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PAEDIATRICS

Lecture Notes

Simon J. Newell

Jonathan C. Darling

9th Edition

LN with extended material online'

We dedicate this book to our students, past, present, and future. 66485457-66485438 www.ketabpezeshki.com

Paediatrics

Lecture Notes

Simon J. Newell

MD FRCP FRCPCH

Consultant and Senior Clinical Lecturer in Paediatrics and Child Health Leeds Teaching Hospitals NHS Trust and University of Leeds

Jonathan C. Darling

MD MRCP FRCPCH FHEA

Senior Lecturer and Honorary Consultant in Paediatrics and Child Health University of Leeds and Leeds Teaching Hospitals NHS Trust Ninth edition66485457-66485438 www.ketabpezeshki.com  is edition  rst published 2014 © 2014 by John Wiley & Sons Ltd Previous editions published 1973, 1975, 1978, 1981, 1986, 1991, 2002, 2008 by Blackwell Publishing Registered o ce: John Wiley & Sons, Ltd,  e Atrium, Southern Gate, Chichester, West Sussex,

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Library of Congress Cataloging-in-Publication Data

Newell, Simon J., author.

Lecture notes. Paediatrics/Simon J. Newell, Jonathan C. Darling. ... Ninth edition. 1 online resource. Paediatrics Includes bibliographical references and index. Description based on print version record and CIP data provided by publisher; resource not viewed. ISBN 978-1-118-81448-2 ... ISBN 978-1-118-81449-9 (ePub) ... ISBN 978-0-470-65707-2 (pbk.) I. Darling, Jonathan C., author. II. Title. III. Title: Paediatrics. [DNLM: 1. Pediatrics...methods. 2. Child Development...physiology. WS 100] RJ45 618.92...dc23
2013030203
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.

Cover image Sawayasu Tsuji / iStockphoto.com

Cover design by Grounded Design

Set in 8.5/11 pt Utopia Std by Aptara

® Inc., New Delhi, India

1 201466485457-66485438 www.ketabpezeshki.com

Contents

OSCE stations, vi

Preface, vii

Acknowledgements, viii

Further reading, ix

How to use your textbook, x

About the companion website, xvi

Part 1 Essentials of paediatrics

1 Children and their health, 2 2 Parents and children: listening and talking, 16 3 Examination of children, 25 4 Emergency paediatrics, 40

Part 2 Normal and abnormal in

childhood: growth, development, behaviour and prevention 5 Genetics, 51 6 Fetal medicine, 58 7 Birth and the newborn infant, 62 8 Disorders of the newborn, 71 9 Child development and how to assess it, 81 10 Learning problems, 89 11 Emotional and behavioural problems, 99 12 Nutrition, 109 13 Abnormal growth and sexdevelopment, 118 14 Immunization and infections, 124 15 Accidents and non-accidents, 139 16 Adolescent health, 149

Part 3 Systems and specialties

17 Neurology, 156 18 Ear, nose and throat, 172 19 Respiratory medicine, 177 20 Cardiology, 191 21 Gastroenterology, 204
22 Urinary Tract and Genitalia, 220
23 Bones and joints, 234
24 Skin, 242
25 Haematology, 250
26 Neoplasia, 256
27 Endocrine and metabolic disorders, 261

Part 4 After paediatrics

28 Preparing for clinical examinations in paediatrics and
child health, 270 29 Safe prescribing, 279
30 Careers in paediatrics, 283

Self-test

Extended matching questions, 285

Answers to extended matching questions, 301

Paediatric symptom sorter, 308

Index, 31166485457-66485438 www.ketabpezeshki.com

OSCE stations

OSCE station 2.1: Counselling, p. 24

OSCE station 4.1: Shock, p. 48

OSCE station 9.1: Developmental assessment, p. 88

OSCE station 10.1: Examination for squint, p. 98

OSCE station 11.1: History-taking "pain, p. 108

OSCE station 13.1: Failure to thrive, p.123

OSCE station 14.1: Fever and a  t in an infant, p. 136

OSCE station 14.2: Allergic reaction, p.138

OSCE station 15.1: Accidental poisoning, p. 148

OSCE station 16.1: Discussion of asthma

treatment,p. 154 OSCE station 17.1: Neurological examination of the legs, p.171 OSCE station 19.1: Examination of the respiratory system, p. 189

OSCE station 19.2: Prescribing and explaining

asthma treatment, p. 189 OSCE station 20.1: Examination of the cardiovascular system, p. 203

OSCE station 21.1: Persistent diarrhoea, p. 218

OSCE station 21.2: Constipation, p. 219

OSCE station 22.1: Urine testing, p. 232

OSCE station 22.2: Enuresis, p. 232

OSCE station 22.3: Urinary tract infection

management and prevention, p. 233 OSCE station 23.1: Testing for dislocation of the hips,p. 241

OSCE station 25.1: Assessment of bruising,

p. 255

OSCE station 27.1: Examination of the neck,

p. 267

OSCE station 28.1: Equipment, p. 278

OSCE station 29.1: Safe prescribing"otitis media

and fever, p. 28166485457-66485438 www.ketabpezeshki.com

Preface

When Lecture Notes: Paediatrics began over 40

years ago, the notion of a weblink to watch a You-

Tube video would have been science  ction. (Try

http://tinyurl.com/lnpcell Inner life of the cell from Harvard and imagine trying to watch and believe this in 1973.) Looking back at the  rst edi- tion, it tells of: high mortality from Rhesus disease; life-threatening infections, since abolished by immunization; lead poisoning; frequent admissions for accidental ingestion of drugs, before childproof containers and blister packs; and At present there is no cure for leukaemiaƒ. Paediatrics and child health have come a long way. Children are 20% of the population and are seen in

40% of general practice consultations. We have again

set out to focus on the core of the paediatric cur- riculum that every medical student should learn. We hope our book will also be useful to other health pro- fessionals who care for children, especially our col- leagues in advanced nursing roles.

In this new edition we have advanced the use of

information boxes indicating key points, practice points, treatment guides, learning logs, and web- based support material. Each chapter begins with a chapter map and suggests practical ways of gaining experience in paediatrics in the learning log at the end.  is edition o ers many updated and new sec- tions, as well as new chapters in adolescent health, genetics, safe prescribing and careers in paediatrics.

Students and teachers all want success in exami-

nations. We have added more OSCE stations, along with OSCE tips at the end of each chapter, to be used alongside the section on Preparing for Clinical

Examinations in Paediatrics and Child Health and

the extended matching questions (EMQs). We hope you will  nd these useful.

We have amended the book to give it what we hope

will be an easy-to-follow structure: Part 1 takes you through the essentials you need to know at the out- set; Part 2 covers normal and abnormal from fetal life through to adolescence; then Part 3 moves to systems and specialties; and  nally we explain in Part 4 what happens next ... exams and (we hope) careers in pae- diatrics.

We both used Lecture Notes when we were medi-

cal students and it is a popular choice of text at home in the UK and abroad. We hope you will enjoy read- ing Lecture Notes during your paediatrics and that it will in some way contribute to still higher and better standards for childrens health during your careers in the next 40 years.

Simon Newell

Jonathan Darling66485457-66485438 www.ketabpezeshki.com

Acknowledgements

 is book was conceived by Professor Sir Roy

Meadow and Professor Dick Smithells, whose teach-

ing inspired many students in paediatrics.

We are grateful to the European Resuscitation

Council for permission to use their illustrations, and algorithms in emergency paediatrics. We thank the focus groups of medical students, whose re ections

on the previous edition were so helpful to us. 66485457-66485438 www.ketabpezeshki.com

Further reading

Large comprehensive textbooks:

Kliegman RM, Stanton BMD, St Geme J, Schor NF

(eds) (2011) Nelson Textbook of Pediatrics. 19th edi- tion, Elsevier Saunders.

McIntosh N, Helms PJ, Smyth RL, Logan S (eds)

(2008) Forfar and Arneils Textbook of Pediatrics, 7th edition, Churchill Livingstone. Rennie JM (ed.) (2012) Rennie & Robertons Textbook of Neonatology, 5th edition, Churchill Livingstone.

We have included links to useful supplementary

reading and resources throughout the text ... look out for the Resources boxes.66485457-66485438 www.ketabpezeshki.com

How to use your textbook

Features contained within your textbook

Overview pages give a summary of the chapters in each part.

Part 1

Essentials of

paediatrics

Chapter 1 Children and their health, 2

Chapter 2 Parents and children: listening and talking, 16

Chapter 3 Examination of children, 25

Chapter 4 Emergency paediatrics, 40

? is section covers the toolkit" of skills and knowledge that you need at the outset of your paediatric

attachment. ? e  rst chapter sets the scene, putting the paediatrics you will learn in the wider context

of child morbidity and mortality, societal issues, and community and social aspects relevant to child

public health and paediatric practice. ? e skills of history taking and examination are di erent when assessing children, and the next two chapters help you learn a systematic yet  exible and child friendly approach.

We hope you won"t have the stress of being  rst on the scene when a child collapses, but you need to

know the basics of what to do, and how this di ers from adults. ? is is covered in Emergency paediatrics,

along with the equally important skill of being able to recognize impending collapse before it happens.

Remember that children can deteriorate quickly, and if you are in doubt, ask for help!

Chapter map

1.1 Global Child Health, 2

1.2 Child mortality and morbidity in the UK, 4

1.2.1 Infant mortality, 4

1.2.2 Child mortality, 5

1.2.3 Childhood morbidity, 5

1.3 Children in society, 6

1.3.1 Socioeconomic inequalities, 6

1.3.2 Changes in family structure, 7

1.3.3 Ethnicity, 7

1.3.4 Laws relating to the young, 8

1.3.5 Ethics and children"s rights, 8

1.4 Child health in the community, 8

1.4.1 Health personnel, 8

1.4.2 Health surveillance and promotion, 9

1.4.3 Schools and nurseries, 11

1.5 Social aspects of child health and care, 12

1.5.1 Parental responsibility, 12

1.5.2 Social services, 12

1.5.3 Voluntary services, 13

1.5.4 Adoption, 13

1.6 Children in hospital, 13

Summary, 15

Children under the age of 16 comprise 20% of the population of the UK and of most industrialized countries,

but in many developing countries children represent more than 50% of the population. In all countries, the

management of children"s health problems is a high proportion of the medical workload. Many GPs  nd that

30% of their consultations are for children, particularly pre-school children (under 5 years). (Medical students

in the middle of a 2- or 3-month paediatric attachment may wonder why only 5% of their training should be

devoted to children!) ? is chapter sets the scene for your study of paediatrics, starting with an overview of child

health globally and in the UK. We then review societal factors relevant to paediatrics, community and social

aspects of child health, and  nally the child in hospital.

Every chapter begins with a chapter map showing the contents of the chapter and an introduction to the topic.66485457-66485438 www.ketabpezeshki.com

How to use your textbook xi

Key point boxes highlight important information

about a topic.

Treatment boxes give prescribing guidelines

and advice. TREATMENT

Vitamin K is given to all newborns as an oral

supplement or as a single IM injection. Oral vitamin K is repeated over the  rst month in breast-fed infants. OSCE TIP In an exam, never do anything that is painful, likely to cause discomfort, or which is emabarassing. Some tasks are not practical in the OSCE settting. If you are going to omit part of the examination for these reasons, explain this to the examiner (e.g. in the cardiac examination, say that you would want to: plot growth centiles, measure BP with correct cuff, and examine femoral pulses).

OSCE tip boxes and OSCE stations help you

prepare and revise for exams. KEY POINTS

All children need:

€

Self-esteem (we need to feel wanted)

€

At least one good human relationship (we need

to trust and feel trusted) €

Firm supervision and clear boundaries (we need

rules). A small change that helps to achieve one of these for a child may make a big difference. RESOURCE €

See the United Nations Development Programme

website for the latest information on progress: www.undp.org and click Millenium Development

Goals".

€

Health Metrics and Evaluation has a superb

site to explore health and other data (www .healthmetricsandevaluation.org). Go to Tools" then Visualizations" and select GBD 2010" to review the global burden of different diseases by age and region. € Visit www.gapminder.org for another great site to compare health and other data between countries and historically.

Resource boxes point you to useful information

in books and online.66485457-66485438 www.ketabpezeshki.com xii How to use your textbook Practice point boxes give practical tips on how best to handle a speci c scenario. PRACTICE POINT € If a parent suspects a problem with their child, they are often right. €

Take the views and concerns of parents and other

carers seriously. €

If in doubt, refer.

€ Children at high risk of certain conditions may need additional screening tests. Summary

We have described how the paediatric history and

consultation di ers from adult medicine. ? ere are di erent elements (such as birth, immunizations, development), but more importantly there is a dif- ferent approach. ? is includes involving the child according to age, understanding the constraints of working through a third party (the parent), and being aware of the possibility of child abuse. ? ere is no substitute for practice, and we hope you will enjoy taking and presenting many paediatric histories, and reviewing them with your teachers. OSCE TIP

€ History of any common presenting symptom or

problem. € Counselling and explaining common and important paediatric problems, e.g. constipation, weaning, immunization, gastro-oesophageal re ux, asthma, febrile convulsions, epilepsy, enuresis. FOR YOUR LOG Summarizing a history is key clinical skill. Write a brief (2...3 sentence) summary for every history you take. The process clari es what is important in your mind, makes your verbal presentation clearer, and means you  nish neatly. OSCE stations involving history taking or presentation will often ask for a summary. Each chapter ends with a Summary and a section called For your log which suggests practical ways of gaining experience in paediatrics.66485457-66485438 www.ketabpezeshki.com

How to use your textbook xiii

 e Emergency and Paediatric symptom sorter quick reference guide sections are clearly indicated for

quick reference.

Paediatric symptom

sorter

I am about to see a child withƒ..

 bolditalics () are easy to miss, and may have serious consequences if you do.

 ere is some overlap between acute and clinic presentations, so check both lists. Page numbers direct you to

where to  nd main relevant information in the book. Check the index for a complete listing.

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