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Textbook of Pediatric Care Directed by a distinguished editorial team and featuring contributions from experienced clinicians nationwide Thomas K. McInerny, MD, FAAP Henry M. Adam, MD, FAAP Deborah E. Campbell, MD, FAAP Thomas G. DeWitt, MD, FAAP Jane Meschan Foy, MD, FAAP Deepak M. Kamat, MD, PhD, FAAP

Includes FREE eBook access!

The landmark guide to pediatric medicine — updated and streamlined for today’s clinicians and students

COMPREHENSIVE SCOPE More than 3,000 pages cover screening, pathophysiology, diagnosis,

treatment, management, prevention, critical care, practice management, ethical and legal considerations, and much more. ESSENTIAL CLINICAL GUIDANCE Step-by-step recommendations on diagnosis, evaluation,

treatment, when to admit, and when to refer. PRACTICAL FOCUS Directly addresses day-to-day practice concerns for efficient patient

problem-solving. EVIDENCE-BASED APPROACH State-of-the-art approach includes relevant AAP policy, plus

links to essential online tools for practice.

New and revised in the second edition • 75 new chapters (375 total chapters) covering the full breadth of pediatric practice • Extensive coverage of presenting signs and symptoms • New sections on pediatric assessment and care of special populations • Comprehensive coverage of health supervision • Enhanced focus on patient- and family-centered medical home, plus expanded coverage of mental health topics • eBook accessible on mobile devices AAP Textbook of Pediatric Care, 2nd Edition, and related products can be purchased directly from the AAP at shop.aap.org.

2nd EDITION

For more than 80 years, the American Academy of Pediatrics (AAP) has been the nation’s leading and most trusted child health authority. The new second edition of the AAP Textbook of Pediatric Care continues the tradition by providing a wealth of expert guidance spanning every aspect of current clinical practice.

M C I N E R N Y  A D A M  C A M P B E L L  D E W I T T  F O Y  K A M AT

2nd Edition

Textbook of Pediatric Care

AMERICAN ACADEMY OF PEDIATRICS

AAP

From AAP Textbook of Pediatric Care, 2nd Ed: , McInerny, Thomas K.;Adam, Henry M.;Campbell, Deborah E.;Foy, Jane Meschan;Kamat, Deepak M. Downloaded on Mar 23, 2019, 7:09 AM at 170.0.178.42 Published by AAP, 2016. All rights reserved.

AMERICAN ACADEMY OF PEDIATRICS

Textbook of Pediatric Care 2nd EDITION

McInerny A D A M  C A M P B E L L  D E W I T T  F O Y  K A M AT

From AAP Textbook of Pediatric Care, 2nd Ed: , McInerny, Thomas K.;Adam, Henry M.;Campbell, Deborah E.;Foy, Jane Meschan;Kamat, Deepak M. Downloaded on Mar 23, 2019, 7:09 AM at 170.0.178.42 Published by AAP, 2016. All rights reserved.

AMERICAN ACADEMY OF PEDIATRICS

Textbook of Pediatric Care

From AAP Textbook of Pediatric Care, 2nd Ed: , McInerny, Thomas K.;Adam, Henry M.;Campbell, Deborah E.;Foy, Jane Meschan;Kamat, Deepak M. Downloaded on Mar 23, 2019, 7:09 AM at 170.0.178.42 Published by AAP, 2016. All rights reserved.

From AAP Textbook of Pediatric Care, 2nd Ed: , McInerny, Thomas K.;Adam, Henry M.;Campbell, Deborah E.;Foy, Jane Meschan;Kamat, Deepak M. Downloaded on Mar 23, 2019, 7:09 AM at 170.0.178.42 Published by AAP, 2016. All rights reserved.

AMERICAN ACADEMY OF PEDIATRICS

Textbook of Pediatric Care 2ND EDITION

Thomas K. McInerny,

MD, FAAP

Editor in Chief Professor Emeritus, Department of Pediatrics University of Rochester Medical Center Rochester, New York

Co-editors

Henry M. Adam,

Jane Meschan Foy,

MD, FAAP

Bronx, New York

Deborah E. Campbell,

MD, FAAP

Professor of Clinical Pediatrics Chief, Division of Neonatology Department of Pediatrics The Children’s Hospital at Montefiore Albert Einstein College of Medicine Bronx, New York

Thomas G. DeWitt,

MD, FAAP

Professor of Pediatrics Wake Forest School of Medicine Winston-Salem, North Carolina

Deepak M. Kamat,

MD, PhD, FAAP

Professor of Pediatrics Vice Chair for Education Department of Pediatrics Wayne State University School of Medicine Designated Institutional Official Children’s Hospital of Michigan Detroit, Michigan

MD, FAAP

Carl Weihl Professor of Pediatrics Director of the Division of General and Community Pediatrics Associate Chair for Education Department of Pediatrics University of Cincinnati College of Medicine Designated Institutional Official Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio

Tools Editors

Rebecca Baum,

MD, FAAP

Associate Professor of Pediatrics Section of Developmental Behavioral Pediatrics Nationwide Children’s Hospital The Ohio State University School of Medicine Columbus, Ohio

Kelly J. Kelleher,

MD, MPH, FAAP

Professor of Pediatrics, Psychiatry, and Public Health Nationwide Children’s Hospital The Ohio State University School of Medicine Columbus, Ohio

From AAP Textbook of Pediatric Care, 2nd Ed: , McInerny, Thomas K.;Adam, Henry M.;Campbell, Deborah E.;Foy, Jane Meschan;Kamat, Deepak M. Downloaded on Mar 23, 2019, 7:09 AM at 170.0.178.42 Published by AAP, 2016. All rights reserved.

Director, Department of Publishing: Mark Grimes Senior Product Development Editor: Chris Wiberg Editorial Assistant: Carrie Peters Manager, Publications Production and Manufacturing: Theresa Wiener Manager, Graphic Design and Production: Peg Mulcahy Director, Department of Marketing and Sales: Mary Lou White Brand Manager, Clinical and Professional Publications: Linda Smessaert, MSIMC Library of Congress Control Number: 2016939165 ISBN-13: 978-1-58110-966-5 eISBN: 978-1-61002-047-3 MA0773 The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Every effort is made to keep this publication consistent with the most recent advice and information available from the American Academy of Pediatrics. Every effort has been made to ensure that the drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. It is the responsibility of the health care provider to check the package insert of each drug for any change in indications and dosage and for added warnings and precautions. The mention of product names in this publication is for informational purposes only and does not imply endorsement by the American Academy of Pediatrics. The American Academy of Pediatrics is not responsible for the content of the resources mentioned in this publication. Web site addresses are as current as possible, but may change at any time. The publishers have made every effort to trace the copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. © 2017 by the American Academy of Pediatrics. 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, without prior permission from the publisher (locate title at http://ebooks.aappublications.org and click on © Get Permissions; you may also fax the permissions editor at 847/434-8780 or e-mail [email protected]). Printed in the United States of America. Disclosures Dr. Alexander indicated a speakers’ bureau relationship with Merck Vaccines. Dr. Antaya indicated an expert witness relationship with Hoffmann-LaRoche. Dr. Caserta indicated an editorial relationship with Merck & Co. Dr. Chitlur indicated advisory board relationships with Novo Nordisk and Biogen Idec. Dr. Congeni indicated speakers’ bureau relationships with Pfizer, Merck, and Sanofi Pasteur. Dr. Dinakar indicated a speakers’ bureau relationship with Teva Pharmaceutical Industries Ltd. Dr. Goldstein indicated a consulting and clinical trial relationship with Baxter Healthcare and stock ownership in Hema Metrics Inc. Dr. Kerlin indicated an advisory board relationship with Bayer HealthCare US. Dr. Kocoshis indicated a consultant and funded investigator relationship with NPS Pharmaceuticals. Dr. Levitt indicated stock ownership in JustRight Surgical. Dr. Marcus indicated a speakers’ bureau relationship with Meda Pharmaceuticals. Dr. McFarren indicated a family member has stock ownership in Novartis. Dr. Ross indicated a family member has stock ownership in General Electric, Bristol-Myers Squibb, and Mead Johnson. Dr. Saeed indicated a speakers’ bureau relationship with AbbVie Inc. Dr. Sahai indicated stock ownership in Dr. Reddy’s Laboratories. Dr. Schanler indicated an advisory board relationship with Medela. Dr. Schmitt indicated that he is a co-owner and has an intellectual property relationship with Self Care Decisions and Schmitt-Thompson Clinical Content. Dr. Simon indicated that he is president of and a majority stockholder in Secretory IgA, Inc. and sIRNAx, Inc. Dr. Tan indicated a consultant and advisory board relationship with Sanofi Pasteur, and a consultant and advisory board relationship with GlaxoSmithKline. Dr. Trent indicated an advisory council relationship with Church & Dwight. All other contributors disclosed no relevant financial relationships.

Suggested Citation: McInerny TK, Adam HM, Campbell DE, DeWitt TG, Foy JM, Kamat DM, eds. American Academy of Pediatrics Textbook of Pediatric Care. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017. 9-379/0516 1 2 3 4 5 6 7 8 9 10

From AAP Textbook of Pediatric Care, 2nd Ed: , McInerny, Thomas K.;Adam, Henry M.;Campbell, Deborah E.;Foy, Jane Meschan;Kamat, Deepak M. Downloaded on Mar 23, 2019, 7:09 AM at 170.0.178.42 Published by AAP, 2016. All rights reserved.

DEDICATION

We dedicate this edition to Robert Hoekelman, MD, whose legacy of excellence, commitment to quality health care for children, and dedication to education in pediatrics are reflected in these pages.

From AAP Textbook of Pediatric Care, 2nd Ed: , McInerny, Thomas K.;Adam, Henry M.;Campbell, Deborah E.;Foy, Jane Meschan;Kamat, Deepak M. Downloaded on Mar 23, 2019, 7:09 AM at 170.0.178.42 Published by AAP, 2016. All rights reserved.

From AAP Textbook of Pediatric Care, 2nd Ed: , McInerny, Thomas K.;Adam, Henry M.;Campbell, Deborah E.;Foy, Jane Meschan;Kamat, Deepak M. Downloaded on Mar 23, 2019, 7:09 AM at 170.0.178.42 Published by AAP, 2016. All rights reserved.

Foreword The American Academy of Pediatrics (AAP) and our member pediatricians dedicate ourselves to promoting the optimal physical, mental, and social health and well-being of infants, children, adolescents, and young adults. An important aspect of our work is creating the educational materials necessary to provide appropriate, equitable, and high-quality pediatric care. I am proud to announce the second edition of the AAP Textbook of Pediatric Care. The AAP is the leading publisher in the field of pediatrics, offering more than 500 publications, both print and electronic, for pediatricians and other health professionals who care for children. This kind of leadership saves lives, improves children’s health, and supports the high quality of the profession of pediatrics. The second edition of the AAP Textbook of Pediatric Care was created by a distinguished editorial team led by Thomas K. McInerny, MD, FAAP. Featuring contributions from experienced clinicians worldwide, this textbook addresses clinical issues faced by physicians who care for children: screening, diagnosis, treatment, and management for both common and uncommon diseases. The second edition contains more than 75 new chapters on specific diseases, conditions, signs, symptoms, and

more. Priorities for the 21st century, including the practice of evidence-based medicine, electronic health records, and continuous quality improvement, are also addressed. There is fully integrated coverage of mental health topics, in keeping with the Academy’s mission, and enhanced discussion of the family-centered medical home, including important topics such as health literacy. Because the practice of pediatrics is constantly changing and because we need information to be accessible in multiple ways, we also offer this textbook as part of Pediatric Care Online, our Web-based point-of-care resource. Pediatric Care Online was brand new when the first edition of this textbook was published. It has since grown into an indispensable and comprehensive resource for the practicing pediatrician. It features the complete text of this book and the Red Book, an extensive library of patient education handouts in English and Spanish, quick reference topics based on this book, interactive clinical tools, and much more. Please see pediatriccare.solutions.aap.org for updates to the Textbook and the latest news in pediatric health care. Benard P. Dreyer, MD, FAAP President, American Academy of Pediatrics, 2016

Foreword

From AAP Textbook of Pediatric Care, 2nd Ed: , McInerny, Thomas K.;Adam, Henry M.;Campbell, Deborah E.;Foy, Jane Meschan;Kamat, Deepak M. Downloaded on Mar 23, 2019, 7:09 AM at 170.0.178.42 Published by AAP, 2016. All rights reserved.

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From AAP Textbook of Pediatric Care, 2nd Ed: , McInerny, Thomas K.;Adam, Henry M.;Campbell, Deborah E.;Foy, Jane Meschan;Kamat, Deepak M. Downloaded on Mar 23, 2019, 7:09 AM at 170.0.178.42 Published by AAP, 2016. All rights reserved.

Introduction In

2008, the American Academy of Pediatrics (AAP) revised and updated Dr. Robert Hoekelman’s venerable Primary Pediatric Care to create a new, comprehensive resource centered around the concept of the medical home. The first edition of the AAP Textbook of Pediatric Care applied the principles of evidence-based medicine to a diverse range of practice settings, including community health clinics, solo and private group practices, and hospitals, and to pediatricians practicing in urban, suburban, and rural areas. The nearly eight years since that first publication have seen enormous changes in the practice of pediatric medicine; in our understanding of the relationships between mental and physiologic health and between early childhood adversity and longterm health outcomes; and, not the least, in the ways in which medical information can be organized, distributed, and accessed. This new, fully revised second edition has been created in response to these important challenges. Reflecting the importance of incorporating mental health care into routine primary pediatric care, we have reorganized the book’s content so that mental health screening, surveillance, promotion, symptoms, and conditions are now fully integrated throughout, rather than being divided into a separate section. New chapters have been added, including several based directly on the work of the AAP Task Force on Mental Health. In addition to the enhanced coverage of mental health topics, new chapters have been developed that cover more than 25 new diseases and conditions and more than a dozen new signs and symptoms. Furthermore, each chapter’s selection of Tools for Practice has been fully updated. Two dedicated tools editors have undertaken the task of reviewing and curating these tools for patient engagement, medical decision support, community advocacy, and practice management throughout the book. The AAP recognizes that physicians need not only in-depth educational and resource materials for learning but also point-of-care decision support and tools to engage patients. To meet these needs, the Textbook is now seamlessly integrated within Pediatric Care Online, the essential AAP resource

for trusted pediatric information. The Textbook, linked with the other components of Pediatric Care Online—namely, Red Book Online and Pediatric Patient Education—provides a single point-of-care resource for child health professionals as we continue to move into an increasingly digital world. In addition, Pediatric Care Online provides a morethan-complete version of the Textbook, including full reference lists, interactive tools and forms, new and updated Point-of-Care Quick Reference topics, and exclusive online-only chapters, beginning with an important chapter on Disaster Preparedness and Response, which is available now. In addition to these exciting electronic developments, we think you will find the core content of the Textbook more valuable and relevant than ever. Part 1, Delivering Pediatric Health Care, discusses health care delivery and organizational issues for pediatric practices, including the use of electronic health records, digital resources, evidence-based medicine, and methodologies for quality improvement. This new edition highlights the importance of patient- and family-centered care. Part 2, Principles of Care, has been reorganized to encompass the full range of traditional pediatric practice as well as emerging issues that pediatricians now deal with day to day. Section One covers physical, behavioral, and social assessment. Section Two features a greatly expanded discussion of health promotion based on the Bright Futures guidelines, including environmental health, community pediatrics, surveillance and screening, and, crucially, emerging issues such as obesity, physical activity, healthy use of media, and violence prevention. Section Three covers the general management of children with health and behavioral problems, including communication strategies, the provision of culturally effective care, pain management, psychosocial and psychopharmacologic therapies, transitions to adulthood, and palliative, end-of-life, and bereavement care. Section Four highlights the unique challenges to the pediatrician in caring for special populations, such as children exposed to adverse childhood experiences, in foster or kinship care, in the juvenile justice system, and in military families, as well as lesbian, gay, and bisexual youth.

Introduction

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x

Introduction

Part 3, Maternal and Fetal Health: Effect on Pregnancy Outcomes and Perinatal Health, discusses the developing opportunities in prenatal diagnosis and fetal interventions as well as perinatal preventive care, assisted reproductive technologies, and the effects of maternal depression. Part 4, Care of Healthy and High-Risk Infants, covers the primary care pediatrician’s role in neonatal care. Section One addresses routine care issues, such as breastfeeding, the circumcision decision, hospital discharge, and follow-up care, as well as medical-legal considerations. Section Two deals with assessment and physical examination of the newborn, including maternal medical history, common congenital anomalies, and postnatal evaluation of prenatal findings. Section Three covers the most common neonatal medical conditions, including jaundice, abnormalities of growth, breathing disorders, heart murmur, cyanosis, metabolic conditions, and neurologic findings. Section Four provides guidance in caring for the high-risk infant, including surgical emergencies of the chest and abdomen. Section Five encompasses health and developmental outcomes of medically complex neonates, including very preterm and very lowbirth-weight infants as well as those with significant congenital heart disease and those treated with therapeutic hypothermia. This section also discusses palliative and supportive care needs. Section Six provides guidance on supporting families whose infant is sick or dying. Part 5, Adolescence, discusses issues specific to teenagers, such as interviewing and counseling, as well as adolescent sexuality, including contraception, pregnancy, and abortion. Part 6, Presenting Signs and Symptoms, provides alphabetized, easy-to-use guidance on 85 of the most common physiologic and behavioral signs

and symptoms encountered by the pediatrician. These chapters include the physical and laboratory evaluation necessary to formulate a differential diagnosis, followed by approaches to initial management and guidance on when to refer and when to admit. Part 7, Specific Clinical Problems, details the common physical and mental health issues seen in pediatric primary care settings. The latest evidencebased medicine information is used to enable the pediatrician to follow the recommended guidelines for diagnosis and treatment. Part 8, Critical Situations, guides the pediatrician in responding to life-threatening illnesses and injuries seen in children, including psychiatric emergencies such as suicidality and psychosis, enabling rapid diagnosis and treatment. As always, this textbook marshals the full resources and expertise of the AAP. The contributing authors include more than 500 top clinicians and experts across the scope of pediatrics and children’s health. Each chapter has been reviewed by experts representing the relevant AAP committees, sections, and councils to ensure that the best evidence and AAP policy are reflected. Finally, chapters are cross-referenced to relevant AAP policy statements, clinical and technical reports, and clinical practice guidelines. We would like to gratefully acknowledge the work of the AAP editorial team, including senior developmental editor Chris Wiberg and assistant editor Carrie Peters, along with the many other staff members from AAP Publishing who have made this new edition possible. We hope you will find this textbook to be a valuable addition to your library—in print, digital, or both formats—and an indispensable resource as you care for your patients.

From AAP Textbook of Pediatric Care, 2nd Ed: , McInerny, Thomas K.;Adam, Henry M.;Campbell, Deborah E.;Foy, Jane Meschan;Kamat, Deepak M. Downloaded on Mar 23, 2019, 7:09 AM at 170.0.178.42 Published by AAP, 2016. All rights reserved.

Thomas K. McInerny Henry M. Adam Deborah E. Campbell Thomas G. DeWitt Jane Meschan Foy Deepak M. Kamat