Paediatrics at a Glance Lawrence Miall Mary Rudolf Malcolm Levene Blackwell Science Paediatrics at a Glance This book is dedicated to our children Charlie, Mollie, Rosie Aaron, Rebecca Alysa, Katie, Ilana, Hannah, David and all those children who enlightened and enlivened us during our working lives. Paediatrics at a Glance LAWRENCE MIALL MB BS, BSc, MMedSc, MRCP, FRCPCH Consultant Neonatologist and Honorary Senior Lecturer Neonatal Intensive Care Unit St James’s University Hospital Leeds MARY RUDOLF MB BS BSc DCH FRCPCH FAAP Consultant Paeditrician in Community Child Health Leeds Community Children’s Services Belmont House Leeds MALCOLM LEVENE MD FRCP FRCPCH FMedSc Professor of Paediatrics School of Medicine Leeds General Infirmary Leeds Blackwell Science © 2003 by Blackwell Science Ltd a Blackwell Publishing company Blackwell Science, Inc., 350 Main Street, Malden, Massachusetts 02148-5018, USA Blackwell Science Ltd, Osney Mead, Oxford OX2 0EL, UK Blackwell Science Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia Blackwell Wissenschafts Verlag, Kurfürstendamm 57, 10707 Berlin, Germany The right of the Authors to be identified as the Authors of this Work has been asserted in accordance with the 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. First published 2003 Library of Congress Cataloging-in-Publication Data Miall, Lawrence. Paediatrics at a glance/Lawrence Miall, Mary Rudolf, Malcolm Levene. p. ; cm.—(At a glance) Includes index. ISBN 0-632-05643-6 1. Pediatrics—Handbooks, manuals, etc. [DNLM: 1. Pediatrics—Handbooks. WS 39 M618p 2002] I. Rudolf, Mary. II. Levene, Malcolm I. III. Title. IV. At a glance series (Oxford, England) RJ48 .M535 2002 618 .92—dc21 2002009515 ISBN 0-632-05643-6 A catalogue record for this title is available from the British Library Set in 9/11.5 Times by SNP Best-set Typesetter Ltd., Hong Kong Printed and bound in United Kingdom by Ashford Colour Press, Gosport Commissioning Editor: Fiona Goodgame Managing Editor: Geraldine Jeffers Production Editor: Karen Moore Production Controller: Kate Charman For further information on Blackwell Science, visit our website: www.blackwell-science.com Contents Preface 6 32 Swollen joints 77 List of Abbreviations 7 33 Swellings in the neck 78 34 Swellings in the groin and scrotum 79 Part 1 Evaluation of the child 35 Pyrexia of unknown origin and serious 1 The paediatric consultation 10 recurrent infections 80 2 Systems examination 12 36 Rashes—types of skin lesions 82 3 Understanding investigations I 18 37 Rashes—acute rashes 83 4 Understanding investigations II 20 38 Rashes—chronic skin problems 86 39 Rashes—discrete skin lesions 88 40 Rashes—nappy rashes and itchy lesions 89 Part 2 The developing child 5 Growth and puberty 22 Part 6 Problems presenting through child 6 Development and developmental assessment 25 health surveillance 7 Infant nutrition 28 41 Short stature and poor growth 90 8 Common problems for parents 30 42 Failure to thrive (weight faltering) 92 9 Adolescent issues 32 43 Heart murmurs 94 44 Anaemia and pallor 96 Part 3 The child in the community 45 Neglect and abuse 98 10 The child health service 34 46 The child with developmental delay 100 11 Child care and school 36 12 Immunization and the diseases they protect against 38 Part 7 The newborn infant 13 Screening and surveillance tests 39 47 The newborn baby 102 48 Congenital abnormalities 104 Part 4 The acutely ill child 49 Prematurity 106 14 The acutely ill child 40 50 Neonatal jaundice 108 15 The unconscious child 44 51 Congenital heart disease 110 16 The fitting child 46 17 The febrile child 48 Part 8 Chronic illness in childhood 18 Acute diarrhoea and dehydration 50 52 Asthma 112 19 Vomiting 52 53 Diabetes 114 20 The chesty child 54 54 Cystic fibrosis 116 21 Stridor 56 55 Juvenile chronic arthritis 117 22 Acute abdominal pain 58 56 Childhood cancer 118 23 Accidents and burns 60 24 Poisoning 61 Part 9 The child with a disability 57 The child with a disability 120 Part 5 Common symptoms 58 The child with visual and hearing impairment 121 25 Chronic diarrhoea 62 59 The child with cerebral palsy 122 26 Recurrent abdominal pain 64 60 Epilepsy 124 27 Constipation 66 61 Learning disability 126 28 Urinary symptoms 68 29 Headache 72 Index 129 30 Fits, faints and funny turns 74 31 Leg pain and limp 76 A colour plate section follows at the end of the book. 5 Preface He knew the cause of every maladye, to paediatric problems and child health as they present in primary, com- Were it of hoot or cold or moiste or drye, munity and secondary care. We have now taken the familiar At a Glance And where engendred and of what humour: format and have visually presented each common symptom and led the He was a verray parfit praktisour. student through the causes and key components of the evaluation so that Geoffrey Chaucer c.1340–1400 a competent diagnosis can be made. Chapters are also devoted to pro- A Doctor of Medicine, From Prologue to The Canterbury viding the reader with an understanding of children’s development and Tales their place in society with additional chapters on nutrition, childcare, Chaucer outlined with some clarity the qualities that a doctor of medi- education and community services. cine requires, and emphasized that knowledge about the causes of mal- Although this book is principally intended for medical students, it adies was required to come to competent diagnosis. We have structured may well provide appropriate reading for nurses and other allied pro- Paediatrics at a Glance around children’s common symptoms and mal- fessionals who would like to deepen their understanding of children and adies, and the likely causes for them. We have also attempted to distil paediatric management. It is particularly likely to appeal to those who for the student not only the knowledge base they require but in addition take a visual approach to learning. the competencies they must acquire in order to become ‘verray parfit Hippocrates wrote in his Aphorisms for Physicians, ‘Life is praktisours’ when working with children and their parents. short, science is long, opportunity is elusive, experience is dangerous, The world has changed since Chaucer’s time, and it is now widely judgement is difficult’. We have produced this concise volume in the acknowledged that the medical curriculum suffers from ‘information hope that it will help students cope with these hurdles to medical train- overload’. We have made great efforts to adhere to the General Medical ing, and facilitate the development of clinical acumen in their work with Council’s recommendations in Tomorrow’s Doctors, and have only children. included the core knowledge that we consider is required by doctors in training. We have in addition placed great emphasis on the evaluation of Lawrence Miall the child as he or she presents. Mary Rudolf The focus of the book is similar to its parent book Paediatrics and Malcolm Levene Child Health. In both we have attempted to provide a working approach July 2002 Acknowledgements 37 Acute rashes Various Figures are taken from: Rudolf, M.C.J. & Levene, M.I. (1999) Figure 37 (chicken pox): Bannister, B.A., Begg, N.T. & Gillespie, S.H. Paediatrics and Child Health. Blackwell Science, Oxford. (2000) Infectious Disease, p. 236. Blackwell Science, Oxford. 5 Growth and puberty 51 Congenital heart disease Figure 5.1: Child Growth Foundation. Figure 51: British Heart Foundation. Figure 5.3: Heffner, L.J. (2001) Human Reproduction at a Glance, pp. 32 & 34. Blackwell Science, Oxford. 36 Rashes; types of skin lesions Figure 36 (papules): Courtesy of Dr Katherine Thompson. Figure 36 (macule): Courtesy of Mollie Miall. 6 List of abbreviations ACTH adrenocorticotrophic hormone IDDM insulin-dependent diabetes mellitus ADD attention deficit disorder Ig immunoglobulin AIDS acquired immunodeficiency syndrome IM intramuscular ALL acute lymphoblastic leukaemia INR international normalized ratio ALTE acute life-threatening event IRT immunoreactive trypsin AML acute myeloid leukaemia ITP idiopathic thrombocytopenic purpura ANA antinuclear antibody IUGR intrauterine growth retardation APTT activated partial thromboplatin time IV intravenous ASD atrial septal defect IVC inferior vena cava ASO antistreptolysin O titre IVF in vitro fertilization A-V ateriovenous IVH intraventricular haemorrhage AVPU alert, verbal, painful, unresponsive IVU intravenous urogram AVSD atrioventricular septal defect JCA juvenile chronic arthritis AXR abdominal X-ray JVP jugular venous pulse AZT zidovudine (azidothymidine) LMN lower motor neurone BCG bacille Calmette–Guérin LP lumbar puncture BP blood pressure MCH mean cell haemoglobin BSER brainstem evoked responses MCUG micturating cystourethrogram CDH congenital dislocation of the hip MCV mean cell volume CFTR cystic fibrosis transmembrane regulator MDI metered dose inhaler CHD congenital heart disease MLD mild learning difficulty CMV cytomegalovirus MRI magnetic resonance imaging CNS central nervous system NEC necrotizing enterocolitis CPAP continuous positive airway pressure NHL non-Hodgkin’s lymphoma CPR cardiopulmonary resuscitation NICU Neonatal Intensive Care Unit CRP C reactive protein NPA nasopharyngeal aspirate CSF cerebrospinal fluid NSAID non-steroidal anti-inflammatory drug