Practical Pediatrics

Front Cover......Page 3
Practical Paediatrics......Page 6
Copyright......Page 7
Preface......Page 8
Contributors......Page 9
Contents......Page 17
Part 1: Current Paediatrics......Page 22
Where do Australian children live and why is this important?......Page 23
Australian children's experiences of child care and early education......Page 24
What affects child health?......Page 25
Individual and social determinants of health......Page 26
Spotlight on Indigenous children......Page 27
Infant mortality......Page 28
Causes of death between 1 and 14 years......Page 29
Causes of death between 15 and 19 years......Page 30
Burden of disease and long-term health conditions......Page 31
Children and adolescents presenting to specialized paediatric services......Page 33
Smoking-related disorders......Page 34
Future directions......Page 35
Child health inequity......Page 36
Causes of global child mortality......Page 37
Child disability and development......Page 38
Children in complex emergencies......Page 39
Evidence for effective interventions in reducing child mortality......Page 40
How can child health professionals in developed countries contribute to global child health?......Page 42
Part 2: Clinical assessment......Page 44
Acuity of the presentation......Page 45
Referral information......Page 46
The presenting problem......Page 47
Family and social history......Page 48
Immunization status......Page 49
Introduction......Page 50
General observation and behaviour......Page 51
Specific examination......Page 52
Abdomen......Page 53
Head and neck......Page 54
Note-taking......Page 55
The consultation as part of the therapy......Page 56
History is everything......Page 57
Any interaction is an opportunity to examine......Page 58
Team benefits......Page 60
Medical investigations......Page 61
Practical outcomes......Page 62
Part 3: Social and preventative paediatrics......Page 64
The emotional and social needs of the child......Page 65
The Australian family......Page 66
Economic disadvantage/poverty......Page 67
Families affected by mental health problems and drug abuse......Page 68
Services for the child and family......Page 69
Health care and cultural safety......Page 71
Mortality......Page 72
Implications for a health-care professional's practice......Page 73
Implications for a health-care professional's practice......Page 74
Family and kinship......Page 75
Language and communication styles......Page 76
Part 2 maori view of child health and illness......Page 77
The Treaty of Waitangi......Page 78
Socioeconomic and cultural contact issues......Page 79
Genetics and environment in clinical situations......Page 80
A way forward......Page 81
Dietary Guidelines for Children and Adolescents in Australia (National Health and Medical Research Council 2003)......Page 82
Body mass index......Page 83
Breastfeeding......Page 84
Composition of standard infant formulas......Page 85
Other milks......Page 88
Vegetarian diets......Page 89
Malnutrition......Page 90
Nutrition in the hospitalized child......Page 91
Routes of feeding......Page 92
Parenteral nutrition......Page 93
Refeeding syndrome......Page 94
Waist circumference and waist  :  height ratio – measures of fat distribution......Page 96
International prevalence rates and secular trends......Page 98
Psychosocial complications......Page 99
Hepatobiliary complications......Page 100
Risk factors for cardiovascular disease......Page 101
Long-term psychosocial complications......Page 102
Television viewing......Page 103
Other factors associated with obesity......Page 104
Physical examination......Page 105
Behaviour modification......Page 106
Physical activity and sedentary behaviour......Page 107
Primary prevention of child and adolescent obesity......Page 108
Requirements of vaccines......Page 110
Principles of vaccine selection......Page 111
Immunization schedule for routine childhood immunization......Page 112
Adverse effects of immunization......Page 113
Live virus vaccines......Page 114
Other vaccines......Page 115
Travel......Page 116
Future vaccines and vaccine development......Page 117
Initial care......Page 118
Ongoing care......Page 119
Prevention......Page 120
Summary......Page 121
Causes......Page 123
History......Page 124
Investigation......Page 125
Management......Page 126
General issues of management......Page 127
Medical assessment......Page 128
Fragile X syndrome......Page 129
Down syndrome......Page 130
Microdeletion syndromes......Page 131
Speech and language impairment......Page 132
Learning difficulty......Page 133
Development of current concepts......Page 134
Child protection and the concept of mandatory reporting......Page 135
Principles of interagency practice in relation to the management of suspected child abuse or neglect......Page 136
1. An allegation is made on behalf of a child to a professional by another person......Page 137
Presentations that of themselves should raise suspicions......Page 138
The injury history......Page 140
C. The forensic assessment in children in whom abuse or neglect is suspected......Page 141
E. The health professional's ongoing responsibility to the child and family when abuse or neglect is suspected......Page 142
The wellbeing of health professionals involved with child protection......Page 143
Definitions......Page 144
Explained SUDI......Page 145
The vulnerable infant......Page 146
The contribution of developmental age......Page 147
Parent support after an unexpected infant death......Page 148
Prevention......Page 149
Adolescent development......Page 151
Burden of illness in adolescence......Page 152
Risk and protective factors......Page 153
Medicolegal context and confidentiality......Page 154
Confidentiality......Page 155
Psychosocial screening (HEADSS)......Page 156
Chronic illness......Page 158
Towards self-management......Page 159
Transition to adult health care......Page 160
Labial fusion or adhesions......Page 162
Overview of puberty, adolescence and the menstrual cycle......Page 163
Delayed onset of menses – primary amenorrhoea......Page 164
Secondary amenorrhoea......Page 165
Endometriosis......Page 166
Emergency contraception......Page 167
Intellectual disability – menstrual and contraceptive management......Page 168
Behavioural aspects of children's sleep......Page 170
Sleep phenomena or parasomnias in children......Page 171
Spectrum of paediatric sleep disorders......Page 172
Complications of untreated OSA......Page 173
Rare conditions......Page 174
Conclusion......Page 175
Refugee health assessments......Page 176
Specific health issues......Page 177
Nutrition and growth......Page 178
Screening......Page 180
Tuberculosis screening......Page 181
 Strongyloides infection......Page 182
Dental issues......Page 183
Assessment of development and learning......Page 184
Settlement considerations......Page 185
Part 4: Behaviour and mental healthneeds......Page 186
Developmental stages......Page 187
Early infancy (0–6 months)......Page 188
Common problems in the toddler period......Page 189
School years (over 5 years)......Page 190
Adolescence......Page 191
Conclusion......Page 192
Features of internalizing problems......Page 193
Features of externalizing problems......Page 194
Management......Page 195
Problems of infancy......Page 196
School refusal due to anxiety problems......Page 197
Nocturnal enuresis......Page 198
Encopresis......Page 199
Assessment......Page 200
Management......Page 201
Alternative/complementary therapies......Page 202
Prevention......Page 203
Reactive attachment disorders......Page 204
Pervasive developmental disorders......Page 205
Disruptive behaviour disorder......Page 206
Anxiety disorders......Page 207
Major depressive disorder......Page 208
Schizophrenia......Page 209
Post-traumatic stress disorder......Page 210
Eating disorders......Page 211
Part 5: Paediatric emergencies......Page 214
Breathing......Page 215
Effort of breathing......Page 216
Assessment of circulation......Page 217
Conscious level......Page 218
Putting it all together......Page 219
Life support......Page 221
Airway......Page 222
Breathing......Page 223
Circulation......Page 224
Ongoing resuscitation......Page 225
Resuscitation guide B......Page 226
Age 6–12 years......Page 229
Prevent absorption......Page 230
Gastric lavage......Page 231
Administer an antidote......Page 232
Prevention......Page 234
Envenomation......Page 235
Pressure–immobilization first aid......Page 236
Antivenom......Page 238
Spider bite......Page 239
Box jellyfish......Page 240
Irukandji syndrome......Page 241
Part 6: Fluid replacement......Page 242
Regulation of extracellular fluids......Page 243
Weight change......Page 245
Resuscitation for shock......Page 246
Replacing the fluid deficit......Page 247
Maintenance fluids......Page 248
Ongoing losses......Page 249
Management......Page 250
Metabolic acidosis......Page 251
Gastroenteritis......Page 252
Burns......Page 253
Bacterial meningitis......Page 254
Diabetic ketoacidosis......Page 255
Part 7: Principles of imaging......Page 256
Introduction......Page 257
Acute head trauma, all ages......Page 258
Spinal dysraphism......Page 259
First episode of wheezing......Page 261
Thoracic mass......Page 262
Notes......Page 263
Bilious vomiting......Page 264
Notes......Page 265
Urinary infection......Page 267
Notes......Page 268
Notes......Page 269
Inflicted injury (non-accidental injury)......Page 270
Abbreviations......Page 271
Part 8: Common orthopaedic problems and fractures......Page 272
Flat feet......Page 273
In-toe gait (pigeon toeing)......Page 275
Main risk factors......Page 276
Diagnosis in the older infant......Page 277
Scoliosis......Page 278
Adolescent idiopathic scoliosis......Page 279
Chondromalacia patellae......Page 280
Injuries in infancy and childhood......Page 281
Supracondylar fracture of the humerus......Page 282
Toddler fracture of the tibia......Page 283
Pulled elbow......Page 284
Part 9: Common paediatric surgical problems......Page 286
Hypospadias......Page 287
Circumcision......Page 288
Inguinal hernia......Page 289
Undescended testis......Page 290
Other causes of scrotal pathology......Page 291
Discharge from the umbilicus......Page 292
Midline neck swellings......Page 293
MAIS lymphadenitis......Page 294
Torticollis......Page 295
Part 10: Inherited and metabolic problems......Page 296
Genes......Page 297
Frequency......Page 298
Birth defect/congenital malformation registers......Page 299
Prenatal diagnosis......Page 300
Nuchal translucency screening......Page 301
Indications for diagnostic prenatal tests......Page 302
Imaging techniques......Page 303
Prenatal diagnosis for specific genetic conditions......Page 304
Timing of exposure......Page 305
Antiepileptic medication......Page 306
Vitamin A analogues: isotretinoin and acetretin......Page 307
Diethylstilbestrol (DES)......Page 308
Teratogen information services......Page 309
Nuclear DNA forms tightly coiled lengths of DNA called chromosomes......Page 310
One X chromosome is inactivated in females......Page 311
Protein-coding genes......Page 312
The regulation of human gene expression is incompletely understood......Page 313
Genes and networks......Page 314
Most genetic variations are common and do not cause disease......Page 315
What types of mutation cause disease?......Page 316
Triplet repeat mutations......Page 317
Mutations occurring after embryogenesis cause many of the features of ageing......Page 318
Autosomal dominant inheritance......Page 319
X-linked dominant inheritance......Page 320
Polygenic and multifactorial disorders......Page 321
Acknowledgements......Page 323
10.3 The dysmorphic child......Page 324
Putting it all together......Page 325
Investigations......Page 326
Trisomy 18 (Edwards syndrome)......Page 327
Velocardiofacial syndrome......Page 328
Trinucleotide repeat sequence disorders......Page 329
Noonan syndrome......Page 330
Achondroplasia......Page 331
Process of genetic counselling......Page 332
Obtaining and recording a family history......Page 333
Unknown diagnosis......Page 335
The burden......Page 336
Donor gametes......Page 337
Acknowledgements......Page 338
Decreased conscious state......Page 339
Hypoglycaemia......Page 340
Lactic acidosis......Page 341
Lysosomal storage disorders......Page 343
Congenital disorders of glycosylation......Page 345
Peri-mortem protocol......Page 346
Part 11: Neonatal problems......Page 348
Temperature control......Page 349
Gastrointestinal......Page 350
Neonatal stabilization and resuscitation......Page 351
Basic care and stabilization ( Fig. 11.1.3)......Page 352
Chest compressions......Page 354
When should it be done?......Page 355
Head and scalp......Page 356
Chest and heart......Page 357
Limbs......Page 358
Analgesia......Page 359
Vomiting......Page 360
List of (normal) newborn topics in other chapters......Page 361
Causes of preterm birth......Page 362
Patent ductus arteriosus......Page 363
Intraventricular haemorrhage......Page 364
Periventricular leukomalacia......Page 365
Infection......Page 366
The late preterm baby......Page 367
Prognosis......Page 368
History......Page 369
Physiological jaundice......Page 370
Complications of jaundice......Page 371
Treatment of jaundice......Page 372
General principles of management of respiratory distress......Page 373
Causes of respiratory distress......Page 374
Infection......Page 375
Respiratory distress syndrome or hyaline membrane disease......Page 376
Pulmonary air leaks......Page 377
Pulmonary hypoplasia......Page 378
Nasal obstruction......Page 379
Pharyngeal obstruction......Page 380
Apnoea......Page 381
Neuromuscular causes......Page 383
Cytomegalovirus......Page 384
Diagnosis......Page 385
Fetal risks following maternal infection......Page 386
Diagnosis......Page 387
 Treponema pallidum (syphilis)......Page 388
Varicella-zoster virus......Page 389
Clinical features......Page 390
Treatment......Page 391
Clinical features......Page 392
Clinical features......Page 393
Hepatitis B virus......Page 394
Human immunodeficiency virus......Page 395
Hirschsprung disease......Page 396
Small bowel atresias......Page 397
Exomphalos......Page 398
Gastroschisis......Page 399
Sacrococcygeal teratoma......Page 400
Part 12: Infections......Page 402
Measles (rubeola, morbilli)......Page 403
Complications......Page 405
Epidemiology......Page 406
Clinical features ( Figs 12.1.4 , 12.1.5)......Page 407
Erythema infectiosum (slapped cheek disease, fifth disease)......Page 408
Prevention......Page 409
Scarlet fever and scarlatina......Page 410
Treatment......Page 411
Clinical features......Page 412
Diagnosis......Page 413
Microbiology......Page 414
Osteomyelitis......Page 415
Osteomyelitis......Page 416
Pus aspirated from bone......Page 417
Ultrasonography......Page 418
Septic arthritis......Page 419
Surgical management......Page 420
Discitis and vertebral osteomyelitis......Page 421
Human genetic factors......Page 423
Infants......Page 424
Antibiotic treatment......Page 425
Subdural effusion......Page 427
Primary prevention......Page 428
Infants aged 1–3 months and the immunocompromised......Page 429
Tuberculous meningitis......Page 430
Infectious encephalitis and myelitis......Page 431
Herpes simplex encephalitis......Page 432
Slow virus infection......Page 433
Prevention and disease control......Page 434
Invasive bacterial disease......Page 435
Tuberculosis......Page 436
Malaria......Page 437
Dengue virus infection......Page 438
Diarrhoeal disease......Page 439
Schistosomiasis (bilharzia)......Page 440
Hookworm......Page 442
Strongyloidiasis......Page 443
Specific infections of the Australian tropics......Page 444
Part 13: Allergy, immunity and inflammation......Page 446
History and examination......Page 447
Assessment......Page 448
Management of symptomatic atopic disease......Page 449
Specific atopic disorders......Page 451
Definition and clinical presentation......Page 452
Definition and clinical presentation......Page 453
Definition and clinical presentation......Page 454
Food allergy and intolerances......Page 455
Non-IgE-mediated food allergies......Page 456
Management......Page 457
Skin infection in atopic dermatitis......Page 458
Spasmodic croup......Page 459
Acquisition of immunological memory......Page 460
Defects associated with prematurity and delays in immunological development......Page 461
Investigations......Page 463
X-linked agammaglobulinaemia/Btk deficiency......Page 466
Common variable immunodeficiency......Page 468
Severe combined immunodeficiency......Page 469
Wiskott–Aldrich syndrome......Page 470
Hyper-IgE syndrome......Page 471
Chronic granulomatous disease......Page 472
Complement disorders......Page 473
Oligoarthritis......Page 474
Systemic arthritis......Page 476
Eye disease in juvenile arthritis......Page 477
Relief of pain......Page 478
Outcomes of juvenile arthritis......Page 479
Systemic lupus erythematosus......Page 480
Neonatal lupus syndrome......Page 481
Juvenile dermatomyositis......Page 482
Scleroderma......Page 483
Kawasaki disease......Page 484
Chronic recurrent multifocal osteomyelitis......Page 485
Chronic pain disorders......Page 486
Part 14: Respiratory disorders......Page 488
Identifiable URTI syndromes......Page 489
Common cold (uncomplicated viral URTI or ‘head cold’)......Page 490
Ulcerative pharyngotonsillitis......Page 491
Acute bacterial tonsillitis (‘streptococcal pharyngitis’)......Page 492
Acute sinusitis (rhinosinusitis)......Page 493
Prevention and treatment......Page 494
Summary......Page 495
Differential diagnosis......Page 496
Laryngomalacia......Page 497
Subglottic stenosis......Page 498
Investigations......Page 499
Management......Page 500
Recurrent (spasmodic) croup......Page 501
Pathogenesis......Page 503
Viruses......Page 504
Classification......Page 505
Investigations......Page 506
Chronic asthma......Page 508
Steroids......Page 509
Long-acting β -agonists......Page 510
Prognosis......Page 511
Infections......Page 512
Aspiration pneumonia......Page 513
Airway ‘malacia’......Page 514
Cardiac causes of wheeze......Page 515
Infection......Page 516
Vocal cord dysfunction......Page 517
Investigations......Page 519
Pneumococcal pneumonia......Page 520
Management......Page 521
 Mycoplasma pneumonia......Page 522
Viral pneumonia......Page 523
Acute viral bronchiolitis......Page 524
Investigations......Page 525
Congenital lung abnormalities......Page 526
Congenital lower airway abnormalities......Page 527
Approach to diagnosis and management......Page 528
Management of non-specific cough......Page 530
Cough, gastro-oesophageal reflux and aspiration lung disease......Page 531
Bronchiectasis......Page 532
Diagnosis......Page 533
Principles of management of a child with cystic fibrosis......Page 534
Summary......Page 535
Acknowledgements......Page 536
Part 15: Cardiac disorders......Page 538
Blood pressure......Page 539
Auscultatory findings......Page 540
Characterization......Page 541
Venous hum......Page 542
Cardiac catheterization......Page 543
Prostaglandin......Page 545
Surgery......Page 546
Management......Page 547
Patent ductus arteriosus......Page 548
Atrioventricular septal defect......Page 549
Pulmonary stenosis......Page 550
Coarctation of the aorta......Page 551
Cyanotic defects......Page 552
Course and prognosis......Page 553
Clinical features......Page 554
Diagnosis......Page 555
Cardiomyopathy......Page 556
Infective endocarditis......Page 557
Heart block......Page 558
Part 16: Haematological disordersand malignancies......Page 560
Clinical presentations......Page 561
Fanconi anaemia......Page 563
Acquired aplastic anaemia......Page 567
Transient erythroblastopenia of childhood (TEC)......Page 568
Vitamin B 12 deficiency......Page 569
Folate deficiency......Page 570
Iron deficiency......Page 571
 b -Thalassaemia major (Cooley anaemia)......Page 572
Sickle cell disease......Page 573
Anaemia due to increased red cell destruction (haemolysis)......Page 574
Intrinsic membrane defects......Page 575
Autoimmune haemolysis in children......Page 576
Non-viral risks associated with blood and blood products......Page 577
Where is the bleeding?......Page 579
Miscellaneous......Page 580
Immune thrombocytopenic purpura......Page 581
Bleeding due to coagulation disorders......Page 582
Severity......Page 584
Haemophilia centres......Page 585
Anaphylactoid purpura (Henoch–Schönlein purpura)......Page 586
Physiology of anticoagulation......Page 587
Approach to management of a patient with suspected malignancy......Page 589
Acute leukaemia......Page 590
Treatment......Page 591
Classification and prognostic factors......Page 592
Brain and central nervous system tumours......Page 593
Treatment......Page 594
Treatment......Page 595
Neuroblastoma......Page 596
Wilms' tumour (nephroblastoma)......Page 597
Osteosarcoma......Page 598
Rhabdomyosarcoma and soft tissue sarcoma......Page 599
Late effects of cancer therapy......Page 600
Palliative care......Page 601
Part 17: Seizure disorders and disorders of the nervous system......Page 602
Febrile seizures......Page 603
Treatment......Page 604
Treatment......Page 605
Treatment......Page 606
Benign focal epilepsies of childhood......Page 607
Treatment......Page 608
Epilepsies with focal seizures due to structural brain abnormalities......Page 609
Breath-holding attacks......Page 610
Assessment of children with seizures......Page 611
General principles of treatment of seizures in children......Page 612
What are the prenatal causes?......Page 614
Why are premature and low-birth-weight infants at risk of cerebral palsy?......Page 615
Ataxic cerebral palsy (less than 5%)......Page 616
Associated disabilities......Page 617
Consequences of the motor disorder......Page 618
Developmental assessment and referral to appropriate services for the child and family......Page 619
Is there evidence of regression or lack of progress in any area of development?......Page 620
One functional system or group of systems......Page 621
Are any other, less evident, diagnoses suggested by a systematic review of known mechanisms of disease?......Page 622
Are there any treatable disorders among the diagnoses being considered in this child?......Page 623
Diagnosis of neuromuscular disease based on anatomical, electrophysiological, biochemical, histopathological or DNA identif .........Page 624
Spinal muscular atrophy type I (Werdnig–Hoffmann disease)......Page 625
Guillain–Barré syndrome......Page 626
Charcot–Marie–Tooth disease (hereditary motor and sensory neuropathy)......Page 627
Congenital myasthenic syndromes......Page 628
Muscular dystrophies......Page 629
Duchenne muscular dystrophy......Page 630
Congenital type......Page 632
Acknowledgements......Page 633
Embryology and pathogenesis......Page 634
Clinical features......Page 635
Management of myelomeningocele......Page 636
Management of physical disability and mobility......Page 637
Arnold–Chiari malformation......Page 638
Prevention of neural tube defects......Page 639
Large heads (macrocephaly)......Page 640
Hydrocephalus......Page 641
Approach to clinical diagnosis......Page 642
Investigations......Page 643
Ventriculoperitoneal shunt......Page 644
Complications of ventricular shunts......Page 645
Clinical manifestations......Page 646
Types of migraine......Page 647
Aetiology......Page 648
Treatment......Page 649
Tension-type headache......Page 650
Chronic daily headache......Page 651
Idiopathic intracranial hypertension (previously known as benign intracranial hypertension)......Page 653
Extracranial causes......Page 654
Investigations......Page 655
Part 18: Urinary tract disorders andhypertension......Page 658
Urinalysis and microscopy......Page 659
Initial treatment......Page 660
Investigations......Page 661
Urinary tract infection and normal renal ultrasound findings......Page 663
Vesicoureteric reflux......Page 665
Duplication......Page 666
Management......Page 667
Cystic renal disease......Page 668
Post-streptococcal glomerulonephritis......Page 669
Lupus erythematosus......Page 670
Minimal change nephrotic syndrome......Page 671
Congenital nephrotic syndrome......Page 672
Chronic kidney disease......Page 673
Hypertension......Page 674
Part 19: Endocrine disorders......Page 678
Growth hormone–insulin-like growth factor I axis......Page 679
Childhood growth......Page 680
Mid-parental height......Page 681
Short stature......Page 683
Chromosomal abnormalities and syndromes......Page 684
Issues to determine......Page 685
Management......Page 686
Investigations......Page 687
Psychological support and counselling......Page 688
Approach to diagnosis and treatment......Page 689
Treatment......Page 690
Premature thelarche......Page 691
Asymmetrical breast development......Page 692
Aetiology and genetics......Page 693
Acquired......Page 694
Aetiology......Page 695
Aetiology......Page 696
Management......Page 697
Management......Page 698
Prognosis......Page 699
Summary......Page 700
Internal genitalia......Page 701
External genitalia......Page 702
History......Page 703
Diagnostic categories for disorders of sexual development......Page 704
Undervirilized XY......Page 705
Congenital adrenal hyperplasia......Page 706
Long-term management......Page 707
Clinical presentation......Page 708
Stabilization of newly diagnosed type 1 diabetes......Page 709
Insulin......Page 710
Long-term microvascular and macrovascular complications......Page 711
Hypoglycaemia......Page 713
Adherence......Page 714
Type 2 diabetes......Page 715
Hypocalcaemia......Page 717
Rickets......Page 720
Renal osteodystrophy......Page 721
Hypercalcaemia......Page 722
Osteoporosis......Page 723
Magnesium disorders......Page 724
Part 20: Gastrointestinal tract and hepatic disorders......Page 726
Intussusception......Page 727
Acute appendicitis......Page 728
Differential diagnosis......Page 730
Recurrent abdominal pain in children......Page 731
Malrotation with volvulus......Page 732
Pyloric stenosis......Page 733
Migraine......Page 734
Cyclical vomiting syndrome......Page 735
Bacterial and parasitic gastroenteritis......Page 736
Clinical features......Page 737
Electrolyte loss......Page 738
Severe dehydration ( ≥  10%)......Page 739
Sugar malabsorption......Page 740
Ulcerative colitis......Page 741
Exclusive enteral nutrition......Page 742
Cancer risk......Page 743
Clinical assessment......Page 745
Stool examination......Page 746
Fatty diarrhoea (steatorrhoea)......Page 747
Fat malabsorption......Page 748
Chronic pancreatitis......Page 749
Impaired lymphatic drainage......Page 750
Carbohydrate malabsorption......Page 751
Congenital......Page 752
Vitamin B 12......Page 753
Amino acids......Page 754
Summary of the diagnostic approach to suspected malabsorption......Page 755
Clinical manifestations......Page 756
Diagnostic tests......Page 757
24-hour intra-oesophageal pH monitoring......Page 758
Oesophageal manometry and multi-channel intraluminal impedance......Page 759
Acid suppression......Page 760
Epidemiology......Page 761
Gastric adenocarcinoma......Page 762
Diagnostic tests ( Box 20.4.9)......Page 763
Treatment......Page 764
Laboratory patterns of liver dysfunction......Page 765
Clinical signs of liver dysfunction......Page 767
Liver disease in the neonate and infant......Page 769
The acutely unwell neonate and infant with liver disease......Page 770
Chronic liver disease in the infant......Page 771
Liver disease in the older child......Page 772
The older child with chronic liver dysfunction......Page 773
Liver failure......Page 774
Part 21: Skin disorders......Page 776
Infections......Page 777
Red, scaly rashes in the neonate or young infant......Page 778
Congenital melanocytic naevi (CMN)......Page 779
Epidermal naevi......Page 780
Complications of haemangiomas......Page 781
Moles (acquired melanocytic naevi)......Page 782
Specific patterns......Page 783
Clinical features......Page 784
Neonatal herpes simplex......Page 785
Indolent ulceration in the immunosuppressed patient......Page 786
Staphylococcal scalded skin syndrome......Page 787
Streptococcal perianal disease......Page 788
Tinea versicolor......Page 789
Clinical features and diagnosis......Page 790
Papular urticaria......Page 791
Explanation and education......Page 792
Discoid eczema......Page 793
Allergic contact dermatitis......Page 794
Other causes......Page 795
Photosensitivity in children......Page 796
Hair loss in children......Page 797
Management......Page 798
Recurrent mouth ulcers......Page 799
Part 22: ENT, eye and dental disorders......Page 800
The nose......Page 801
Otitis media......Page 802
Diagnosis and management of otitis media......Page 803
Management......Page 805
Acute sore throat......Page 806
Obstructive sleep apnoea......Page 808
Aetiology in older children......Page 809
Assessment......Page 810
Examination......Page 811
Misalignment of the eyes......Page 812
Accommodative esotropia......Page 813
Trauma......Page 814
Conjunctivitis......Page 815
Visual handicap......Page 816
Glaucoma......Page 817
Diabetes mellitus......Page 818
Summary......Page 819
Teething......Page 820
Developmental defects of enamel......Page 821
Dental caries......Page 822
Fluoride......Page 823
Fluorosis......Page 824
Trauma......Page 825
Permanent dentition......Page 826
Bleeding gums......Page 827
Infections......Page 828
Treatment......Page 829
Congenital heart disease......Page 830
A
......Page 832
B
......Page 833
C
......Page 834
D
......Page 836
E
......Page 837
F
......Page 838
H
......Page 839
I
......Page 840
M
......Page 842
N
......Page 843
O
......Page 844
P
......Page 845
R
......Page 846
S
......Page 847
U
......Page 849
W
......Page 850
Z
......Page 851