Additional Information
Book Details
Abstract
Winner of the 2012 British Medical Association book awards' first prize in the paediatrics category!
This is the fourth edition of a highly popular 'must have textbook for paediatrics for medical students'. The previous edition has been translated into eight languages and also won British Medical Association and Royal Society of Medicine prizes for the best paediatrics textbook.
- Case studies throughout
- Online access through StudentConsult
- Concise, synoptic, clinically-focused
- Highly accessible colour-coded layout
- Comprehensive and authoritative
- New section on child protection
- New section on global paediatrics
- Over fifty new images
- Thoroughly revised and updated throughout
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Illustrated Textbook of Paediatrics | i | ||
| Copyright page | iv | ||
| Contents | v | ||
| Foreword | vii | ||
| Acknowledgements | viii | ||
| Preface | ix | ||
| Contributors | xi | ||
| 1 The child in society | 1 | ||
| The child’s world | 1 | ||
| The child | 1 | ||
| Immediate social environment | 1 | ||
| Family structure | 1 | ||
| Parenting styles | 3 | ||
| Siblings and extended family | 3 | ||
| Cultural attitudes to child-rearing | 3 | ||
| Peers | 4 | ||
| Socioeconomic status | 4 | ||
| Local social fabric | 4 | ||
| Neighbourhood | 4 | ||
| Health service delivery | 4 | ||
| Schools | 4 | ||
| Travel | 5 | ||
| National and international environment | 5 | ||
| Economic wealth | 5 | ||
| Media and technology | 5 | ||
| War and natural disasters | 6 | ||
| Public health issues for young people | 6 | ||
| Children’s rights | 6 | ||
| Global child health | 7 | ||
| Child mortality | 7 | ||
| Where deaths occur | 7 | ||
| Reducing child mortality | 8 | ||
| Conclusion | 11 | ||
| Further reading | 11 | ||
| Websites (Accessed May 2011) | 11 | ||
| 2 History and examination | 13 | ||
| Taking a history | 13 | ||
| Introduction | 13 | ||
| Presenting symptoms | 14 | ||
| General enquiry | 15 | ||
| Systems review | 15 | ||
| Past medical history | 15 | ||
| Medication | 15 | ||
| Family history | 15 | ||
| Social history | 15 | ||
| Development | 15 | ||
| An approach to examining children | 16 | ||
| Obtaining the child’s cooperation | 16 | ||
| Adapting to the child’s age | 16 | ||
| Undressing children | 16 | ||
| Warm, clean hands | 16 | ||
| Developmental skills | 16 | ||
| Examination | 17 | ||
| Initial observations | 17 | ||
| Severity of illness | 17 | ||
| Measurements | 17 | ||
| General appearance | 17 | ||
| Respiratory system | 17 | ||
| Cyanosis | 17 | ||
| Clubbing of the fingers and/or toes | 17 | ||
| Tachypnoea | 17 | ||
| Dyspnoea | 17 | ||
| Chest shape | 17 | ||
| Palpation | 17 | ||
| Percussion | 17 | ||
| Auscultation (ears and stethoscope) | 17 | ||
| Cardiovascular system | 18 | ||
| Cyanosis | 18 | ||
| Clubbing of fingers or toes | 18 | ||
| Pulse | 18 | ||
| Inspection | 18 | ||
| Palpation | 19 | ||
| Percussion | 19 | ||
| Auscultation | 19 | ||
| Heart sounds | 19 | ||
| Murmurs | 19 | ||
| Hepatomegaly | 19 | ||
| Femoral pulses | 19 | ||
| Blood pressure (see later in chapter) | 19 | ||
| Abdomen | 20 | ||
| Associated signs | 20 | ||
| Inspection | 20 | ||
| Palpation | 20 | ||
| Tenderness | 20 | ||
| Hepatomegaly (Table 2.4, Fig. 2.8) | 20 | ||
| Splenomegaly (Table 2.5) | 20 | ||
| Kidneys | 20 | ||
| Abnormal masses | 20 | ||
| Percussion | 21 | ||
| Auscultation | 21 | ||
| Genital area | 21 | ||
| Rectal examination | 21 | ||
| Urinalysis | 22 | ||
| Neurology/neurodevelopment | 22 | ||
| Brief neurological screen | 22 | ||
| More detailed neurological examination | 22 | ||
| Patterns of movement | 22 | ||
| Coordination | 22 | ||
| Inspection of limbs | 23 | ||
| Muscle bulk | 23 | ||
| Muscle tone | 23 | ||
| Tone, in limbs | 23 | ||
| Truncal tone | 23 | ||
| Head lag | 23 | ||
| Power | 23 | ||
| Reflexes | 23 | ||
| Plantar responses | 23 | ||
| Sensation | 23 | ||
| Cranial nerves | 23 | ||
| Bones and joints | 24 | ||
| Neck | 24 | ||
| Thyroid | 24 | ||
| Lymph nodes | 24 | ||
| Blood pressure | 24 | ||
| Indications | 24 | ||
| Technique | 24 | ||
| Measurement | 24 | ||
| Eyes | 24 | ||
| Examination | 24 | ||
| Ophthalmoscopy | 24 | ||
| Ears and throat | 27 | ||
| Throat | 27 | ||
| Ears | 27 | ||
| Communicating with children | 27 | ||
| Summary and management plan | 29 | ||
| Further reading | 29 | ||
| 3 Normal child development, hearing and vision | 31 | ||
| Influence of heredity and environment | 31 | ||
| Fields of development | 31 | ||
| Developmental milestones | 32 | ||
| Median and limit ages | 32 | ||
| Variation in the pattern of development | 33 | ||
| Adjusting for prematurity | 33 | ||
| Is development normal? | 33 | ||
| Pattern of child development | 34 | ||
| Cognitive development | 34 | ||
| Analysing developmental progress | 34 | ||
| Detailed assessment | 34 | ||
| The short-cut approach | 34 | ||
| Observation during questioning | 40 | ||
| Equipment for developmental testing | 41 | ||
| Developmental screening and assessment | 41 | ||
| Child health surveillance | 42 | ||
| Hearing | 42 | ||
| Hearing tests | 44 | ||
| Newborn | 44 | ||
| Distraction testing | 44 | ||
| Visual reinforcement audiometry | 44 | ||
| Performance and speech discrimination testing | 44 | ||
| Audiometry | 44 | ||
| Parental concern | 44 | ||
| Vision | 44 | ||
| Vision testing | 47 | ||
| Further reading | 47 | ||
| Website (accessed May 2011) | 47 | ||
| 4 Developmental problems and the child with special needs | 49 | ||
| Abnormal development – key concepts | 50 | ||
| Developmental delay | 52 | ||
| Abnormal motor development | 52 | ||
| Cerebral palsy (CP) | 52 | ||
| Causes | 53 | ||
| Clinical presentation | 54 | ||
| Spastic cerebral palsy | 54 | ||
| Dyskinetic cerebral palsy | 54 | ||
| Ataxic (hypotonic) cerebral palsy | 54 | ||
| Management | 56 | ||
| Abnormal speech and language development | 56 | ||
| Abnormal development of social/communication skills (autistic spectrum disorders) | 57 | ||
| Management | 57 | ||
| Slow acquisition of cognitive skills/general learning difficulty | 57 | ||
| Specific learning difficulty | 58 | ||
| Developmental coordination disorder (DCD) or dyspraxia | 58 | ||
| Dyslexia | 58 | ||
| Dyscalculia, dysgraphia | 58 | ||
| Disorder of executive functions | 58 | ||
| Associated co-morbidities of specific learning disorders | 58 | ||
| Management of specific learning disorders | 58 | ||
| Problems with concentration and attention | 59 | ||
| Hearing impairment | 59 | ||
| Sensorineural hearing loss | 59 | ||
| Conductive hearing loss | 59 | ||
| Abnormalities of vision | 61 | ||
| Squint (strabismus) | 61 | ||
| Corneal light reflex test | 61 | ||
| Cover test | 61 | ||
| Refractive errors | 62 | ||
| Hypermetropia (long sight) | 62 | ||
| Myopia (short sight) | 62 | ||
| Astigmatism (abnormal corneal curvature) | 62 | ||
| Amblyopia | 62 | ||
| Severe visual impairment | 62 | ||
| Multidisciplinary child development services | 63 | ||
| Education | 65 | ||
| Transition of care to adult services | 65 | ||
| The rights of disabled children | 66 | ||
| Further reading | 66 | ||
| Website (Accessed May 2011) | 66 | ||
| 5 Care of the sick child | 67 | ||
| Primary care | 67 | ||
| Hospital care | 67 | ||
| Accident and Emergency | 67 | ||
| Hospital admission | 68 | ||
| Children in hospital | 69 | ||
| Family-centred care | 69 | ||
| Child-orientated environment | 70 | ||
| Information and psychosocial support | 70 | ||
| Skilled staff | 70 | ||
| Multidisciplinary care | 70 | ||
| Tertiary care | 70 | ||
| Pain | 71 | ||
| Acute pain | 71 | ||
| Chronic pain | 71 | ||
| Management | 71 | ||
| Prescribing medicines for children | 72 | ||
| Absorption | 72 | ||
| Distribution | 72 | ||
| Elimination | 72 | ||
| Breaking bad news | 72 | ||
| Initial interview | 72 | ||
| Discharge from hospital | 72 | ||
| Ethics | 73 | ||
| Definitions of the principles of medical ethics | 73 | ||
| Application of ethical principles to paediatrics | 74 | ||
| Non-maleficence | 74 | ||
| Beneficence | 74 | ||
| Justice | 74 | ||
| Autonomy | 74 | ||
| Truth-telling | 74 | ||
| Consent | 74 | ||
| Confidentiality | 75 | ||
| Best interests | 75 | ||
| The ethics of research in paediatrics | 75 | ||
| Evidence-based paediatrics | 77 | ||
| Why practise evidence-based paediatrics? | 77 | ||
| To what extent is paediatric practice based on sound evidence? | 77 | ||
| Further reading | 80 | ||
| Websites (Accessed May 2011) | 80 | ||
| 6 Paediatric emergencies | 81 | ||
| The seriously ill child | 81 | ||
| Cardiopulmonary resuscitation | 81 | ||
| Basic life support | 82 | ||
| Advanced life support (Fig. 6.6) | 82 | ||
| The seriously injured child | 82 | ||
| Shock | 86 | ||
| Why are children so susceptible to fluid loss? | 86 | ||
| Clinical features | 87 | ||
| Management priorities | 87 | ||
| Fluid resuscitation | 87 | ||
| Subsequent management | 87 | ||
| Septicaemia | 88 | ||
| Clinical features | 88 | ||
| Management priorities | 88 | ||
| Antibiotics | 88 | ||
| Fluids | 88 | ||
| Circulatory support | 88 | ||
| Disseminated intravascular coagulation (DIC) | 88 | ||
| Steroids | 88 | ||
| Coma | 88 | ||
| Status epilepticus | 89 | ||
| Anaphylaxis | 89 | ||
| Apparent life-threatening events (ALTE) | 90 | ||
| The death of a child | 92 | ||
| Sudden infant death syndrome | 93 | ||
| Following the sudden death of a child | 96 | ||
| Further reading | 96 | ||
| 7 Accidents, poisoning and child protection | 97 | ||
| Accidents | 97 | ||
| Types of accident affecting children | 98 | ||
| Accident prevention | 98 | ||
| Road traffic accidents | 98 | ||
| Pedestrian road traffic accidents | 98 | ||
| Child passengers in cars | 98 | ||
| Bicycle accidents | 99 | ||
| Head injuries | 99 | ||
| Internal injuries | 99 | ||
| Burns and scalds | 99 | ||
| Management | 99 | ||
| Treatment | 99 | ||
| Drowning and near-drowning | 101 | ||
| Near-drowning | 101 | ||
| Choking, suffocation and strangulation | 101 | ||
| Dog bites | 101 | ||
| Poisoning | 102 | ||
| Accidental poisoning | 102 | ||
| Management | 103 | ||
| Deliberate poisoning in older children | 103 | ||
| Chronic poisoning | 103 | ||
| Lead poisoning | 103 | ||
| Smoking | 106 | ||
| Child protection | 106 | ||
| Types of child abuse and neglect | 107 | ||
| Physical abuse | 107 | ||
| Emotional abuse | 107 | ||
| Sexual abuse | 107 | ||
| Neglect | 107 | ||
| Fabricated or induced illness (FII) | 107 | ||
| Risk factors | 107 | ||
| Presentation | 108 | ||
| Child abuse and neglect | 108 | ||
| Neglect | 108 | ||
| Emotional abuse | 108 | ||
| Sexual abuse | 111 | ||
| Recognition | 111 | ||
| Physical symptoms | 111 | ||
| Behavioural symptoms | 111 | ||
| Signs | 111 | ||
| Investigation | 111 | ||
| Management | 112 | ||
| Further reading | 113 | ||
| 8 Genetics | 115 | ||
| Chromosomal abnormalities | 115 | ||
| Down syndrome (trisomy 21) | 115 | ||
| Clinical features | 116 | ||
| Cytogenetics | 116 | ||
| Meiotic non-disjunction (94%) | 116 | ||
| Translocation (5%) | 117 | ||
| Mosaicism (1%) | 117 | ||
| Edwards syndrome (trisomy 18) and Patau syndrome (trisomy 13) | 118 | ||
| Turner syndrome (45, X) | 118 | ||
| Klinefelter syndrome (47, XXY) | 119 | ||
| Reciprocal translocations | 119 | ||
| Deletions | 120 | ||
| Mendelian inheritance | 120 | ||
| Autosomal dominant inheritance | 120 | ||
| Variation in expression | 122 | ||
| Non-penetrance | 122 | ||
| No family history of the disorder | 122 | ||
| Homozygosity | 122 | ||
| Autosomal recessive inheritance | 122 | ||
| Consanguinity | 122 | ||
| X-linked inheritance | 122 | ||
| X-linked dominant inheritance | 123 | ||
| Y-linked inheritance | 123 | ||
| Unusual genetic mechanisms | 123 | ||
| Trinucleotide repeat expansion mutations | 123 | ||
| Fragile X syndrome | 124 | ||
| Mitochondrial or cytoplasmic inheritance | 125 | ||
| Imprinting and uniparental disomy | 125 | ||
| Polygenic, multifactorial or complex inheritance | 126 | ||
| Dysmorphology | 127 | ||
| Pathogenic mechanisms | 127 | ||
| Malformation | 127 | ||
| Deformation | 127 | ||
| Disruption | 127 | ||
| Dysplasia | 127 | ||
| Clinical classification of birth defects | 127 | ||
| Single-system defects | 127 | ||
| Sequence | 127 | ||
| Association | 128 | ||
| Syndrome | 128 | ||
| Syndrome diagnosis | 128 | ||
| Gene-based therapies | 129 | ||
| Genetic services | 130 | ||
| Genetic investigations | 130 | ||
| Mutation analysis | 130 | ||
| Genetic linkage | 130 | ||
| Genetic counselling | 130 | ||
| Pre-symptomatic (predictive) testing | 132 | ||
| Further reading | 132 | ||
| Websites (Accessed January 2011) | 132 | ||
| 9 Perinatal medicine | 133 | ||
| Pre-pregnancy care | 133 | ||
| Antenatal diagnosis | 134 | ||
| Fetal medicine | 135 | ||
| Fetal surgery | 136 | ||
| Obstetric conditions affecting the fetus | 137 | ||
| Pre-eclampsia | 137 | ||
| Placental insufficiency and intrauterine growth restriction (IUGR) | 137 | ||
| Multiple births | 137 | ||
| Maternal conditions affecting the fetus | 138 | ||
| Diabetes mellitus | 138 | ||
| Hyperthyroidism | 138 | ||
| Systemic lupus erythematosus | 139 | ||
| Autoimmune thrombocytopenic purpura | 139 | ||
| Maternal drugs affecting the fetus | 139 | ||
| Alcohol and smoking | 139 | ||
| Drug abuse | 140 | ||
| Drugs given during labour | 140 | ||
| Congenital infections | 140 | ||
| Rubella | 140 | ||
| Cytomegalovirus | 141 | ||
| Toxoplasmosis | 141 | ||
| Varicella zoster | 141 | ||
| Syphilis | 141 | ||
| Adaptation to extrauterine life | 141 | ||
| Neonatal resuscitation | 143 | ||
| Meconium aspiration | 143 | ||
| Naloxone | 146 | ||
| Resuscitation of the preterm infant | 146 | ||
| Failure to respond to resuscitation | 147 | ||
| Size at birth | 147 | ||
| Definitions | 147 | ||
| Patterns of growth restriction | 147 | ||
| Monitoring the growth-restricted fetus | 148 | ||
| The growth-restricted infant | 148 | ||
| Large-for-gestational-age infants | 148 | ||
| Routine examination of the newborn infant | 148 | ||
| Testing for developmental dysplasia of the hip (DDH) | 149 | ||
| Vitamin K therapy | 152 | ||
| Biochemical screening (Guthrie test) | 153 | ||
| Newborn hearing screening | 153 | ||
| Further reading | 153 | ||
| Website (Accessed May 2011) | 153 | ||
| 10 Neonatal medicine | 155 | ||
| Hypoxic-ischaemic encephalopathy | 156 | ||
| Management | 156 | ||
| Prognosis | 156 | ||
| Birth injuries | 157 | ||
| Soft tissue injuries | 157 | ||
| Nerve palsies | 158 | ||
| Fractures | 159 | ||
| Clavicle | 159 | ||
| Humerus/femur | 159 | ||
| Stabilising the preterm or sick infant | 159 | ||
| The preterm infant | 159 | ||
| Respiratory distress syndrome | 159 | ||
| Pneumothorax | 162 | ||
| Apnoea and bradycardia and desaturation | 162 | ||
| Temperature control | 163 | ||
| Patent ductus arteriosus | 163 | ||
| Fluid balance | 163 | ||
| Nutrition | 164 | ||
| Infection | 164 | ||
| Preterm brain injury | 164 | ||
| Necrotising enterocolitis | 164 | ||
| Retinopathy of prematurity | 165 | ||
| Bronchopulmonary dysplasia | 166 | ||
| Problems following discharge | 166 | ||
| Jaundice | 168 | ||
| Kernicterus | 168 | ||
| Clinical evaluation | 168 | ||
| Age at onset | 168 | ||
| Jaundice <24 h of age | 169 | ||
| Haemolytic disorders | 169 | ||
| Congenital infection | 170 | ||
| Jaundice at 2 days to 2 weeks of age | 170 | ||
| Physiological jaundice | 170 | ||
| Breast milk jaundice | 170 | ||
| Dehydration | 170 | ||
| Infection | 170 | ||
| Other causes | 170 | ||
| Severity of jaundice | 170 | ||
| Rate of change | 170 | ||
| Gestation | 171 | ||
| Clinical condition | 171 | ||
| Management | 171 | ||
| Phototherapy | 171 | ||
| Exchange transfusion | 171 | ||
| Jaundice at >2 weeks of age | 171 | ||
| Respiratory distress in term infants | 172 | ||
| Transient tachypnoea of the newborn | 172 | ||
| Meconium aspiration | 172 | ||
| Pneumonia | 172 | ||
| Pneumothorax | 173 | ||
| Milk aspiration | 173 | ||
| Persistent pulmonary hypertension of the newborn | 173 | ||
| Diaphragmatic hernia | 173 | ||
| Other causes | 173 | ||
| Infection | 173 | ||
| Early-onset infection | 173 | ||
| Late-onset infection | 174 | ||
| Some specific infections | 174 | ||
| Group B streptococcal infection | 174 | ||
| Listeria monocytogenes infection | 174 | ||
| Gram-negative infections | 175 | ||
| Conjunctivitis | 175 | ||
| Umbilical infection | 175 | ||
| Herpes simplex virus (HSV) infections | 175 | ||
| Hepatitis B | 175 | ||
| Hypoglycaemia | 175 | ||
| Neonatal seizures | 176 | ||
| Cerebral infarction (neonatal stroke) | 176 | ||
| Craniofacial disorders | 176 | ||
| Cleft lip and palate | 176 | ||
| Pierre Robin sequence | 177 | ||
| Gastrointestinal disorders | 177 | ||
| Oesophageal atresia | 177 | ||
| Small bowel obstruction | 177 | ||
| Large bowel obstruction | 178 | ||
| Exomphalos/gastroschisis | 178 | ||
| Further reading | 179 | ||
| Websites (Accessed May 2011) | 179 | ||
| 11 Growth and puberty | 181 | ||
| Fetal | 181 | ||
| The infantile phase | 181 | ||
| Childhood phase | 181 | ||
| Pubertal growth spurt | 181 | ||
| Measurement | 181 | ||
| Puberty | 183 | ||
| Short stature | 186 | ||
| Familial | 186 | ||
| Intrauterine growth restriction (IUGR) and extreme prematurity | 186 | ||
| Constitutional delay of growth and puberty | 186 | ||
| Endocrine | 186 | ||
| Hypothyroidism | 186 | ||
| Growth hormone deficiency | 186 | ||
| Corticosteroid excess, Cushing syndrome | 187 | ||
| Nutritional/chronic illness | 187 | ||
| Psychosocial deprivation | 187 | ||
| Chromosomal disorder/syndromes | 187 | ||
| Extreme short stature | 187 | ||
| Disproportionate short stature | 187 | ||
| Examination and investigation | 187 | ||
| Growth hormone treatment of short stature | 187 | ||
| Tall stature | 190 | ||
| Abnormal head growth | 191 | ||
| Microcephaly | 191 | ||
| Macrocephaly | 192 | ||
| Asymmetric heads | 192 | ||
| Craniosynostosis | 192 | ||
| Premature sexual development | 193 | ||
| Precocious puberty | 193 | ||
| Females | 193 | ||
| Males (see Case History 11.2) | 194 | ||
| Management | 194 | ||
| Premature breast development (thelarche) | 194 | ||
| Premature pubarche (adrenarche) | 195 | ||
| Delayed puberty | 195 | ||
| Disorders of sexual differentiation (DSD) | 196 | ||
| Congenital adrenal hyperplasia (CAH) | 197 | ||
| Diagnosis | 197 | ||
| Management | 199 | ||
| Further reading | 199 | ||
| 12 Nutrition | 201 | ||
| The nutritional vulnerability of infants and children | 201 | ||
| Low nutritional stores | 201 | ||
| High nutritional demands for growth | 201 | ||
| Rapid neuronal development | 201 | ||
| Acute illness or surgery | 202 | ||
| Long-term outcome of early nutritional deficiency | 202 | ||
| Linear growth of populations | 202 | ||
| Disease in adult life | 202 | ||
| Infant feeding | 203 | ||
| Breast-feeding | 203 | ||
| Advantages (see Box 12.1) | 203 | ||
| Potential complications (Box 12.2) | 203 | ||
| Establishing breast-feeding | 203 | ||
| Formula-feeding | 205 | ||
| Introduction of whole, pasteurised cow’s milk | 205 | ||
| Specialised infant formula | 206 | ||
| Weaning | 206 | ||
| Failure to thrive | 206 | ||
| Causes | 207 | ||
| Clinical features and investigation | 207 | ||
| Management | 207 | ||
| Outcome | 208 | ||
| Malnutrition | 209 | ||
| Assessment of nutritional status | 209 | ||
| Dietary assessment | 209 | ||
| Anthropometry | 209 | ||
| Laboratory investigations | 209 | ||
| Consequences of malnutrition | 210 | ||
| The role of intensive nutritional support | 210 | ||
| Enteral nutrition | 210 | ||
| Parenteral nutrition | 211 | ||
| Marasmus and kwashiorkor | 211 | ||
| Management | 212 | ||
| Vitamin D deficiency | 213 | ||
| Rickets | 213 | ||
| Aetiology | 213 | ||
| Clinical manifestations | 213 | ||
| Diagnosis | 213 | ||
| Management | 215 | ||
| Vitamin A deficiency | 215 | ||
| Obesity | 215 | ||
| Definitions | 216 | ||
| Aetiology | 216 | ||
| Prevention | 217 | ||
| Endogenous causes | 217 | ||
| Management | 217 | ||
| Drug treatment and surgery | 217 | ||
| Dental caries | 217 | ||
| Further reading | 218 | ||
| Websites (Accessed May 2011) | 218 | ||
| 13 Gastroenterology | 219 | ||
| Vomiting | 219 | ||
| Gastro-oesophageal reflux | 220 | ||
| Investigation | 221 | ||
| 14 Infection and immunity | 241 | ||
| The febrile child | 241 | ||
| Clinical features | 241 | ||
| (i) How is fever identified in children? | 241 | ||
| (ii) How old is the child? | 241 | ||
| (iii) Are there risk factors for infection? | 241 | ||
| (iv) How ill is the child? | 242 | ||
| (v) Is there a rash? | 243 | ||
| (vi) Is there a focus for infection? | 243 | ||
| Management | 243 | ||
| Serious life-threatening infections | 243 | ||
| Septicaemia | 243 | ||
| Meningitis | 243 | ||
| Bacterial meningitis | 244 | ||
| Pathophysiology | 244 | ||
| Organisms | 244 | ||
| Presentation | 245 | ||
| Investigations | 245 | ||
| Management | 245 | ||
| Cerebral complications | 245 | ||
| Prophylaxis | 245 | ||
| Partially treated bacterial meningitis | 245 | ||
| Viral meningitis | 245 | ||
| Uncommon pathogens and other causes | 246 | ||
| Neonatal meningitis | 246 | ||
| Encephalitis/encephalopathy | 247 | ||
| Toxic shock syndrome | 247 | ||
| Necrotising fasciitis/cellulitis | 248 | ||
| Specific bacterial infections | 248 | ||
| Meningococcal infection | 248 | ||
| Pneumococcal infections | 249 | ||
| Haemophilus infection | 249 | ||
| Staphylococcal and group A streptococcal infections | 249 | ||
| Impetigo | 249 | ||
| Boils | 250 | ||
| Periorbital cellulitis | 250 | ||
| Scalded skin syndrome | 250 | ||
| Common viral infections | 250 | ||
| The human herpesviruses | 251 | ||
| Herpes simplex infections | 251 | ||
| Asymptomatic | 251 | ||
| Gingivostomatitis | 251 | ||
| Skin manifestations | 252 | ||
| Eye disease | 252 | ||
| Central nervous system infection | 252 | ||
| Chickenpox (primary varicella zoster infection) | 252 | ||
| Clinical features | 252 | ||
| Treatment and prevention | 252 | ||
| Shingles (herpes zoster) | 253 | ||
| Epstein–Barr virus: infectious mononucleosis (glandular fever) | 254 | ||
| Cytomegalovirus | 254 | ||
| Human herpesvirus 6 (HHV6) and HHV7 | 255 | ||
| Parvovirus B19 | 255 | ||
| Enteroviruses | 255 | ||
| Hand, foot and mouth disease | 255 | ||
| Herpangina | 255 | ||
| Meningitis/encephalitis | 255 | ||
| Pleurodynia (Bornholm disease) | 255 | ||
| Myocarditis and pericarditis | 255 | ||
| Uncommon viral infections | 256 | ||
| Measles | 256 | ||
| Clinical features | 256 | ||
| Treatment | 257 | ||
| Prevention | 257 | ||
| Mumps | 257 | ||
| Clinical features | 257 | ||
| Viral meningitis and encephalitis | 257 | ||
| Orchitis | 257 | ||
| Rubella (German measles) | 257 | ||
| Prolonged fever | 258 | ||
| Kawasaki disease | 258 | ||
| Tuberculosis | 260 | ||
| Clinical features | 260 | ||
| Diagnosis | 260 | ||
| Treatment | 260 | ||
| Prevention and contact tracing | 260 | ||
| Non-tuberculous mycobacterial infection | 261 | ||
| Tropical infections | 262 | ||
| HIV infection | 262 | ||
| Diagnosis | 262 | ||
| Clinical features | 262 | ||
| Treatment | 262 | ||
| Reduction of vertical transmission | 265 | ||
| Lyme disease | 265 | ||
| Clinical features | 265 | ||
| Diagnosis | 265 | ||
| Treatment | 265 | ||
| Immunisation | 265 | ||
| Rationale behind the immunisation programme | 266 | ||
| Complications and contraindications | 267 | ||
| Immune deficiency | 268 | ||
| Primary immune deficiencies | 268 | ||
| Investigation | 268 | ||
| Management | 270 | ||
| Further reading | 270 | ||
| Websites for updates on immunisation and current information on infectious diseases (Accessed May 2011) | 270 | ||
| 15 Allergy | 271 | ||
| Paediatric allergy | 271 | ||
| Mechanisms of allergic disease | 271 | ||
| The hygiene hypothesis | 272 | ||
| The allergic march | 272 | ||
| Prevention of allergic diseases | 272 | ||
| History and examination | 272 | ||
| Management | 272 | ||
| Food allergy and food intolerance | 273 | ||
| Clinical features | 273 | ||
| Diagnosis | 274 | ||
| Management | 274 | ||
| Eczema | 275 | ||
| Allergic rhinitis and conjunctivitis (rhinoconjunctivitis) | 275 | ||
| Asthma | 275 | ||
| Urticaria and angioedema | 275 | ||
| Drug allergy | 276 | ||
| Insect sting hypersensitivity | 276 | ||
| Anaphylaxis | 276 | ||
| Further reading | 276 | ||
| Websites (Accessed April 2011) | 276 | ||
| 16 Respiratory disorders | 277 | ||
| Respiratory infections | 277 | ||
| Pathogens | 277 | ||
| Host and environmental factors | 277 | ||
| Classification of respiratory infections | 277 | ||
| Upper respiratory tract infection (URTI) | 278 | ||
| The common cold (coryza) | 278 | ||
| Sore throat (pharyngitis) | 278 | ||
| Tonsillitis | 278 | ||
| Acute infection of the middle ear (acute otitis media) | 278 | ||
| Sinusitis | 279 | ||
| Tonsillectomy and adenoidectomy | 279 | ||
| Laryngeal and tracheal infections | 280 | ||
| Croup | 280 | ||
| Bacterial tracheitis (pseudomembranous croup) | 281 | ||
| Acute epiglottitis | 281 | ||
| Bronchitis | 282 | ||
| Whooping cough (pertussis) | 282 | ||
| Bronchiolitis | 282 | ||
| Clinical features | 282 | ||
| Investigations | 284 | ||
| Management | 284 | ||
| Prognosis | 284 | ||
| Prevention | 284 | ||
| Pneumonia | 284 | ||
| Clinical features | 284 | ||
| Management | 285 | ||
| Prognosis | 285 | ||
| Asthma | 285 | ||
| Transient early wheezing | 285 | ||
| Persistent and recurrent wheezing | 287 | ||
| Pathophysiology of asthma | 287 | ||
| Clinical features | 287 | ||
| Investigations | 288 | ||
| Management | 289 | ||
| Bronchodilator therapy | 289 | ||
| Inhaled corticosteroids | 289 | ||
| Add-on therapy | 289 | ||
| Other therapies | 289 | ||
| Allergen avoidance and other non-pharmacological measures | 289 | ||
| Exercise-induced asthma | 290 | ||
| Acute asthma | 290 | ||
| Assessment | 290 | ||
| Criteria for admission to hospital | 291 | ||
| Management | 292 | ||
| Patient education | 293 | ||
| Recurrent or persistent cough | 293 | ||
| Chronic lung infection | 294 | ||
| Cystic fibrosis | 294 | ||
| Epidemiology, genetics and basic defect | 294 | ||
| Pathophysiology | 295 | ||
| Clinical features | 295 | ||
| Diagnosis | 296 | ||
| Management | 296 | ||
| Respiratory management | 297 | ||
| Nutritional management | 297 | ||
| Teenagers and adults | 297 | ||
| Screening | 297 | ||
| Sleep-related breathing disorders | 298 | ||
| Tracheostomy | 299 | ||
| Long-term ventilation | 299 | ||
| Further reading | 300 | ||
| 17 Cardiac disorders | 301 | ||
| Epidemiology | 301 | ||
| Aetiology | 302 | ||
| Circulatory changes at birth | 302 | ||
| Presentation | 303 | ||
| Antenatal diagnosis | 303 | ||
| Heart murmurs | 303 | ||
| Heart failure | 303 | ||
| Symptoms | 303 | ||
| Signs | 303 | ||
| Cyanosis | 304 | ||
| Diagnosis | 306 | ||
| Nomenclature | 306 | ||
| Left-to-right shunts | 306 | ||
| Atrial septal defect | 306 | ||
| Clinical features | 306 | ||
| Symptoms | 306 | ||
| Physical signs (Fig. 17.5c) | 306 | ||
| Investigations | 306 | ||
| Chest radiograph (Fig. 17.5d) | 306 | ||
| ECG | 307 | ||
| Echocardiography | 307 | ||
| Management | 307 | ||
| Ventricular septal defects | 308 | ||
| Small VSDs | 308 | ||
| 18 Kidney and urinary tract disorders | 325 | ||
| Assessment of the kidneys and urinary tract | 325 | ||
| Congenital abnormalities | 325 | ||
| Anomalies detectable on antenatal ultrasound screening | 325 | ||
| Antenatal treatment | 329 | ||
| Postnatal management | 329 | ||
| Urinary tract infection | 330 | ||
| Clinical features | 330 | ||
| Collection of samples | 330 | ||
| Bacterial and host factors that predispose to infection | 331 | ||
| Infecting organism | 331 | ||
| Antenatally diagnosed renal or urinary tract abnormality | 332 | ||
| Incomplete bladder emptying | 332 | ||
| Vesicoureteric reflux | 332 | ||
| Investigation | 332 | ||
| Management | 334 | ||
| Medical measures for the prevention of UTI | 334 | ||
| Follow-up of children with recurrent UTIs, renal scarring or reflux | 335 | ||
| Enuresis | 335 | ||
| Primary nocturnal enuresis | 335 | ||
| Daytime enuresis | 335 | ||
| Secondary (onset) enuresis | 335 | ||
| Proteinuria | 336 | ||
| Nephrotic syndrome | 336 | ||
| Steroid-sensitive nephrotic syndrome | 336 | ||
| Management | 337 | ||
| Prognosis | 337 | ||
| Steroid-resistant nephrotic syndrome (Table 18.4) | 337 | ||
| Congenital nephrotic syndrome | 338 | ||
| Haematuria | 338 | ||
| Acute nephritis | 338 | ||
| Post-streptococcal and post-infectious nephritis | 338 | ||
| Henoch–Schönlein purpura | 338 | ||
| Clinical findings (Fig. 18.19) | 339 | ||
| IgA nephropathy | 340 | ||
| Familial nephritis | 340 | ||
| Vasculitis | 340 | ||
| Systemic lupus erythematosus (SLE) | 340 | ||
| Hypertension | 340 | ||
| Renal masses | 341 | ||
| Renal calculi | 341 | ||
| Renal tubular disorders | 341 | ||
| Generalised proximal tubular dysfunction (Fanconi syndrome) | 341 | ||
| Specific transport defects | 342 | ||
| Acute kidney injury | 342 | ||
| Management | 343 | ||
| Prerenal failure | 343 | ||
| Renal failure | 343 | ||
| Postrenal failure | 343 | ||
| Dialysis | 343 | ||
| Haemolytic uraemic syndrome | 344 | ||
| Chronic kidney disease | 344 | ||
| Clinical features | 344 | ||
| Management | 344 | ||
| Diet | 344 | ||
| Prevention of renal osteodystrophy | 344 | ||
| Control of salt and water balance and acidosis | 344 | ||
| Anaemia | 345 | ||
| Hormonal abnormalities | 345 | ||
| Dialysis and transplantation | 345 | ||
| Further reading | 345 | ||
| 19 Genitalia | 347 | ||
| Genital disorders in boys | 347 | ||
| Inguinoscrotal disorders | 347 | ||
| Embryology | 347 | ||
| Inguinal hernia | 348 | ||
| Surgery | 348 | ||
| Hydrocele | 348 | ||
| Undescended testis | 348 | ||
| Examination | 349 | ||
| Classification | 349 | ||
| Retractile | 349 | ||
| Palpable | 349 | ||
| Impalpable | 349 | ||
| Investigations | 349 | ||
| Management | 349 | ||
| Surgery | 350 | ||
| Varicocele | 350 | ||
| The acute scrotum | 350 | ||
| Torsion of the testis | 350 | ||
| Torsion of testicular appendage | 350 | ||
| Other causes | 350 | ||
| Abnormalities of the penis | 351 | ||
| Hypospadias | 351 | ||
| Surgery | 351 | ||
| Circumcision | 352 | ||
| Surgery | 353 | ||
| Topical corticosteroids | 353 | ||
| Paraphimosis | 353 | ||
| Genital disorders in girls | 354 | ||
| Inguinal hernias | 354 | ||
| Labial adhesions | 354 | ||
| Vulvovaginitis/vaginal discharge | 354 | ||
| Further reading | 354 | ||
| 20 Liver disorders | 355 | ||
| Neonatal liver disease | 355 | ||
| Bile duct obstruction | 355 | ||
| Biliary atresia (see Case History 20.1) | 355 | ||
| Choledochal cysts | 356 | ||
| Neonatal hepatitis syndrome | 356 | ||
| α1-Antitrypsin deficiency | 356 | ||
| Galactosaemia | 358 | ||
| Other causes | 358 | ||
| Inborn errors of bile acid synthesis | 358 | ||
| Progressive familial intrahepatic cholestasis (PFIC) | 358 | ||
| Intrahepatic biliary hypoplasia | 358 | ||
| Syndromic causes | 358 | ||
| Viral hepatitis | 358 | ||
| Hepatitis A | 358 | ||
| Hepatitis B | 358 | ||
| Chronic hepatitis B | 359 | ||
| Prevention | 359 | ||
| Hepatitis C | 359 | ||
| Hepatitis D virus | 360 | ||
| Hepatitis E virus | 360 | ||
| Non-A to G hepatitis | 360 | ||
| Epstein–Barr virus | 360 | ||
| Acute liver failure (fulminant hepatitis) | 360 | ||
| Diagnosis | 360 | ||
| Management | 360 | ||
| Reye syndrome and Reye-like syndrome | 360 | ||
| Chronic liver disease | 361 | ||
| Autoimmune hepatitis | 361 | ||
| Cystic fibrosis | 361 | ||
| Wilson disease | 361 | ||
| Fibropolycystic liver disease | 362 | ||
| Non-alcoholic fatty liver disease | 362 | ||
| Cirrhosis and portal hypertension | 362 | ||
| Oesophageal varices | 362 | ||
| Ascites | 363 | ||
| Spontaneous bacterial peritonitis | 363 | ||
| Encephalopathy | 363 | ||
| Renal failure | 363 | ||
| Management of children with liver disease | 363 | ||
| Nutrition | 363 | ||
| Fat-soluble vitamins | 363 | ||
| Pruritus | 364 | ||
| Encephalopathy | 364 | ||
| Liver transplantation | 364 | ||
| Further reading | 364 | ||
| 21 Malignant disease | 365 | ||
| Aetiology | 366 | ||
| Clinical presentation | 366 | ||
| Investigations | 366 | ||
| Radiology | 366 | ||
| Tumour marker studies | 366 | ||
| Pathology | 366 | ||
| Management | 366 | ||
| Teenagers and young adults (TYA) | 366 | ||
| Treatment | 366 | ||
| Chemotherapy | 367 | ||
| Radiotherapy | 367 | ||
| Surgery | 367 | ||
| High-dose therapy with bone marrow rescue | 367 | ||
| Supportive care and side-effects of treatment | 367 | ||
| Infection from immunosuppression | 367 | ||
| Bone marrow suppression | 367 | ||
| Gastrointestinal damage, nausea and vomiting and nutritional compromise | 368 | ||
| Drug-specific side-effects | 368 | ||
| Other supportive care issues | 368 | ||
| Fertility preservation | 368 | ||
| Venous access | 368 | ||
| Psychosocial support | 368 | ||
| Leukaemia | 369 | ||
| Clinical presentation | 369 | ||
| Investigations | 369 | ||
| Management of acute lymphoblastic leukaemia | 369 | ||
| Remission induction | 369 | ||
| Intensification | 370 | ||
| Central nervous system | 370 | ||
| Continuing therapy | 370 | ||
| Treatment of relapse | 370 | ||
| Brain tumours | 370 | ||
| 22 Haematological disorders | 381 | ||
| Haemoglobin production in the fetus and newborn | 381 | ||
| Haematological values at birth and the first few weeks of life | 381 | ||
| Anaemia | 382 | ||
| Anaemia due to reduced red cell production | 382 | ||
| Causes of anaemia in infants and children | 383 | ||
| Iron deficiency | 383 | ||
| Clinical features | 384 | ||
| Iron requirements during childhood | 384 | ||
| Diagnosis | 384 | ||
| Management | 385 | ||
| Treatment of iron deficiency with normal Hb | 385 | ||
| Red cell aplasia | 385 | ||
| Increased red cell destruction (haemolytic anaemia) | 386 | ||
| Hereditary spherocytosis | 386 | ||
| Clinical features | 386 | ||
| 23 Emotions and behaviour | 405 | ||
| Principles of normal development | 405 | ||
| Normal parenting | 405 | ||
| Normal early relationships | 405 | ||
| Temperament | 407 | ||
| Self-esteem | 407 | ||
| Cognitive style | 407 | ||
| Coping with chronic or serious illness or adversities in childhood | 407 | ||
| Adversities in the family | 408 | ||
| Problems of the preschool years | 409 | ||
| Meal refusal | 409 | ||
| Sleep-related problems | 409 | ||
| Difficulty in settling to sleep at bedtime | 409 | ||
| Waking at night | 410 | ||
| Nightmares | 410 | ||
| Night (sleep) terrors | 410 | ||
| Disobedience, defiance and tantrums | 410 | ||
| Aggressive behaviour | 411 | ||
| Autism | 412 | ||
| Problems of middle childhood | 412 | ||
| Nocturnal enuresis | 412 | ||
| Explanation | 412 | ||
| Star chart | 412 | ||
| Enuresis alarm | 412 | ||
| Desmopressin | 412 | ||
| Self-help groups | 412 | ||
| Faecal soiling | 413 | ||
| Recurrent unexplained somatic symptoms/somatisation | 413 | ||
| Tics | 414 | ||
| Hyperactivity | 414 | ||
| Antisocial behaviour | 415 | ||
| Anxiety | 415 | ||
| School refusal | 416 | ||
| Educational underachievement | 416 | ||
| Adolescence | 416 | ||
| Cognitive style | 417 | ||
| Anorexia nervosa | 417 | ||
| Management | 418 | ||
| Medical aspects | 418 | ||
| Prognosis | 418 | ||
| Chronic fatigue syndrome | 418 | ||
| Depression | 419 | ||
| Self-harm | 419 | ||
| Drug misuse | 419 | ||
| Psychosis | 420 | ||
| Management of emotional and behavioural problems | 420 | ||
| Cultural considerations | 420 | ||
| Assessment | 421 | ||
| Treatment | 421 | ||
| Further reading | 422 | ||
| 24 Skin disorders | 423 | ||
| The newborn | 423 | ||
| Bullous impetigo | 423 | ||
| Melanocytic naevi (moles) | 423 | ||
| Albinism | 424 | ||
| Epidermolysis bullosa | 424 | ||
| Collodion baby | 424 | ||
| Rashes of infancy | 425 | ||
| Napkin rashes | 425 | ||
| Infantile seborrhoeic dermatitis | 425 | ||
| Atopic eczema (atopic dermatitis) | 425 | ||
| Diagnosis | 426 | ||
| Clinical features | 426 | ||
| Complications | 426 | ||
| Management | 426 | ||
| Avoiding irritants and precipitants | 426 | ||
| Emollients | 426 | ||
| Topical corticosteroids | 428 | ||
| Immunomodulators | 428 | ||
| Occlusive bandages | 428 | ||
| Antibiotics or antiviral agents | 428 | ||
| Dietary elimination | 428 | ||
| Psychosocial support | 428 | ||
| Infections and infestations | 428 | ||
| Viral infections | 428 | ||
| Viral warts | 428 | ||
| Molluscum contagiosum | 428 | ||
| Fungal infections | 428 | ||
| Ringworm | 428 | ||
| Parasitic infestations | 429 | ||
| Scabies | 429 | ||
| Complications | 429 | ||
| Treatment | 429 | ||
| Pediculosis | 430 | ||
| Other childhood skin disorders | 430 | ||
| Psoriasis | 430 | ||
| Pityriasis rosea | 430 | ||
| Alopecia areata | 431 | ||
| Granuloma annulare | 431 | ||
| Acne vulgaris | 431 | ||
| Rashes and systemic disease | 431 | ||
| Urticaria | 431 | ||
| Further reading | 432 | ||
| 25 Endocrine and metabolic disorders | 433 | ||
| Diabetes mellitus | 433 | ||
| Aetiology of type 1 diabetes | 433 | ||
| Clinical features | 434 | ||
| Diagnosis | 434 | ||
| Initial management of type 1 diabetes | 435 | ||
| Insulin | 435 | ||
| Diet | 436 | ||
| Blood glucose monitoring | 436 | ||
| Hypoglycaemia | 437 | ||
| Diabetic ketoacidosis | 437 | ||
| Long-term management | 437 | ||
| Problems in diabetic control | 437 | ||
| Management at school | 439 | ||
| Puberty and adolescence | 439 | ||
| Prevention of long-term complications | 441 | ||
| Hypoglycaemia | 441 | ||
| Causes | 441 | ||
| Treatment | 442 | ||
| Hypothyroidism | 442 | ||
| Congenital hypothyroidism | 442 | ||
| Juvenile hypothyroidism | 443 | ||
| Hyperthyroidism | 443 | ||
| Parathyroid disorders | 444 | ||
| Adrenal cortical insufficiency | 445 | ||
| Presentation | 445 | ||
| Diagnosis | 445 | ||
| Management | 445 | ||
| Cushing syndrome | 445 | ||
| Inborn errors of metabolism | 446 | ||
| Presentation | 446 | ||
| Newborn screening | 446 | ||
| Amino acid disorders | 446 | ||
| Phenylketonuria | 446 | ||
| Homocystinuria | 447 | ||
| Tyrosinaemia | 447 | ||
| Disorders presenting acutely in the neonatal period | 447 | ||
| Disorders of carbohydrate metabolism | 447 | ||
| Galactosaemia | 447 | ||
| Glycogen storage disorders | 447 | ||
| Hyperlipidaemia | 448 | ||
| Familial hypercholesterolaemia (FH) | 449 | ||
| Further reading | 449 | ||
| Websites (Accessed April 2011) | 449 | ||
| 26 Musculoskeletal disorders | 451 | ||
| Assessment of the musculoskeletal system | 451 | ||
| Variations of normal posture | 451 | ||
| Bow legs (genu varum) | 451 | ||
| Knock-knees (genu valgum) | 451 | ||
| Flat feet (pes planus) | 451 | ||
| In-toeing and out-toeing | 451 | ||
| Toe walking | 453 | ||
| Abnormal posture | 453 | ||
| Talipes equinovarus (clubfoot) | 453 | ||
| Vertical talus | 453 | ||
| Talipes calcaneovalgus | 453 | ||
| Flat feet | 454 | ||
| Tarsal coalition | 454 | ||
| Pes cavus | 454 | ||
| Developmental dysplasia of the hip (DDH) | 454 | ||
| Scoliosis | 454 | ||
| Torticollis | 455 | ||
| The painful limb, knee and back | 455 | ||
| Growing pains | 455 | ||
| Hypermobility | 455 | ||
| Complex regional pain syndromes | 455 | ||
| Acute-onset limb pain | 456 | ||
| Osteomyelitis | 456 | ||
| Presentation | 456 | ||
| Investigation | 456 | ||
| Treatment | 456 | ||
| Malignant disease | 456 | ||
| Bone tumours | 456 | ||
| The painful knee | 457 | ||
| Osgood–Schlatter disease | 457 | ||
| Chondromalacia patellae | 457 | ||
| Osteochondritis dissecans (segmental avascular necrosis of the subchondral bone) | 458 | ||
| Subluxation and dislocation of the patella | 458 | ||
| Injuries | 458 | ||
| Back pain | 458 | ||
| Limp | 458 | ||
| Transient synovitis (‘irritable hip’) | 458 | ||
| Perthes disease | 460 | ||
| Slipped capital femoral epiphysis (SCFE) | 460 | ||
| Arthritis | 460 | ||
| Reactive arthritis | 461 | ||
| Septic arthritis | 461 | ||
| Presentation | 461 | ||
| Investigation | 461 | ||
| Juvenile idiopathic arthritis (JIA) | 462 | ||
| Complications | 462 | ||
| Chronic anterior uveitis | 462 | ||
| Flexion contractures of the joints | 462 | ||
| Growth failure | 462 | ||
| Constitutional problems | 464 | ||
| Osteoporosis | 464 | ||
| Amyloidosis | 464 | ||
| Management | 464 | ||
| Prognosis | 465 | ||
| Henoch–Schönlein purpura | 465 | ||
| Systemic lupus erythematosus | 465 | ||
| Juvenile dermatomyositis | 466 | ||
| Genetic skeletal conditions | 466 | ||
| Achondroplasia | 466 | ||
| Thanatophoric dysplasia | 466 | ||
| Cleidocranial dysostosis | 466 | ||
| Arthrogryposis | 466 | ||
| Osteogenesis imperfecta (brittle bone disease) | 466 | ||
| Osteopetrosis (marble bone disease) | 466 | ||
| Marfan syndrome | 466 | ||
| Further reading | 467 | ||
| Websites (Accessed May 2011) | 468 | ||
| 27 Neurological disorders | 469 | ||
| Headache | 469 | ||
| Primary headaches | 469 | ||
| Tension-type headache | 469 | ||
| Migraine without aura | 469 | ||
| Migraine with aura | 469 | ||
| Uncommon forms of migraine | 470 | ||
| Secondary headaches | 470 | ||
| Raised intracranial pressure and space-occupying lesions | 470 | ||
| Other causes | 471 | ||
| Management | 471 | ||
| Rescue treatments | 471 | ||
| Prophylactic agents | 472 | ||
| Psychosocial support | 472 | ||
| Seizures | 472 | ||
| Febrile seizures | 472 | ||
| Paroxysmal disorders | 473 | ||
| Epilepsies of childhood | 474 | ||
| Diagnosis | 474 | ||
| Investigation of seizures | 474 | ||
| EEG | 474 | ||
| Imaging | 474 | ||
| Other investigations | 475 | ||
| Management | 475 | ||
| Anti-epileptic drug (AED) therapy | 475 | ||
| Other treatment options | 477 | ||
| Advice and prognosis | 477 | ||
| Status epilepticus | 478 | ||
| Motor disorders | 478 | ||
| Central motor disorders | 479 | ||
| Cerebral palsy | 479 | ||
| Peripheral motor disorders: the neuromuscular disorders | 479 | ||
| Investigations | 480 | ||
| Disorders of the anterior horn cell | 480 | ||
| Spinal muscular atrophy | 480 | ||
| Spinal muscular atrophy type 1 (Werdnig–Hoffmann disease) | 481 | ||
| Peripheral neuropathies | 481 | ||
| The hereditary motor sensory neuropathies (HMSN) | 481 | ||
| Acute post-infectious polyneuropathy (Guillain–Barré syndrome) | 481 | ||
| Bell palsy and facial nerve palsies | 481 | ||
| Disorders of neuromuscular transmission | 482 | ||
| Myasthenia gravis | 482 | ||
| Transient neonatal myasthenia | 482 | ||
| Juvenile myasthenia | 482 | ||
| Muscle disorders | 482 | ||
| The muscular dystrophies | 482 | ||
| Duchenne muscular dystrophy | 482 | ||
| Becker muscular dystrophy | 483 | ||
| Congenital muscular dystrophies | 483 | ||
| Congenital myopathies | 483 | ||
| Metabolic myopathies | 483 | ||
| The inflammatory myopathies | 483 | ||
| Benign acute myositis | 483 | ||
| Dermatomyositis | 483 | ||
| Myotonic disorders | 483 | ||
| Dystrophia myotonica | 483 | ||
| The ‘floppy infant’ | 484 | ||
| Ataxia | 484 | ||
| Friedreich ataxia | 484 | ||
| Ataxia telangiectasia | 484 | ||
| Other hereditary cerebellar ataxias | 485 | ||
| Cerebrovascular disease | 485 | ||
| Intracranial haemorrhage | 485 | ||
| Extradural haemorrhage | 485 | ||
| Subdural haematoma | 485 | ||
| Subarachnoid haemorrhage | 485 | ||
| Stroke | 485 | ||
| Neural tube defects and hydrocephalus | 486 | ||
| Neural tube defects | 486 | ||
| Anencephaly | 486 | ||
| Encephalocele | 486 | ||
| Spina bifida occulta | 486 | ||
| Meningocele and myelomeningocele | 486 | ||
| Hydrocephalus | 487 | ||
| Clinical features | 488 | ||
| The neurocutaneous syndromes | 488 | ||
| Neurofibromatosis type 1 (NF1) | 489 | ||
| Tuberous sclerosis | 489 | ||
| Sturge–Weber syndrome | 490 | ||
| Neurodegenerative disorders | 490 | ||
| Lysosomal storage disorders | 491 | ||
| Further reading | 492 | ||
| Websites (Accessed May 2011) | 492 | ||
| 28 Adolescent medicine | 493 | ||
| Communicating with adolescents | 494 | ||
| Consent and confidentiality | 495 | ||
| Consent | 495 | ||
| Confidentiality | 495 | ||
| Range of health problems | 495 | ||
| Mortality | 496 | ||
| Impact of chronic conditions | 496 | ||
| Adherence | 496 | ||
| Transition to adult services | 497 | ||
| Fatigue, headache and other somatic symptoms | 498 | ||
| Mental health problems | 499 | ||
| Health-risk behaviour | 499 | ||
| Sexual health | 499 | ||
| Management of sexually transmitted infections | 499 | ||
| Contraception | 500 | ||
| Emergency contraception | 500 | ||
| Teenage pregnancy | 500 | ||
| Health promotion | 500 | ||
| Further reading | 501 | ||
| Websites (Accessed May 2011) | 501 | ||
| Appendix | 503 | ||
| Growth charts | 503 | ||
| Gestational age assessment of newborn infants | 507 | ||
| Neuromuscular maturity | 507 | ||
| Physical maturity | 507 | ||
| Management plan for asthma | 508 | ||
| Blood pressure chart | 509 | ||
| Peak flow chart | 509 | ||
| Normal ranges: haematology | 509 | ||
| Index | 511 | ||
| A | 511 | ||
| B | 513 | ||
| C | 514 | ||
| D | 516 | ||
| E | 517 | ||
| F | 518 | ||
| G | 519 | ||
| H | 520 | ||
| I | 522 | ||
| J | 523 | ||
| K | 523 | ||
| L | 524 | ||
| M | 524 | ||
| N | 526 | ||
| O | 527 | ||
| P | 527 | ||
| Q | 529 | ||
| R | 529 | ||
| S | 530 | ||
| T | 532 | ||
| U | 532 | ||
| V | 533 | ||
| W | 533 | ||
| X | 533 | ||
| Y | 533 | ||
| Z | 533 |