Table of Contents

Cover

Dedication

Title page

Copyright page

Preface to the third edition

Preface to the first edition

Acknowledgements

Key to symbols used in the text

Abbreviations

Evaluation of the child

1 The paediatric consultation

Communication skills in paediatrics

Approaching the consultation

History taking

Beginning the examination—observation

2 Systems examination

3 Development and developmental assessment

Milestones

Developmental warning signs

4 Growth and puberty

5 Understanding investigations:

I Haematology

Understanding investigations: II Radiology

Understanding investigations: III Microbiology

Moving through childhood

6 The newborn baby

The normal newborn

Asphyxia and resuscitation

Intrauterine growth retardation

Vitamin K

7 Congenital abnormalities

Patterns of congenital abnormality

Cleft lip and palate

Neural tube defects (spina bifida)

Developmental dysplasia of the hip

8 Screening and genetics

Screening

Genetic disorders

Genetic inheritance

Screening for Down’s syndrome

9 The premature baby

Respiratory distress syndrome

Necrotizing enterocolitis

Retinopathy of prematurity

Brain injury

10 Nutrition in childhood

Infant nutrition

Technique of breast-feeding

Weaning

Nutrition in the preschool years

Nutrition in the school-age child

11 Common behaviour problems

Common emotional and behavioural problems

Crying babies and colic

Feeding problems

Sleeping problems

Temper tantrums

Unwanted or aggressive behaviour

12 Child care and school

Common problems at school age

Severe educational difficulties

13 Child health promotion

Health education and promotion

Parental mental health

Parenting support

Baby care

Nutrition

Child development

Behavioural problems

Immunization and screening

Passive smoking

Injury prevention

Identifying risks and safeguarding children

Health promotion in school

14 Immunization and the diseases it protects against

Diphtheria

Tetanus

Pertussis (whooping cough)

Polio

Haemophilus influenzae B

Pneumococcal disease

Meningococcal C

Measles

Mumps

Rubella

Tuberculosis

Hepatitis B

Human papillomavirus

Growth, endocrine and metabolic

15 Weight faltering and failure to thrive

Weight faltering due to environmental or psychosocial causes

Failure to thrive

Malabsorption

Chronic illness

Familial causes

Familial causes

16 Short stature and poor growth

Constitutional or familial short stature

Maturational delay

Hypothyroidism

Rarer hormonal problems

Chronic illness

Turner’s syndrome

17 Obesity

Nutritional obesity

Infant obesity

Public health issues

18 Diabetes

Diabetes mellitus

Initial presentation of type 1 diabetes

Growing up with diabetes

Insulin therapy (type 1 diabetes)

Monitoring

Cardiovascular Disorders

19 Congenital heart disease

Congenital heart disease that typically presents in the newborn period

Investigations and their signficance

20 Heart murmurs

Defects causing a left-to-right shunt

Obstructive lesions

Prophylaxis for infective endocarditis

Fever

21 Acute fever

Fever in young infants

Viral upper respiratory tract infections

Tonsillitis

Infectious mononucleosis

Acute otitis media

22 Persistent fever and serious recurrent infections

Persistent fever and pyrexia of unknown origin

Kawasaki’s disease

Infective endocarditis

Osteomyelitis

Serious recurrent infection and immunodeficiency

Splenectomy and hyposplenism

Congenital immunodeficiency

Acquired immunodeficiency

Respiratory Disorders

23 Cough and wheeze

The ‘chesty’ child

Pneumonia

Bronchiolitis

Whooping cough

Croup (acute laryngotracheobronchitis)

Acute epiglottitis

24 Stridor

25 Swellings in the neck

26 Asthma

Presentation

Management of chronic asthma

Medical management of asthma in children

Inhaler devices

Treatment of severe exacerbation

27 Cystic fibrosis

Genetics

Presentation

Common problems and their management

Diagnosis

Prognosis

Abdominal Disorders

28 Acute abdominal pain

Acute appendicitis

Intussusception

Other surgical causes of acute abdominal pain

Non-surgical causes of acute abdominal pain

29 Vomiting

Gastro-oesophageal reflux

Pyloric stenosis

Vomiting due to gastroenteritis

Bowel obstruction

Sepsis presenting with vomiting

Vomiting due to raised intracranial pressure

30 Acute diarrhoea and dehydration

Dehydration

Acute diarrhoea

Management of dehydration

31 Chronic diarrhoea

Toddler diarrhoea

Lactose intolerance

Coeliac disease

Inflammatory bowel disease

Parasites

Cow’s milk protein intolerance

32 Recurrent abdominal pain

Idiopathic recurrent abdominal pain

Other causes

Other causes of recurrent abdominal pain

33 Constipation

Constipation

Idiopathic constipation

Hirschprung’s disease

Risk factors for constipation

Abdominal disorders

34 Urinary tract infections

Investigating urinary tract infections

Renal anomalies

Urological abnormalities

Vesicoureteric reflux

35 Haematuria and proteinuria

Acute post-streptococcal glomerulonephritis

Nephrotic syndrome

Other renal conditions

36 Bedwetting and daytime wetting

37 Swellings in the groin and scrotum

Neurological disorders

38 Developmental delay

Severe learning disabilities (mental retardation)

Intrauterine infections

Fetal alcohol syndrome

Congenital hypothyroidism

Inborn errors of metabolism

Neurodegenerative disorders

Neurocutaneous syndromes

Abuse and neglect

39 Headache

Migraine

Tension headache

Cluster headache

Raised intracranial pressure

Other causes of headache

40 Fits, faints and funny turns

Breath-holding spells

Reflex anoxic seizures

Infantile spasms

Syncope (fainting)

Cardiac arrhythmias

Hyperventilation

Hypoglycaemia and other metabolic conditions

41 Epilepsy

Medical management of epilepsy

Management of a tonic–clonic seizure

Monitoring a child with epilepsy

Living with epilepsy

42 Cerebral palsy

Management of cerebral palsy

Therapy

Orthopaedic problems

Nutrition

Growing up with cerebral palsy

Musculoskeletal Disorders

43 Swollen joints

44 Juvenile idiopathic arthritis

45 Leg pain and limp

46 Common childhood skeletal problems

Blood disorders

47 Anaemia and pallor

Iron deficiency anaemia

Thalassaemia

Sickle-cell anaemia

48 Jaundice

Kernicterus

Treatment

Physiological jaundice

Breast-milk jaundice

Haemolytic disease of the newborn

Biliary atresia

Jaundice in older children

49 Leukaemia and childhood cancer

Acute leukaemia

Short-term side effects of treatment

Late sequelae of treatment

Skin

50 Rashes—types of skin lesions

51 Rashes—newborn, infancy and congenital skin disorders

52 Rashes—infections and infestations

53 Rashes—common inflammatory disorders

54 Allergy

Atopic disease

Eczema

Asthma

Allergic rhinitis

Allergic conjunctivitis

Food allergy

Urticaria, angioedema and anaphylaxis

Emergency paediatrics

55 Assessing the acutely ill child

Respiratory failure

Acute upper airway obstruction

Septic shock

Neurological warning signs

56 The collapsed child

Collapse and cardiorespiratory arrest

Establishing an airway and artificial ventilation

Choking

External cardiac massage

Focal points for the assessment of the collapsed child

57 The unconscious child

Coma

Meningitis

Encephalitis

Metabolic causes of coma

Reye’s syndrome

Unexplained coma

58 The fitting child

Generalized convulsions

Febrile convulsions

Management of the fitting child

Status epilepticus

59 Accidents and burns

60 Poisoning

Child health in the community

61 Living with chronic illness

The effect of chronic illness on the child

The effect of chronic illness on the family

The paediatric care of children with long-term medical conditions

Involvement with school

62 Living with a disability

How disability presents

Assessment and diagnosis of a child with a disability

Paediatric care

Provision of services

The child with special educational needs

63 Learning disability and autism

Paediatric management

Growing up with learning disability

Down’s syndrome (trisomy 21)

Fragile X

Autistic spectrum disorders

64 Visual and hearing impairment

Visual impairment

Hearing impairment

65 Neglect and abuse

Overview

How does child abuse present?

Physical abuse

Neglect

Neglect and failure to thrive

Emotional abuse

Sexual abuse

Factitious or fabricated illness

Medical investigation

The safeguarding process

66 Adolescent issues

Adolescent harmful health behaviours

Sexual health issues

Eating disorders

67 Sudden infant death

Acute life-threatening events and SIDS

Acute life threatening events

68 Ethics and the child in society

Consent, autonomy and confidentiality

Ethics in critical care—withdrawal of intensive care

End-of-life care

Core self-assessment case studies: questions

Extended self-assessment case studies: questions

Core self-assessment case studies: answers

Extended self-assessment case studies: answers

Index

This book is dedicated to our children:

Charlie, Mollie, Rosie

Aaron, Becca

Edward, Daniel

Companion website

This book has an accompanying website at:

www.ataglanceseries.com/paediatrics

Features:

• Interactive self-assessment case studies from the book

• List of online resources

This edition first published 2012 © 2012 by John Wiley & Sons, Ltd

Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing.

Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK

The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

111 River Street, Hoboken, NJ 07030-5774, USA

For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.

The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

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, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

Library of Congress Cataloging-in-Publication Data

Miall, Lawrence.

 Paediatrics at a glance / Lawrence Miall, Mary Rudolf, Dominic Smith. – 3rd ed.

p. ; cm. – (At a glance)

 Includes bibliographical references and index.

 ISBN 978-0-470-65452-1 (pbk. : alk. paper)

 ISBN 978-1-118-30644-4 (epub)

 ISBN 978-1-118-30642-0 (mobi)

 I. Rudolf, Mary. II. Smith, Dominic, 1970– III. Title. IV. Series: At a glance series (Oxford, England)

 [DNLM: 1. Pediatrics–methods–Handbooks. WS 39]

 618.92–dc23

2011042664

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Preface to the third edition

“ ‘What is the use of a book,’ thought Alice, ‘without pictures or conversations?’ ”

Lewis Carroll, Alice in Wonderland

Paediatric medicine requires an understanding of developing anatomy, physiology and psychology as well as a holistic family-orientated approach. There are a wide range of professional challenges: from the technical aspects of intensive care to the ethical and sociological questions relating to issues of autonomy, independence and children’s rights. The paediatric environment is very different to the world of adult medicine. This can all be daunting to those who are new to the specialty but developing the skills and confidence in successfully managing these challenges can enable professionals to make significant differences to the lives of children and families. This makes paediatric medicine amongst the most rewarding of all the medical specialties.

In preparing the third edition we have updated the text to reflect changes in understanding of childhood illness over the last 5 years. The new edition includes advances in genetics, screening and therapy of childhood illness. Topics have been updated to incorporate UK national guidelines on childhood urinary tract infection, constipation, fever, allergy, diabetes and meningitis.

Children have complex needs which require medical staff to work together with other professionals in child health, psychology, education and social care. There is increasing recognition of the need for all health professionals to have a good understanding of their role in safeguarding vulnerable people. New chapters have been added to expand on psychological issues and ethics in child health. There is greater detail on the recognition, investigation and management of child abuse.

We hope that this edition will continue to educate and inspire students and trainees in taking the first steps towards an understanding of children, their illnesses, their resilience in the face of adversity and amazing capacity for recovery. It is a book with many pictures to aid the introduction and revision of the key topics. We hope this will help as students begin their all-important conversations with young patients.

Lawrence Miall

Mary Rudolf

Dominic Smith

Preface to the first edition

He knew the cause of every maladye,

Were it of hoot or cold or moiste or drye,

And where engendred and of what humour:

He was a verray parfit praktisour.

Geoffrey Chaucer c.1340–1400
A Doctor of Medicine, From Prologue to The Canterbury Tales

Chaucer outlined with some clarity the qualities that a doctor of medicine requires, and emphasized that knowledge about the causes of maladies was required to come to competent diagnosis. We have structured Paediatrics at a Glance around children’s common symptoms and maladies, and the likely causes for them. We have also attempted to distil for the student not only the knowledge base they require but in addition the competencies they must acquire in order to become ‘verray parfit praktisours’ when working with children and their parents.

The world has changed since Chaucer’s time, and it is now widely acknowledged that the medical curriculum suffers from ‘information overload’. We have made great efforts to adhere to the General Medical Council’s recommendations in Tomorrow’s Doctors, and have only included the core knowledge that we consider is required by doctors in training. We have in addition placed great emphasis on the evaluation of the child as he or she presents.

The focus of the book is similar to its parent book Paediatrics and Child Health. In both we have attempted to provide a working approach to paediatric problems and child health as they present in primary, community and secondary care. We have now taken the familiar At a Glance format and have visually presented each common symptom and led the student through the causes and key components of the evaluation so that a competent diagnosis can be made. Chapters are also devoted to providing the reader with an understanding of children’s development and their place in society with additional chapters on nutrition, childcare, education and community services.

Although this book is principally intended for medical students, it may well provide appropriate reading for nurses and other allied professionals who would like to deepen their understanding of children and paediatric management. It is particularly likely to appeal to those who take a visual approach to learning.

Hippocrates wrote in his Aphorisms for Physicians, ‘Life is short, science is long, opportunity is elusive, experience is dangerous, judgement is difficult’. We have produced this concise volume in the hope that it will help students cope with these hurdles to medical training, and facilitate the development of clinical acumen in their work with children.

Lawrence Miall

Mary Rudolf

Malcolm Levene

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!