Outcomes Metrics 550
CONTENTS
20. Cardiovascular Diseases
Pei-Ni Jone, MD
John S. Kim, MD
Johannes von Alvensleben, MD
Dole Burkett, MD
551
Introduction 551
Diagnostic Evaluation 551
History 551
Physical Examination 551
Electrocardiography 554
Chest Radiograph 556
Echocardiography 557
Magnetic Resonance Imaging 558
Cardiopulmonary Stress Testing 558
Arterial Blood Gases & Pulse Oximetry 558
Cardiac Catheterization & Angiocardiography 559
Perinatal & Neonatal Circulation 560
Heart Failure 561
Genetic Basis of Congenital Heart Disease 563
Acyanotic Congenital Heart Disease 564
Defects in Septation 564
Patent (Persistent) Ductus Arteriosus 568
Right-Sided Obstructive Lesions 569
Left-Sided Lesions 572
Diseases of the Aorta 576
Coronary Artery Abnormalities 577
Cyanotic Congenital Heart Disease 578
Tetralogy of Fallot 578
Pulmonary Atresia with Ventricular
Septal Defect 580
Pulmonary Atresia with Intact Ventricular
Septum 580
Tricuspid Atresia 581
Hypoplastic Left Heart Syndrome 582
Transposition of the Great Arteries 584
Total Anomalous Pulmonary Venous Return 585
Truncus Arteriosus 587
Quality Improvement in Congenital Heart
Disease 588
Acquired Heart Disease 588
Rheumatic Fever 588
Kawasaki Disease 590
Infective Endocarditis 591
Pericarditis 593
Cardiomyopathy 594
Myocarditis 597
Preventive Cardiology 598
Hypertension 598
Atherosclerosis & Dyslipidemias 598
Chest Pain 599
Cardiac Transplantation 600
Quality Improvement for Pediatric Heart
Transplantation 601
Pulmonary Hypertension 602
Disorders of Rate & Rhythm 603
Disorders of the Sinus Node 603
Premature Beats 604
Supraventricular Tachycardia 605
Ventricular Tachycardia 609
Long QT Syndrome 609
Sudden Cardiac Death 610
Disorders of Atrioventricular Conduction 610
Syncope (Fainting) 612
Introduction 612
Diagnostic Evaluation 612
Vasovagal/Neurocardiogenic Syncope 613
21. GastrofntestfnalTract 615
David Brumbaugh, MD
Glenn T. Furuta, MD
Edward J. Hoffenberg, MD
Gregory E. Kobak, MD
Robert E. Kromer, MD
Seth Septer, MD
Mary Shull, MD
Jason Soden, MD
Thomas Walker, MD
Disorders of the Esophagus 615
Gastroesophageal Reflux & GERD 615
Eosinophilic Esophagitis 617
Achalasia of the Esophagus 618
Caustic Burns of the Esophagus 619
Foreign Bodies in the Alimentary Tract 620
Disorders of the Stomach & Duodenum 621
Hiatal & Paraesophageal Hernia 621
Pyloric Stenosis 622
Gastric & Duodenal illcer 623
Congenital Diaphragmatic Hernia 624
Congenital Duodenal Obstruction 624
Disorders of the Small Intestine 625
Intestinal Atresia & Stenosis 625
Intestinal Malrotation 626
Short Bowel Syndrome 627
Intussusception 628
Inguinal Hernia 629
Umbilical Hernia 629
Patent Omphalomesenteric Duct 630
Meckel Diverticulum 630
Acute Appendicitis 630
Duplications of the
Gastrointestinal Tract 631
Disorders of the Colon 631
CONTENTS
Congenital Aganglionic Megacolon Wilson Disease (Hepatolenticular
(Hirschsprung Disease) 631 Degeneration) 682
Constipation 633 Drug-Induced Liver Diseases 683
Anal Fissure 634 Cirrhosis 684
Congenital Anorectal Anomalies 634 Portal Hypertension 685
Clostridium Difficile Infection in Children 635 Biliary Tract Disease 688
Disorders of the Peritoneal Cavity 636 Pyogenic & Amebic Liver Abscess 693
Peritonitis 636 Liver Tumors 694
Chylous Ascites 637 Liver Transplantation 695
Gastrointestinal Tumors & Malignancies 637 Pancreatic Disorders 696
Juvenile Polyps 637 Acute Pancreatitis 696
Cancers of the Esophagus, Small Chronic Pancreatitis 697
Bowel, & Colon 638 Gastrointestinal & Hepatobiliary
Mesenteric Cysts 638 Manifestations of Cystic Fibrosis 698
Intestinal Hemangiomas & Syndromes with Pancreatic
Vascular Malformations 639 Exocrine Insufficiency 701
Major Gastrointestinal Symptoms & Signs 640 Isolated Exocrine Pancreatic
Acute Diarrhea 640 Enzyme Defect 701
Chronic Diarrhea 641 Pancreatic Tumors 702
Gastrointestinal Bleeding 643 References 703
Vomiting 646
Abdominal Pain 647 23. Fluid, Electrolyte, &: Acid-Base
Acute Abdomen 649 Disorders&: Therapy 704
Malabsorption Syndromes 649
Inflammatory Bowel Disease 653 Melisha G. Hanna, MD, MS
Margret£ Bock, MD, MS
22. Liver&: Pancreas 657 Regulation ofBody Fluids, Electrolytes,
&Tonicity 704
Ronald J. Sokol, MD Acid-Base Balance 705
Michael R. Narkewicz, MD Fluid & Electrolyte Management 706
Jacob A. Mark, MD Dehydration 707
Cara L. Mack, MD Hyponatremia 709
Amy G. Feldman, MD, MSCS Hypematremia 710
Shikha S. Sundaram, MD, MSCI Potassium Disorders 710
Liver Disorders 657 Acid-Base Disturbances 712
Neonatal Cholestatic Jaundice 657 Metabolic Acidosis 712
Intrahepatic Cholestasis 657 Metabolic Alkalosis 712
Extrahepatic Neonatal Cholestasis 666 Respiratory Acidosis 713
Other Neonatal Hyperbilirubinemic Respiratory Alkalosis 713
Conditions (Noncholestatic
N onhemolytic) 668 24. Kidney&: Urinary Trad 714
Hepatitis A 671
HepatitisB 673 Margret£ Bock, MD, MS
HepatitisC 674 Melisha G. Hanna, MD, MS
Hepatitis D (Delta Agent) 676 Evaluation of the Kidney & Urinary Tract 714
HepatitisE 676 History 714
Other Hepatitis Viruses 676 Physical Examination 714
Acute Liver Failure 676 Laboratory Evaluation of
Autoimmune Hepatitis 678 Renal Function 714
Nonalcoholic Fatty Liver Disease 679 Laboratory Evaluation of
a1-Antitrypsin Deficiency Liver Disease 680 Immunologic Function 718
xii CONTENTS
Radiographic Evaluation 718 Seizures & Epilepsy 748
Renal Biopsy 718 Sleep Disorders 760
Congenital Anomalies of the Urinary Tract 718 Headaches 761
Renal Parenchymal Anomalies 718 Pseudotumor Cerebri (Idiopathic Intracranial
Distal Urinary Tract Anomalies 720 Hypertension) 764
Hematuria & Glomerular Disease 720 Cerebrovascular Disease 766
Microhematuria 720 Congenital Malformations of the Nervous
Glomerulonephritis 721 System 769
Tubulointerstitial Disease 722 Abnormal Head Size 772
Acute Interstitial Nephritis 722 Neurocutaneous Dysplasias 774
Proteinuria & Renal Disease 723 Central Nervous System Degenerative
Congenital Nephrosis (Finnish Type) 723 Disorders of Infancy & Childhood 780
Idiopathic Nephrotic Syndrome of Childhood 723 Ataxias of Childhood 780
Focal Segmental Glomerulosclerosis 724 Acute Ataxias of Childhood 780
MembranousNephropathy(Membranous Chronic & Episodic Ataxias 783
Glomerulonephritis) 724 Movement Disorders 783
Diseases of the Renal Vessels 725 Cerebral Palsy 786
Renal Vein Thrombosis 725 Infections & Inflammatory Disorders
Renal Arterial Disease 725 of the Central Nervous System 787
Hemolytic-Uremic Syndrome 725 Bacterial Meningitis 788
Renal Failure 726 Brain Abscess 789
Acute Kidney Injury 726 Vrral Infections 790
Chronic Renal Failure 729 Encephalopathy of Human
Hypertension 730 Immunodeficiency Virus Infection 790
Inherited or Developmental Defects Other Infections 790
of the Kidneys 733 Noninfectious Inflammatory Disorders
Disorders of the Renal Tubules 733 of the Central Nervous System 790
Cystinosis 735 Syndromes Presenting as Acute
Oculocerebrorenal Syndrome Flaccid Weakness 792
{Lowe Syndrome) 735 Disorders of Childhood Affecting Muscles 796
Hypokalemic Alkalosis {Bartter Syndrome, Benign Acute Childhood Myositis 802
Gitelman Syndrome, Disorders of Neuromuscular Transmission 802
& Liddle Syndrome) 735 Lesions of the Peripheral Nerve 805
Nephrogenic Diabetes Insipidus 736 Peripheral N europathy 806
Nephrolithiasis 736 Motor Neuron Disorders 807
Urinary Tract Infections 737 Miscellaneous Neuromuscular Disorders 808
QA/QI in Pediatric Nephrology 739 Floppy Infant Syndrome 808
25. Neurologic & Muscular Disorders 740 26. Orthopedics 811
Ricko Messer, MD, PhD Jason T. Rhodes, MD, MS
Teri L. Schreiner, MD, MPH Alex Tagawa, BS
Diana Walleigh, MD Cameron Niswander, BA
Michele L. Yong, MD Wade Coomer, BS
Jan A. Martin, MD Mark A. Erickson, MD, MMM
Scott Demarest, MD SayanDe,MD
Neurologic Assessment & Neurodiagnostics 740 Introduction 811
History & Examination 740 Disturbances of Prenatal Origin 811
Diagnostic Testing 740 Congenital Amputations &
Pediatric Neuroradiologic Procedures 742 Limb Deficiencies 811
Disorders Affecting the Nervous System in Deformities of the Extremities 812
Infants & Children 746 Common Foot Problems 812
Altered States of Consciousness {Coma) 746 Genu Varum & Genu Valgum 814
CONTENTS xiii
Tibial Torsion & Femoral Anteversion 815 28. Rehabilitation Medicine 866
Developmental Dysplasia of the Hip Joint 815
Slipped Capital Femoral Epiphysis 817 Pamela E. Wilson, MD
Common Spine Conditions 818 Gerald H. Clayton, PhD
Back Pain 818 Pediatric Brain Injury 866
Torticollis 818 Spinal Cord Injury 869
Scoliosis 819 Brachia! Plexus Lesions &
Kyphosis 820 Typical Features 871
Inflammatory Conditions 821 Common Rehabilitation Problems 872
Syndromes with Musculoskeletal Involvement 821 Quality Assurance/Improvement Initiatives
Arthrogryposis Multiplex Congenita in Rehabilitation Medicine 874
(Amyoplasia Congenita) 821
Neurologic Disorders Involving the 29. Rheumatic Diseases 875
Musculoskeletal System 823
Jennifer B. Soep, MD Trauma 824
Traumatic Subluxations & Dislocations 825 Juvenile Idiopathic Arthritis 875
Fractures 826 Systemic Lupus Erythematosus 878
Infections of the Bones & Joints 828 Dermatomyositis 880
Vascular Lesions & Avascular Necrosis Vasculitis 881
( Osteochondroses) 831 Raynaud Phenomenon 882
Neoplasia of the Musculoskeletal System 833 Noninflammatory Pain Syndromes 882
Miscellaneous Diseases of Bone & Joint 834
Fibrous Dysplasia 835 30. Hematologic Disorders 884
Bone Cysts, Balter Cyst. & Ganglions 835 Michael Wang, MD
Quality Assurance/Improvement Initiatives in
Orthopedics 836 Christopher McKinney, MD
Rachelle Nuss, MD
27. Sports Medicine 837
Daniel R. Ambruso, MD
Normal Hematologic Values 884
Katherine S. Dahab, MD, FMP, CAQSM Bone Marrow Failure 884
Stephanie W. Mayer, MD Constitutional Aplastic Anemia
Kyle B. Nagle, MD, MPH, FAAP, CAQSM (Fanconi Anemia) 884
Armando Vidal, MD Acquired Aplastic Anemia 886
Basic Principles 837 Anemias 887
Fitness & Conditioning 837 Approach to the Child with Anemia 887
Sports Nutrition 838 Pure Red Cell Aplasia 888
Preparticipation Physical Evaluation 838 Nutritional Anemias 890
Rehabilitation of Sports Injuries 845 Anemia of Chronic Disorders 892
Common Sports Medicine Issues & Injuries 846 Congenital Hemolytic Anemias:
Infectious Diseases 846 Red Cell Membrane Defects 893
Head & Neck Injuries 847 Congenital Hemolytic Anemias:
Spine Injuries 850 Hemoglobinopathies 895
Shoulder Injuries 851 Congenital Hemolytic Anemias:
Elbow Injuries 853 Disorders of Red Cell Metabolism 901
Hand & Wrist Injuries 855 Acquired Hemolytic Anemia 903
Hip Injuries 857 Polycythemia & Methemoglobinemia 905
Knee Injuries 859 Methemoglobinemia 906
Foot & Ankle Injuries 863 Disorders of Leukocytes 906
Prevention 864 Neutropenia 906
Neutrophilia 908
Disorders ofNeutrophil Function 909
Lymphocytosis 911
xiv CONTENTS
Eosinophilia 911 Endocrine Complications 970
Bleeding Disorders 912 Cardiopulmonary Complications 971
Abnormalities of Platelet Number Renal Complications 971
or Function 913 Neuropsychological Complications 971
Inherited Bleeding Disorders 917 Second Malignancies 971
Von Willebrand Disease 921
Acquired Bleeding Disorders 922 32. Pain Management a Pediatric
Vascular Abnormalities Associated with Palliative & End-of-Life Care 973
Bleeding 924
Thrombotic Disorders 925 Brian 5. Greffe, MD
Splenic Abnormalities 928 Jeffrey L Galinkin, MD
Splenomegaly & Hypersplenism 928 Nancy A. King, M5N, RN, CPNP
Asplenia & Splenectomy 928 Introduction 973
Transfusion Medicine 930 Pain Assessment 973
Donor Screening & Blood Processing: Acute Pain 973
Risk Management 930 Chronic Pain Management 975
Storage & Preservation of Blood & Blood Pediatric Palliative &
Components 931 End-of-Life Care 978
Pretransfusion Testing 931 Introduction 978
Transfusion Practice 935 Children Who May Benefit From
References 938 Palliative Care Interventions 978
Pain Management in Pediatric
31. Neoplastic Disease 939 Palliative Care 979
Amy K. Keating, MD
Quality-of-Life Adjuncts & Symptom
Management in Pediatric Palliative Care 979
Jessica Knight-Perry, MD, MB Psychosocial Aspects of Pediatric
Kelly Maloney, MD Palliative Care 979
Jean M. Mulcahy Levy, MD Children's Concept of Death 980
Brian 5. Greffe, MD Spiritual & Cultural Support 981
Anna R. K. Franklin, MD Withdrawal of Medical Life Support 982
Timothy Price Garrington, MD Advance Care Planning 982
Major Pediatric Neoplastic Diseases 939 References 983
Acute Lymphoblastic Leukemia 939
Acute Myeloid Leukemia 942 33. Immunodeficiency 984
Myeloproliferative Diseases 945
Brain Tumors 946 Jordan K. Abbott, MD, MA
Lymphomas & Lymphoproliferative Disorders 950 Pia J. Hauk, MD
Neuroblastoma 955 Introduction 984
Wilms Tumor (Nephroblastoma) 958 Immunodeficiency Evaluation:
BoneTumors 959 Primary Considerations 984
Rhabdomyosarcoma 961 Severe Combined Immunodeficiency
Retinoblastoma 963 Diseases 988
Hepatic Tumors 964 SCID Classification 990
Langerhans Cell Histiocytosis 966 Other Combined Immunodeficiencies 990
Blood & Marrow Transplant & Antibody Deficiency Syndromes 993
Cellular Therapeutics 967 Phagocyte Disorders 996
General Considerations 967 Deficiencies of the Innate Immune System 998
BMT Complications 968 Immunodeficiency Diseases That Present
Cellular Therapeutics 968 with Autoimmunity 999
Late Effects of Pediatric Immunodeficiency Diseases That Overlap
Cancer Therapy 969 with Allergy 1000
Growth Complications 970
CONTENTS
34. Endocrine Disorders 1003 Congenital Adrenal Hyperplasias 1035
Sarah Bartz, MD
AdrenocorticalHyperfunction 1037
Primary Hyperaldosteronism 1038
Christina Chambers, MD Uses of Glucocorticoids &
Christine M. Chan, MD Adrenocorticotropic Hormone in
Melanie Cree-Green, MD, PhD Treatment ofNonendocrine Diseases 1039
Shan/ee Davis, MD, MSCS Adrenal Medulla Pheochromocytoma 1040
Stephanie Hsu, MD, PhD
General Concepts 1003 35. Diabetes Mellitus 1042
Hormone Types 1003
Feedback Control of Brigitte I. Frohnert, MD, PhD
Hormone Secretion 1003 Peter H. Chase, MD
Disturbances of Growth 1004 Marian Rewers, MD, PhD
Target Height & Skeletal Maturation 1005 Quality Assessment
Short Stature 1005 & Outcomes Metrics 1049
Tall Stature 1011 Associated Autoimmune Diseases
Disorders of the Posterior Pituitary Gland 1012 in Type 1 Diabetes 1053
Arginine Vasopressin Associated Conditions with
(Antidiuretic Hormone) Physiology 1012 Type 2 Diabetes 1054
Central Diabetes Insipidus 1012 References 1054
Thyroid Gland 1013
Fetal Development of the Thyroid 1013 36. Inborn Errors of Metabolism 1055
Physiology 1013
Janet A Thomas, MD Hypothyroidism (Congenital & Acquired) 1013
Thyroiditis 1015 Johan L. K. Van Hove, MD, PhD, MBA
Hyperthyroidism 1016
Austin A. Larson, MD
Thyroid Cancer 1018 Peter R. Baker II, MD
Disorders of Calcium & Phosphorus Introduction 1055
Metabolism 1018 Diagnosis 1055
Hypocalcemic Disorders 1018 Suspecting Inborn Errors 1055
Pseudohypoparathyroidism Laboratory Studies 1056
(Resistance to Parathyroid Common Clinical Situations 1056
Hormone Action) 1022 Management of Metabolic Emergencies 1057
Hypercalcemic States 1022 Newborn Screening 1057
Familial Hypocalciuric Hypercalcemia Disorders of Carbohydrate Metabolism 1058
(Familial Benign Hypercalcemia) 1024 Glycogen Storage Diseases 1058
Hypervitaminosis D 1024 Galactosemia 1059
Williams Syndrome 1024 Hereditary Fructose Intolerance 1060
Immobilization Hypercalcemia 1024 Disorders of Energy Metabolism 1060
Hypophosphatasia 1024 Disorders of Amino Acid Metabolism 1063
Gonads (Ovaries & Testes) 1025 Disorders of the Urea Cycle 1063
Development 1025 Phenylketonuria & the
Disorders of Sexual Development 1025 Hyperphenylalaninemias 1064
Abnormalities in Female Pubertal Hereditary Tyrosinemia 1066
Development & Ovarian Function 1027 Maple Syrup Urine Disease
Polycystic Ovarian Syndrome 1030 (Branched-Chain Ketoaciduria) 1066
Abnormalities in Male Pubertal Homocystinuria 1067
Development & Testicular Function 1031 Nonketotic Hyperglycinemia 1067
Adrenal Cortex 1033
Adrenocortical Insufficiency 1034
CONTENTS
Organic Acidemias 1068 Nonmendelian Disorders 1102
Propionic & Methylmalonic Acidemia Disorders of Imprinting 1102
(K.etotic Hyperglycinemias) 1068 Disorders Associated with Anticipation 1103
Carboxylase Deficiency 1070 Disorders of Multifactorial Inheritance 1104
Glutaric Acidemia Type I 1070 Cleft Lip & Cleft Palate 1104
Disorders of Fatty Acid Oxidation Neural Tube Defects 1105
&Carnitine 1071 Common Recognizable Disorders with
Fatty Acid Oxidation Disorders 1071 Variable or Unknown Cause 1106
Carnitine 1072 Genetic Evaluation of the Child with
Purine Metabolism Disorders 1072 Developmental Disabilities 1108
Lysosomal Diseases 1073 Perinatal Genetics 1109
Peroxisomal Diseases 1076 Teratogens 1109
Congenital Disorders of Glycosylation 1077 Assisted Reproduction 1110
Smith-Lemli-Opitz Syndrome & Prenatal Diagnosis 1110
Disorders of Cholesterol Synthesis 1077
Disorders of Brain Specific Metabolism: 38. Allergic Disorders 1112
Neurotransmitters, Synthesis of Amino
Ronina A. Covar, MD Acids & Glucose Transport 1078
Creatine Synthesis Disorders 1079 David M. Fleischer, MD
Quality Initiatives in the Field
Christine Cho, MD
of Metabolic Disease 1080 Mark Boguniewicz, MD
Introduction 1112
37. Genetics 8r Dysmorphology 1081 Asthma 1112
Naomi J. L. Meeks, MD
Allergic Rhinoconjunctivitis 1132
Atopic Dermatitis 1136
Margarita Saenz, MD Urticaria & Angioedema 1141
Anne Chun-Hui Tsai, MD, MSc Anaphylaxis 1143
Ellen R. Elias, MD Adverse Reactions to Drugs & Biologicals 1145
Foundations of Genetic Diagnosis 1081 Food Allergy 1148
Cytogenetics 1081 Insect Allergy 1150
Molecular Genetics 1085
Principles of Inherited Human Disorders 1087 39. Antimicrobial Therapy 1152
Mendelian Inheritance 1087
Multifactorial Inheritance 1090 Sarah K. Parker, MD
Nonmendelian Inheritance 1091 Jason Child, PharmD
Family History & Pedigree 1092 Christine E. MacBrayne, PharmD, MSC
Dysmorphology & Human Embryology 1092 Andrew Haynes, MD
Mechanisms 1093
Justin Searns, MD
Clinical Dysmorphology 1093 Principles of Antimicrobial Therapy 1152
Chromosomal Disorders: Abnormal Concepts for Judicious
Number 1094 Use of Antimicrobials 1152
Trisomies 1094 Susceptibility Testing & Drug
Sex Chromosome Abnormalities 1095 Dosing Properties 1154
Chromosomal Abnormalities: Pharmacodynamic Concepts 1154
Abnormal Structure 1096 Use of Antimicrobial Agents
Chromosome Deletion Disorders 1097 to Prevent Disease 1155
Contiguous Gene Disorders 1097 Choice of Antimicrobial Agents 1155
Mendelian Disorders 1098 Specific Antimicrobial Agents 1155
Autosomal Dominant Disorders 1098 ~-Lactam Antibiotics 1155
Autosomal Recessive Disorders 1100 ~-Lactam: Penicillins 1156
X-Linked Disorders 1102 ~-Lactam: Cephalosporins 1170
~-Lactam: Monobactams 1172
CONTENTS xvii
~-Lactam: Carbapenems 1172 Measles (Rubeola) 1214
Glycopeptide Agents 1172 Rubella 1216
Daptomycin 1173 Infections Due to Other Viruses 1217
Trimethoprim/Sulfamethoxazole 1173 Hantavirus Cardiopulmonary Syndrome 1217
Metronidazole 1173 Mumps 1218
Macrolides 1173 Rabies 1219
Lincosamides 1174 Rickettsial Infections and Q Fever 1220
Oxazolidinones 1174 Human Ehrlichiosis & Anaplasmosis 1221
Tetracyclines 1174 Rocky Mountain Spotted Fever 1222
Arninoglycosides 1175 Endemic Typhus (Murine Typhus) 1222
Rifamycins 1175 QFever 1223
Fluoroquinolones 1176
Antifungals 1176 41. Human Immunodeficiency
Antivirals 1177 Virus Infection 1224
References 1177
Elizabeth J. McFarland, MD
40. Infections: Viral I! Rlckettslal 1178 Pathogenesis & Epidemiology 1224
Prevention 1226
Daniel Olson, MD Perinatally HIV-Exposed Infant 1227
Myron J. ll!vin, MD Adolescents & Youth with HIV Exposure 1228
Edwin J. Asturias, MD Progressive HIV Disease 1229
Viral Infections 1178 Treatment 1231
Respiratory Infections 1178 Quality Assurance & Outcome Metrics 1234
Viruses Causing the Common Cold 1178
Infections Due to Adenoviruses 1181 42. Infections: Bacterial I! Splrochetal 1236
Influenza 1184
Parainfluenza (Croup) 1186 James Gaensbauer, MD, MScPH
Respiratory Syncytial Virus Disease 1187 Yosuke Nomura, MD
Human Metapneumovirus Infection 1188 John W. Ogle, MD
Infections Due to Human Coronaviruses 1189 Bacterial Infections 1236
Infections Due to Enteroviruses & Group A Streptococcal Infections 1236
Parechoviruses 1190 Group B Streptococcal Infections 1240
Acute Febrile Illness 1190 Streptococcal Infections with Organisms
Respiratory Tract Illnesses 1190 Other Than Group A or B 1243
Rashes (Including Hand-Foot-&-Mouth Pneumococcal Infections 1244
Disease) 1191 Staphylococcal Infections 1247
Central Nervous System Illnesses 1192 Meningococcal Infections 1251
Infections Due to Herpesviruses 1194 Gonococcal Infections 1254
Herpes Simplex Infections 1194 Botulism 1256
Varicella & Herpes Zoster 1197 Tetanus 1258
Roseola Infantum (Exanthem Subitum) 1200 Gas Gangrene 1260
Cytomegalovirus Infections 1201 Diphtheria 1261
Infectious Mononucleosis Infections Due to Enterobacteriaceae 1263
(Epstein-Barr Virus) 1204 Pseudomonas Infections 1265
Viral Infections Spread by Insect Vectors 1205 Salmonella Gastroenteritis 1267
Encephalitis 1209 Typhoid Fever & Paratyphoid Fever 1269
Dengue 1209 Shigellosis (Bacillary Dysentery) 1270
Chikungunya 1210 Cholera 1271
Zika 1211 Campylobacter Infection 1273
Colorado Tick Fever 1212 Tularemia 1274
Other Major Vrral Childhood Exanthems 1213 Plague 1275
Erythema Infectiosum 1213 Haemophilus Influenzae Type B Infections 1277
xv iii CONTENTS
Pertussis {Whooping Cough) 1279 The Spectrum of Signs &: Symptoms of
Listeriosis 1281 Sexually Transmitted Infections 1348
Tuberculosis 1283 Cervicitis 1348
Infections with Nontuberculous Pelvic Inflammatory Disease 1349
Mycobacteria 1286 Urethritis 1350
Legionella Infection 1287 Epididymitis 1351
Chlamydophila & Chlamydia Infections Proctitis, Proctocolitis, &: Enteritis 1351
(Psittacosis, C Pneumoniae, & Vaginal Discharge 1351
C Trachomatis) 1288 Genital Ulcerations 1353
Cat-Scratch Disease 1290 Genital Warts &: Human Papillomavirus 1356
Spirochetal Infections 1292 Other Viral Infections 1358
Syphilis 1292 Ectoparasitic Infections 1359
Relapsing Fever 1295 References 1360
Leptospirosis 1296
Lyme Disease 1298 45. Travel Medicine 1361
43. Infections: Parasitic• Mycotic 1300 Suchitra Rao, MBBS, MSCS
Introduction 1361
James Gaensbauer, MD, MScPH Preparing Children & Infants for Travel 1361
Myron J. Levin, MD Vaccinations-Routine Childhood Vaccines
Parasitic Infections 1300 Modified for Travel 1363
Protozoa! Infections 1301 Vaccinations-Travel-Specific 1365
Systemic Infections 1301 Traveler's Diarrhea 1367
Gastrointestinal Infections 1308 Malaria Prophylaxis & Prevention 1368
Trichomoniasis 1313 VJSits to Friends & Relatives {VFR)
Metazoal Infections 1313 in High-Risk Areas 1369
Nematode Infections 1313 HIV & Sexually Transmitted Diseases 1369
Cestode Infections (Flukes) 1320 Fever in the Returned Traveler 1372
Trematode Infections 1323 References 1375
Mycotic Infections 1324
Pneumoc:ystis & Other Opportunistic 46. Chemistry• Hematology Reference
Fungal Infections 1335 Intervals 1376
Pneumoc:ystis Jircwec:i Infection 1337
Melkon G. DomBourian, MD
44. Sexually Transmitted Infections 1339 Aimee LeDoux, MT (ASCP)
Jordana E. Hoppe, MD
Daniel H. Reirden, MD Robert Snyder, MT (ASCP)
Ann-Christine Nyquist, MD, MSPH Challenges in Determining &: Interpreting
Introduction 1339 Pediatric Reference Intervals 1376
Adolescent Sexuality 1339 Guidelines for Use of Data in a Reference
Risk Factors 1340 Range Study 1376
Prevention of Sexually Statistical Computation
Transmitted Infections 1340 of Reference Intervals 1377
Screening for Sexually Why Reference Intervals Vary 1378
Transmitted Infections 1340 Sensitivity, Specificity, &
Signs & Symptoms 1341 Predicitive Values 1378
The Most Common Antibiotic-Responsive Pediatric Reference Intervals 1379
Sexually Transmitted Infections 1341
Chlamydia Trac:homatis Infection 1341 Index 1393
