Pediatric primary care

Description

Front Cover Inside Front Cover Pediatric Primary Care Copyright Page Contributors Reviewers Preface Special Features of the Sixth Edition Organization of the Book Acknowledgments Contributors to the Fifth Edition Our Thanks to Family and Friends References Table Of Contents Unit 1 Pediatric Primary Care Foundations 1 Health Status of Children Global Health Status of Children Global Food Insecurity and Effect on Children’s Health United Nations Millennium Development Goals: Project Goals Progress on the Millennium Development Goals Health Status of Children in the United States Food Insecurity in Children in the United States Addressing Children’s Health in the United States Healthy People 2020 Social Determinants of Health and Health Equity Adverse Childhood Events and Impact on Child Health Outcomes Child Health and Quality Improvement Measures The Role of Advanced Practice Nurses for Improving Child Health Health Promotion and Evidence-Based Clinical Preventive Services Health Supervision Guidelines American Academy of Pediatrics Guidelines Bright Futures References 2 Child and Family Health Assessment Foundations for Child and Family Assessment Child Health Assessment Foundations Domains of Health Care Problems Developmental Problems Functional Health Problems Diseases Problem Interactions Developmental Assessment Foundations Developmental Monitoring (Surveillance) Developmental Screening and Assessment Screening Developmental Assessment Strategies Specific to Developmental Assessment Family Assessment Foundations The Family’s Role in Health Care of Children Family Assessment Basic Elements Family Structure and Roles Family Social Network Genograms Genogram Construction The Environment for Data Collection Setting up the Assessment Environment Communication with Children and Families Redesigning Primary Care to Achieve Assessment Goals The Database The Child Health History The Initial (Complete) Health History Patient-Identifying Information Adolescent Health History Adaptations The Physical Examination Other Data Laboratory and Radiographic Data Data from Other Disciplines Creating the Problem List Avoiding Diagnostic Errors Creating the Management Plan Shared Decision-Making with Child and Family Communicating Assessment Data Informatics and Child Health Care References 3 Cultural Considerations for Pediatric Primary Care Culture Essentialist and Constructivist Concepts of Culture Individualism and Collectivism Culture, Privilege, and Health Care Biomedicine and the Culture of Client, Family, and Community Cultural Humility and Cultural Competence Cultural Humility Cultural Competence Best Practices for Developing Cultural Humility and Cultural Competence Awareness Engagement Application Intrapersonal Domain Awareness Engagement and Application Interpersonal Domain Awareness Engagement and Application Communication Conflict Negotiation System/Organization Domain Awareness Engagement and Application Intra-Organizational Standards Global Domain Awareness Engagement and Application Health Care for Immigrant and Refugee Populations Immigrants, Refugees, and Settlement Processes Prearrival Health Requirements Postarrival Health Care Initial Health Visit, Screening, and Assessment Assessment References Additional Resources Unit 2 Management of Development 4 Developmental Management in Pediatric Primary Care Developmental Principles Theories of Child Development Ethology: Animal Studies Maturational Theories: Developmental Milestones Cognitive-Structural Theories: Language and Thought Sensorimotor Stage (Birth to 2 Years) Preoperational Stage (2 to 7 Years) Concrete Operational Stage (7 to 12 Years) Formal Operational Stage (13 Years through Adulthood) The Role of Social Interaction in Cognitive Development Psychoanalytic Theories Personality and Emotions Behavioral Theories: Human Actions and Interactions Humanistic Theories Innermost Self Ecologic Theories Temperament Self-Regulation Early Brain Development Theories of Family and Parenting Development Family Theories Parent Development Theory Cultural Influences on Development Management Strategies in Child Development Promoting Parent Development and Parent-Child Interaction: Anticipatory Guidance Discipline Concerns about Delayed Development Developmental Red Flags Talking with Parents about Developmental Delays Implementing Individualized Interventions Early Intervention Programs Family-Centered Care References Additional Resources 5 Developmental Management of Infants Birth Rates and Infant Mortality Development of Infants Birth to One Month Old Physical Development Motor Skills Development Communication and Language Development Social and Emotional Development Cognitive-Sensory Development One through Three Months Old Physical Development Motor Skills Development Communication and Language Development Social and Emotional Development Cognitive Development Four through Five Months Old Physical Development Motor Skills Development Communication and Language Development Social and Emotional Development Cognitive Development Six through Eight Months Old Physical Development Motor Skills Development Communication and Language Development Social and Emotional Development Cognitive Development Nine through Twelve Months Old Physical Development Motor Skills Development Communication and Language Development Social and Emotional Development Cognitive Development Developmental Assessment of Infants Screening Strategies for Infants Anticipatory Guidance for Infants The Prenatal Visit The Neonatal Visit Birth to One Month Old Regulation and Sleep-Wake Patterns Strength and Motor Coordination Feeding and Self-Care Communication and Language Social and Emotional Growth Cognitive and Environmental Stimulation One through Three Months Old Regulation and Sleep-Wake Patterns Strength and Motor Coordination Feeding and Self-Care Communication and Language Social and Emotional Growth Cognitive and Environmental Stimulation Four through Five Months Old Regulation and Sleep-Wake Patterns Strength and Motor Coordination Feeding and Self-Care Communication and Language Social and Emotional Growth Cognitive and Environmental Stimulation Six through Eight Months Old Regulation and Sleep-Wake Patterns Strength and Motor Coordination Feeding and Self-Care Communication and Language Social and Emotional Growth Cognitive and Environmental Stimulation Nine through Twelve Months Old Regulation and Sleep-Wake Patterns Strength and Motor Coordination Feeding and Self-Care Communication and Language Social and Emotional Growth Cognitive and Environmental Stimulation Common Developmental Issues for Infants and Families Sleep Feeding Crying Postpartum Depression Red Flags for Infant Development References Additional Resources 6 Developmental Management of Early Childhood Development of Early Childhood Physical Development Motor Development Communication and Language Development Articulation Lexicon Syntax Semantics Bilingualism Social and Emotional Development Morality Peer Relationships Body Image Cognitive Development Developmental Assessment of Early Childhood Screening Strategies During Early Childhood Physical Development Motor Skills Development Communication and Language Development Social and Emotional Development Cognitive Development Anticipatory Guidance for Early Childhood Regulation and Sleep-Wake Patterns Strength and Motor Coordination Feeding and Self-Care Communication and Language Social and Emotional Growth Cognitive and Environmental Stimulation Common Developmental Issues in Early Childhood Sibling Rivalry Assessment Management Temper Tantrums Child Care and Preschools Child Care Preschool Toileting Safety Early Childhood Developmental Red Flags Physical Disorders Cognitive Disorders Language Disorders References 7 Developmental Management of School-Age Children Development of School-Age Children Physical Development Motor Skills Development Communication and Language Development Social and Emotional Development Peer Relationships Morality Body Image Coping Skills Cognitive Development Developmental Assessment of School-Age Children Screening Strategies for School-Age Children Physical Development Motor Skills Development Communication and Language Development Social and Emotional Development Cognitive Development Diagnostic Studies Anticipatory Guidance for School-Age Children Parent Development Regulation and Sleep-Wake Patterns Strength and Motor Coordination Nutrition, Self-Care, and Safety Nutrition Self-Care Safety Communication and Language Social and Emotional Growth Cognitive and Environmental Stimulation Common Developmental Issues for School-Age Children School Readiness Clinical Findings History Diagnostic Studies Management Learning Problems Clinical Findings History Differential Diagnosis Management School Refusal (Phobia) Description Clinical Findings History Differential Diagnosis Management Recurrent Physical Symptoms Clinical Findings History Differential Diagnosis Management Red Flags for School-Age Children References Additional Resources Resources for Screening Tools 8 Developmental Management of Adolescents Adolescent Development Physical Development Tanner Stages Female Stages Male Stages Psychosocial, Emotional, and Cognitive Development Influences on Psychosocial, Emotional, and Cognitive Development Principles of Behavior Changes Smooth Transition Cognitive Changes Emotional Changes of Adolescence Egocentrism of Adolescents Developmental Screening and Assessment Principles and Approaches to Assessment Focus of Assessment Physical Development Cognitive Development Social and Emotional Development Parent Assessment Anticipatory Guidance During Adolescence Phases of Adolescence Early Adolescence (11 to 14 Years Old) Physical Development Cognitive Development Social and Emotional Development Health Supervision Anticipatory Guidance Middle Adolescence (15 to 17 Years Old) Physical Development Cognitive Development Social and Emotional Development Health Supervision Anticipatory Guidance Late Adolescence (18 to 21 Years Old) Physical Development Cognitive Development Social and Emotional Development Health Supervision Anticipatory Guidance Common Developmental Issues for Adolescents Risk Behavior: General Description Factors that Contribute to Risk-Taking Assessment Management Risk Behavior: Tobacco Use Description Assessment Management Risk Behavior: Self-Injurious Behaviors Description Assessment Management Risk Behavior: Social Media Use Description Assessment Management References Additional Resources Unit 3 Approaches to Health Management in Pediatric Primary Care 9 Introduction to Functional Health Patterns and Health Promotion Functional Health Patterns— The Behaviors of Health Health Perception and Health Management Functional Health Pattern Health Perception Components of Health Perception Children’s Conceptualizations of Health and Illness Assessment Foundations: Health Behavior Prediction Models Health Belief and Self-Efficacy Models Health Promotion Model Health Management Assessment of Health Management Pattern Clinical Findings Indicating Health Perception and Health Management Functional Health Pattern Problems Management Strategies for Functional Health Patterns The Provider-Child-Family Triad: Family-Centered Collaborative Negotiations Health Promotion Care Behavioral Counseling Interventions The Five As Motivational Interviewing Health Education Assessing and Fostering Health Literacy Patient Education Process Patient Education Strategies Health System Interventions Skills to Access Resources: Referrals, Email, and Telephone Communication Management Strategies for Children with Special Needs Evaluating Health Promotion Interventions References Additional Resources 10 Nutrition Standards for Preventive Care Nutritional Requirements and Dietary Reference Intakes Energy Water and Electrolytes Water Sodium Potassium Chloride Macronutrients Protein Carbohydrates Fats Micronutrients Vitamins Fat-Soluble Vitamins Minerals and Elements Use of Vitamin and Mineral Supplements Assessment of Nutritional Status History Physical Examination Diagnostic Studies Management Strategies for Optimal Nutrition Developing Healthy Eating Behaviors Parents Decide What Foods to Eat Parents Create an Environment Conducive to Healthy Eating Children Decide How Much of Healthful Foods to Eat Nutritional Education MyPlate, MyPlate for Kids, and SuperTracker Age-Specific Considerations Newborns and Infants Toddlers and Preschoolers School-Age Children Physical Activity Vegetarian Diets Management Complications Altered Patterns of Nutrition Disorders Requiring Increased Caloric Intake Clinical Findings History Physical Examination Management Complications Disorders Requiring Decreased Caloric Intake Clinical Findings History Management Disorders Requiring Restricted or Supplemental Diets Clinical Findings Management Complications Disorders Requiring Physical Alterations in Diet Management Clinical Findings History Physical Examination Management Complications Eating Disorders Obesity and Overweight Risk Factors and Predictors for Obesity Biological Mechanisms Temperament Clinical Findings History Physical Examination Differential Diagnosis Management Lifestyle Changes Community Changes Surgery Complications Adverse Food Reactions Clinical Findings History Diagnostic Studies Differential Diagnosis Management Elimination Diet Immunotherapy Complications Effect of Medications on Nutritional Status Clinical Findings Management Complications Toxic Exposures in Foods Controversies in Pediatric Nutrition Effects of Sugar or Food Additives on Behavior Gluten-Free Diets References Additional Resources 11 Breastfeeding Breastfeeding Recommendations Hospital-Based Support The Baby-Friendly Hospital Initiative Benefits of Breastfeeding Contraindications to Breastfeeding Special Situations Characteristics of Human Milk Colostrum Transitional Milk Mature Milk Water Lipid (Fat) Content Protein Carbohydrates Vitamins and Minerals Anatomy and Physiology Assessment of the Breastfeeding Dyad Maternal History Infant History Maternal Examination Infant Examination Positions for Breastfeeding Principles of Correct Positioning Cradle Position Side-Lying Position Football Hold Dynamics of Breastfeeding Early Feedings Frequency and Duration of Feedings Pumping Collection and Storage of Breast Milk Growth Spurts Breastfeeding Toddlers Weaning Clinical Indications of Successful Breastfeeding Infant Weight Gain Urine Output Guidelines Stool Output Guidelines Maternal Nutritional Needs during Breastfeeding Medications for Breastfeeding Mothers Returning to Work Common Breastfeeding Problems Flat or Inverted Nipples Differential Diagnosis Management Prenatal Complications Sore Nipples Clinical Findings Differential Diagnosis Management Severe Engorgement Clinical Findings Differential Diagnosis Management Mastitis Clinical Findings Management Complications Nipple Confusion Clinical Findings Differential Diagnosis Management Complications Breast Milk Jaundice Clinical Findings Physical Examination Differential Diagnosis Management Thrush Poor Weight Gain Clinical Findings Infant Factors Differential Diagnosis Management Complications References Additional Resources 12 Elimination Patterns Standards Normal Patterns of Elimination: Bowel and Urinary Infants Bowel Patterns Urinary Patterns Toddlers and Preschoolers Bowel Patterns Urinary Patterns School-Age Children Bowel Patterns Urinary Patterns Adolescents Bowel and Urinary Patterns Assessment of Patterns Health History Description of Current Status Birth and Early Infancy History Review of Systems Family History Environment and Psychosocial Issues Physical Examination Diagnostic Studies Management Strategies for Normal Patterns Toilet Training Altered Patterns of Elimination: Bowel and Bladder Dysfunction Encopresis/Constipation Physiologic Psychosocial Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Stool Toileting Refusal Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Dysfunctional Voiding Clinical Findings History Differential Diagnosis Management Patient and Family Education Enuresis Clinical Findings History Physical Examination Differential Diagnosis Management Complications Patient and Family Education References Additional Resources Enuresis Encopresis General 13 Physical Activity and Sports for Children and Adolescents Physical Activity: Overview Promoting Physical Activity: Guidelines and Standards Health Benefits of Physical Activity Physical Activity and Children with Special Health Care Needs Special Consideration: Atlantoaxial or Atlanto-Occipital Instability (AAI) Strategies to Support Physical Activity for Children and Adolescents Motivation and Barriers to Maintaining Physical Activity Can Health Care Providers Influence Lifestyle Behaviors? Counseling Families about Organized Sports for Their Children Strength Training Preseason Conditioning and Injury Prevention Use of Helmets for Cycling and Winter Sports Basic Metabolic and Nutritional Needs and Abuses in Athletes Carbohydrates Protein Fats Intentional Weight Loss Is There a Role for Sports Drinks? The Preparticipation Sports Physical Examination for Sports Benefits of the Preparticipation Sports Physical Examination Frequency of Preparticipation Examinations Medical Clearance and Liability Issues Where the Preparticipation Physical Examination Should Take Place Components of the Preparticipation Physical Examination Health History Physical Examination Diagnostic Studies Evaluation and Management of Sports Participation for Athletes with Specific Health Conditions Chronic Medical Conditions Asthma Cardiac Conditions Cardiac Murmurs Diabetes Mellitus Hypertension Seizures Sickle Cell Trait Acute Infectious Conditions Infectious Mononucleosis Skin Infections Human Immunodeficiency Virus and Other Blood-Borne Viral Pathogens Exercise-Induced Dyspnea High-Risk Conditions for Sports Participation Sudden Cardiac Death in Young Athletes Musculoskeletal Overuse or Traumatic Injuries Baseball/Softball Burners and Stingers Neck Injury Head Injury/Concussions Transient Quadriplegia Hernia Absence of Paired Organs Special Considerations for the Female Athlete Injuries and the Female Athlete The Female Athlete Triad Heat and Humidity Sports Training Acclimatization for Prevention of Heat-Related Illnesses Dehydration Use of Ergogenic Drugs and Supplements Recognition and Prevention of Ergogenic Substance Use Anabolic-Androgenic Steroids Androstenedione and Dehydroepiandrosterone Growth Hormone Creatine and Other Supplements Ephedra Energy Drinks Nutritional Supplements Recreational Activities: Safety Issues References Additional Resources 14 Sleep and Rest Normal Sleep Stages and Cycles Circadian Rhythm and Establishment of Normal Sleep Patterns Sleep Cycle Non-Rapid Eye Movement Sleep Stage 1 (NREM1 or N1) Rapid Eye Movement Sleep Sleep Cycle Processes Sleep Patterns by Age Group Newborns Sudden Infant Death Syndrome and Sleep Positioning Toddlers Preschoolers (3 to 5 Years Old) School-Age Children (5 to 12 Years Old) Older Children and Adolescents Sleep Across Cultures Assessment of Sleep History Chief Complaint General Health History Past Medical History and Review of Systems Family Assessment Physical Examination Diagnostic Studies Strategies for Prevention and Management of Sleep Problems Sleep Hygiene Promotion Dyssomnia Interventions Primary Care Interventions for Dyssomnias Unmodified Extinction Sleep in Children with Developmental and Neurologic Conditions Medications Common Sleep Problems Parasomnias: Night Terrors, Sleepwalking, and Nightmares Non-Rapid Eye Movement Parasomnias Confusional Arousals Rapid Eye Movement Parasomnias Assessment of Parasomnias History Treatment of Parasomnias Sleep Cycle Problems (Circadian Rhythm Disorders) Delayed Sleep Phase Differential Diagnoses Advanced Sleep Phase Management Inappropriate or Unpredictable Schedules Management Nocturnal Enuresis Restless Legs Syndrome and Periodic Limb Movements Clinical Findings and Diagnosis Laboratory Studies Treatment Head Banging and Bruxism Fear and Anxiety Dyssomnias Depression and Sleep Epilepsy and Sleep Sleep Disordered Breathing Clinical Findings Diagnostic Studies Surgical and Medical Treatment of Sleep Disordered Breathing Central Sleep Apnea Narcolepsy References Additional Resources 15 Sexuality Standards Normal Patterns of Sexuality Historical and Cultural Context of Sexuality Contemporary Definitions Sexual Health Stages of Developmental Patterns of Sexuality Infancy to 2 Years Old Two to 5 Years Old Five to 9 Years Old Preadolescence Adolescence Sexuality in Individuals With Intellectual and Physical Developmental Disabilities Factors That Can Alter Sexual Behaviors Assessment of Normal Patterns of Sexual Development Confidentiality History Functions of the Sexual History Types of Sexual Histories Approach to Taking a Sexual History Physical Examination Management Strategies Setting the Stage Sex Education Counseling of the Adolescent Contraceptive and Safer Sex Counseling Special Counseling Needs Lesbian, Gay, Bisexual, Transgendered, and Questioning Youth Clinical Findings Management Complications References Additional Resources 16 Values, Beliefs, and Spirituality Standards of Practice Normal Patterns of Behavior Definitions of Values, Beliefs, Faith, Spirituality, and Morality Development of Moral Integrity or Conscience Development of Spirituality Assessment of Normal Patterns History Moral Integrity or Conscience Physical Examination Management of Normal Patterns Altered Patterns Lack of Moral Integrity or Conscience Assessment Clinical Findings Differential Diagnosis Management Complications Moral and Spiritual Distress Assessment Clinical Findings Differential Diagnosis Management Complications References Additional Resources 17 Role Relationships Standards of Care Family Functioning Dimensions of Family Functioning Family Life Dynamics The Interactive Family Assessment of Family Relationships and Dynamics Management for Health Promotion and Disease Prevention Family Units Two-Parent Families Single-Parent Families Clinical Findings Management Patient and Family Education and Prevention Children Living with Grandparents or Extended Family Members Children Living with Two Unmarried Parental Figures—Cohabitation Children Living with Homosexual Parents Adolescent Parents Clinical Findings Infancy Management Families with Special Circumstances Adoptive Parent Families Assessment Management Patient and Family Education and Prevention Children Living in Foster or Group Homes Families with a Premature Infant Families with Multiple Births Children with Chronic Illness or Special Needs Dynamics Affecting Family Life Working Parents Separation and Divorce Clinical Findings Management Patient Education and Prevention Remarriage: The Blended Family Clinical Findings Management Patient and Family Education and Prevention Military Deployment Children Living in Poverty Displaced or Homeless Children and Their Families Disaster Affecting the Family Death in the Family Role-Relationship Problems Violence Clinical Findings Management Prevention of Youth Violence Primary Prevention Secondary Prevention Intimate Partner Violence (Domestic Violence) Clinical Findings Management Patient Education and Prevention Bullying Clinical Findings Management Patient and Family Education and Prevention Child Maltreatment General Assessment Guidelines General Management Strategies Neglect Clinical Findings Differential Diagnosis Management Psychological Maltreatment Clinical Findings History Differential Diagnosis Management Patient and Family Education and Prevention Physical Abuse Clinical Findings History Diagnostic Studies Differential Diagnosis Management Patient and Family Education and Prevention Sexual Abuse, Assault, and Date Rape Clinical Findings Diagnostic Studies Differential Diagnosis Management Patient and Family Education and Prevention References Additional Resources 18 Self-Perception Issues Standards of Care Normal Patterns of Self-Perception Components of Self-Perception Developmental Stages Developmental Assets, Family Assets, Sparks, and Developmental Relationships Developmental Assets Family Assets Sparks Developmental Relationships Factors Influencing Self-Perception Significant Relationships Parent-Child Attachment, Temperament, and Stress and Trauma Health and Chronic Conditions Cultural Identity, Race, and Ethnicity Social Experiences Media and Technology Red Flags and Risk Factors for Self-Perception Assessment of Self-Perception History Observations During the History and Examination Management Strategies for Developing Positive Self-Perception Facilitate Good Parenting Maintain Appropriate Expectations of the Child Use Discipline Techniques That Enhance Self-Perception Communicate Positively and with Respect Provide Helpful Strategies for the Child, Adolescent, and Parent Encourage Asset Building, Sparks, and Developmental Relationships Complications of Self-Perception Specific Self-Perception Problems in Children Self-Esteem Problems Description Assessment Differential Diagnosis Management Complications Personal Identity Problems Description Clinical Findings Differential Diagnosis Management Complications Role Performance Problems Description Clinical Findings Differential Diagnosis Management Complications Body Image Problems Description Clinical Findings Differential Diagnosis Management References Additional Resources 19 Coping and Stress Tolerance Mental Health Influences Neurobiologic Context Mental Health in Primary Care Prevention Primary Prevention Secondary Prevention Tertiary Prevention Approaches to Children by Developmental Level Special Approaches from Infancy Through Early Childhood Special Approaches During the School-Age Years Through Adolescence (Level 3) Temperament Influences on Mental Health Temperament as a Risk Factor Temperament Management Assessment and Management of Mental Health Disorders Assessment Approaches to Children of Different Ages Infants History The Symptom Analysis: Behavioral Manifestations Disease Domain Physical Examination Diagnostic Studies Behavioral/Developmental Screening and Assessment Tools Making Mental Health and Behavioral Diagnoses Management Strategies Common Mental Health Problems Special Problems of Infancy and Early Childhood The Shy Child Differential Diagnosis Management Bereavement Clinical Findings Fears, Phobias, and Anxieties Fears and Phobias Clinical Findings Anxiety Separation Anxiety Disorder Clinical Findings Generalized Anxiety Disorder Clinical Findings Obsessive-Compulsive Disorder Clinical Findings Management Tic Disorders Clinical Findings Diagnostic Studies Posttraumatic Stress Disorder Clinical Findings Differential Diagnosis Mood Disorders Depression Clinical Findings Depression Scales Management Prognosis Bipolar Disorder Clinical Findings Attention-Deficit/Hyperactivity Disorder The Aggressive Child Social Aggression Clinical Findings Conduct Disorder Clinical Findings Oppositional Defiant Disorder Clinical Findings Autism Spectrum Disorder Eating Disorders Clinical Findings Differential Diagnosis Diagnostic Studies Management Complications Substance Abuse Clinical Findings Differential Diagnosis Diagnostic Studies Management References Additional Resources 20 Cognitive-Perceptual Disorders Standards for Care Cognitive-Perceptual Development Piaget: Cognitive Development Information Processing Theories Social Cognition Neurodevelopmental Framework Multiple Intelligences Executive Functions and the Prefrontal Cortex Sensory Processing Social and Emotional Skills that Lead to Academic Success Elements of Learning Assessment of Cognitive-Perceptual Development History Screening Management Strategies for Cognitive-Perceptual Development Primary Care Strategies and Interprofessional Collaboration Educational Strategies Family Support Strategies Social and Adaptive Strategies Cognitive-Perceptual Problems of Children Attention-Deficit/Hyperactivity Disorder Prevalence in the United States Cross-Cultural Considerations Effect of Attention-Deficit/Hyperactivity Disorder on Individuals, Families, and Communities Genetics and Neurobiologic Pathophysiology Environmental Factors Clinical Findings History and Physical Examination Attention-Deficit/Hyperactivity Disorder Standardized Assessment (Behavior) Scales and Other Diagnostic Tools Differential Diagnosis and Comorbidities Management Diagnostic Formulation and Initial Meeting with Family and Child Plan of Care, Special Health Needs Status, and Medical Home Behavior Management Supports and Services: Family, Home, Friends, Activities, and Self-Esteem Complementary Therapies Learning Disorders and Neurodevelopmental Dysfunctions Clinical Findings Assessment Screening Differential Diagnosis Management Educational and Adaptive Support Complications Patient and Family Education and Prevention Sensory Processing Disorder Clinical Findings Assessment History and Physical Examination Differential Diagnosis and Comorbidities Management Complications Autistic Spectrum Disorder Clinical Findings Infants Toddlers Assessment Screening and Specialty Referral for Diagnosis Differential Diagnosis Management Behavior/Mental Health Educational System Hearing Impairment Clinical Findings and Developmental and Behavioral Effects Assessment Management Habilitation and Assistive Devices and Amplification Devices Educational System and Family Support Visual Impairment Clinical Findings and Developmental and Behavioral Effects Assessment Management Habilitation and Assistive Devices References Additional Resources Unit 4 Approaches to Disease Management 21 Introduction to Disease Management Key Concepts in Illness Management in Children Shared Decision-Making as Part of Child- and Family-Centered Care Overview of Parent and Child Education: Illness Management and Prevention Health Literacy Health Care Education Discharge Education Education for Chronic Illnesses of Children Provider Considerations for Care of Children with Illnesses Parents as Observers of Illness Medications and Illness Day Care and Illnesses Working with Non–English-Speaking Families Emergency Department Utilization Chronic Disease Management Issues Children and Youth with Special Health Care Needs Legislative and Governmental Support for Children and Youth with Special Health Care Needs Emotional Support for Children and Youth with Special Health Care Needs and Their Families Family-Centered Care for Children with Chronic Conditions Challenges in the Patient-Centered Health Care Model Primary Care for Chronically Ill Children Child and Family Issues about Quality of Life Chronic Care of Children and the Health Care System Common Concerns of Children and Families Related to Chronic Illness Care Assessment and Management of Children with Acute or Chronic Illnesses History and Physical Examination Considerations about Diagnostic Studies Laboratory Studies Imaging Studies Determining an Accurate Diagnosis Management Considerations Acute Illness Medication Management Prescribing Pharmacologic Agents Parental Education Related to Medication Use Referral and Consults Referral to National and Local Organizations and Resources for Chronic Medical Issues Tips Regarding Documentation: Patient Visit and Follow-Up Telehealth Management of Illnesses Telephone Triage Systems Steps of an Effective Triage System Documentation of Triage Telephone Calls Texting Social Media Websites Email Educating Parents about Office Telephone and Electronic Messaging Policy Illness Prevention Child Care Settings and Infectious Diseases Fever in Children Fever Assessment Types of Thermometers and Measurement Sites Fever Management References Additional Resources Computer-Aided Diagnostic Decision Support Health Literacy Information Hand Washing Guidelines Transitions from Pediatric to Adult Health Care Patient Education and Choices Chronic Illness–Information About Medical Home Model Miscellaneous Shared Decision-Making Programs Support Groups for Families and Patients 22 Prescribing Medications in Pediatrics National Safety Goals Regarding Prescribing Medications Regulation and Safety of Pharmaceuticals Safety Issues with Pharmaceutical Manufacturers Ethical Issues with Pharmaceutical Testing Guidelines for Writing a Prescription General Prescribing Guidelines Prescribing Medications for Children Pharmaceuticals Used In Pediatrics: Off-Label Prescribing Perils of Prescribing Off-Label Other Factors to Consider in Medication Management Medication Adherence Overprescribing Antibiotics; a Continuing Problem Advances in Pharmacologic Research: Maximizing Therapeutic Efficacy Disposal of Pharmaceuticals References Additional Resources Mobile Phone Applications Text Messaging Mobile Games: Available as Mobile Applications 23 Pediatric Pain Management Pain in Children Barriers to Treatment of Pain in Children Overview of Pain Pain Assessment Clinical Findings History Behavioral Indicators Physiologic Indicators Management Acute Pain Management Infants Children and Adolescents Pharmacologic Considerations Factors that Produce Age-Related Differences in Analgesia Responses Chronic Pain Management Pharmacologic Measures Nonpharmacologic Measures Additional Measures Partnership in Care References Additional Resources 24 Infectious Diseases and Immunizations Pathogenesis of Infectious Diseases Clinical Findings History Physical Examination Diagnostic Aids Laboratory and Imaging Studies Complete Blood Count Platelet Count/Mean Platelet Volume C-Reactive Protein Procalcitonin Erythrocyte Sedimentation Rate Cultures, Stains, and Antimicrobial Susceptibility Testing Other Technologies Immunoserology Imaging Techniques General Management Strategies Preventing the Spread of Infection Use of Antibiotics Prevention of Infection Through the Use of Vaccines Barriers to Vaccination Adverse Reactions to Vaccines Vaccines for Children Program Vaccine Shortages Vaccine Safety and Resources for Providers Vaccines on the Horizon Acetaminophen Prophylaxis after Vaccination? Active Immunity General Principles Considerations When Choosing Inactive Vaccines Inactivated Vaccines Diphtheria-Tetanus-Acellular Pertussis Vaccine Hepatitis A Virus Vaccine Human Papillomavirus Vaccine Pneumococcal Vaccines Live Vaccines Precautions Regarding Administration of Live Vaccines Measles-Mumps-Rubella Vaccine Measles, Mumps, Rubella, and Varicella Vaccine Passive Immunity: The Immunoglobulins Respiratory Syncytial Virus Prophylaxis Infections in Children in Child Care Settings Specific Viral Diseases Enteroviruses Nonpolio Enteroviruses Clinical Findings Differential Diagnosis and Management Poliomyelitis Virus Differential Diagnosis and Management Hepatoviruses Hepatitis A Virus Clinical Findings Hepatitis B Virus Clinical Findings Complications and Prevention Hepatitis C Virus Clinical Findings Hepatitis D Virus Hepatitis E Virus Herpes Family of Viruses Herpes Simplex Virus Clinical Findings Diagnostic Studies Differential Diagnosis and Management Complications Patient and Family Education Infectious Mononucleosis Syndrome Clinical Findings Diagnostic Studies Differential Diagnosis and Management Complications and Patient and Family Education Roseola Infantum (Exanthem Subitum) Clinical Findings Diagnostic Studies Differential Diagnosis, Management, and Complications Varicella Clinical Findings Diagnostic Studies Differential Diagnosis and Management Complications Patient and Family Education Influenza Viral Infections Typical Influenza Clinical Findings Differential Diagnosis, Management, and Complications Highly Pathogenic Avian Influenza Other Viral Diseases Human Immunodeficiency Virus Clinical Findings Diagnostic Studies Differential Diagnosis Management and Complications Prevention and Reduction of Perinatal Transmission of Human Immunodeficiency Virus Preexposure Prophylaxis for Certain High Risk Individuals Postexposure Prophylaxis After Nonoccupational Exposure Measles (Rubeola) Clinical Findings Diagnostic Studies Differential Diagnosis and Management Care of Exposed Individuals Complications Mumps Clinical Findings Diagnostic Studies Differential Diagnosis, Management, and Complications Erythema Infectiosum Clinical Findings Diagnostic Studies Differential Diagnosis, Management, and Complications Parainfluenza Virus Clinical Findings Diagnostic Studies Differential Diagnosis, Management, and Complications Rubella (German or 3-Day Measles) Clinical Findings Diagnostic Studies Differential Diagnosis, Management, and Complications Mosquito-Borne Viruses West Nile Virus Clinical Findings Differential Diagnosis, Management, and Complications Dengue Virus Clinical Findings Differential Diagnosis, Management, and Complications Hantavirus Pulmonary Syndrome Additional Noteworthy Viruses in Circulation Human Pneumovirus (Metapneumovirus) Human Calicivirus Infections (Norovirus and Sapovirus) Coronaviruses Potential Emerging and Reemerging Viruses on the Horizon Middle Eastern Respiratory Syndrome Monitoring the Global Spread of Viruses Parasitic-Caused Disease: Malaria Tick-Borne Diseases Lyme Disease Clinical Findings Diagnostic Studies Differential Diagnosis, Management, and Complications Patient and Family Education Ehrlichiosis and Anaplasmosis Rocky Mountain Spotted Fever Clinical Findings Diagnostic Studies Differential Diagnoses Management Complications and Patient and Family Education Bacterial Infections Community-Acquired Methicillin-Resistant Staphylococcus Aureus Other Emerging Drug-Resistant Bacterial Infections Cat-Scratch Disease Clinical Findings Diagnostic Studies Differential Diagnosis, Management, and Complications Kingella Kingae Infection Meningococcal Disease Clinical Findings Diagnostic Studies Differential Diagnosis Management, Control Measures, and Complications Streptococcal Disease Group A Streptococcus Clinical Findings and Diagnostic Studies Non–Group A or B Streptococci Tuberculosis Clinical Findings Primary Pulmonary Tuberculosis Screening Tests for Infection Mantoux Tuberculin Skin Test. Diagnostic Studies Differential Diagnosis Management Monitoring Response to Treatment Complications Helminthic Zoonoses Toxocariasis Clinical Findings Physical Examination Differential Diagnosis Management and Complications Patient and Family Education The Child Presenting with Fever Fever Without Focus in Infants and Young Children Clinical Findings History and Physical Examination Diagnostic Studies Differential Diagnosis Management Applying Risk Criteria Fever of Unknown Origin Clinical Findings History Physical Examination Differential Diagnosis and Management Infectious Agents Used in Bioterrorism References Additional Resources Vaccines Centers for Disease Control and Prevention European Society of Pediatric Gastroenterology, Hepatology and Nutrition World Health Organization 25 Atopic, Rheumatic, and Immunodeficiency Disorders Pathophysiology and Defense Mechanisms Atopic and Allergic Disorders Immune Deficiency Rheumatic Disorders Overview of Laboratory Diagnostic Studies in Rheumatic Diseases General Management Strategies Rheumatologic Disorders Juvenile Idiopathic Arthritis Clinical Findings History Diagnostic Studies Differential Diagnosis Management Complications and Prognosis Patient and Parent Education and Prevention Systemic Lupus Erythematosus Clinical Findings History Differential Diagnosis Management Complications and Prognosis Fibromyalgia Syndrome Clinical Findings History Differential Diagnosis Management Patient and Parent Education Prognosis Chronic Fatigue Syndrome Clinical Findings Differential Diagnosis Management Reactive Arthritis Related to Streptococcal Infection: Acute Rheumatic Fever and Post-Streptococcal Reactive Arthritis Post-Streptococcal Reactive Arthritis Acute Rheumatic Fever Clinical Findings and History Major Manifestations Minor Manifestations Management Prevention of Acute Rheumatic Fever Complications Pediatric Vasculitis Henoch-Schönlein Purpura Clinical Findings History Differential Diagnosis Management Complications and Prognosis Patient and Parent Education Kawasaki Disease Clinical Findings Stage 1: Acute Phase Differential Diagnosis Management Complications and Prognosis Atopic Disorders Asthma Clinical Findings History Physical Examination Differential Diagnosis Management Chronic Asthma Acute Exacerbations of Asthma Complications Patient and Parent Education and Prevention Prognosis Allergic Rhinitis Clinical Findings Diagnostic Studies and Allergy Testing Differential Diagnosis Management Avoidance Strategies Pharmacologic Therapy Allergy Immunotherapy and Other Treatments Complications and Prognosis Patient and Parent Education and Prevention Atopic Dermatitis Clinical Findings Diagnostic Studies Differential Diagnosis Management Pharmacotherapy Non-Pharmacological Therapy Environmental Management Complications and Prognosis Patient and Parent Education and Prevention Pediatric Immunodeficiency Disorders Physiology of the Immune System Primary and Secondary Immunodeficiency Disorders Clinical Presentation History Physical Assessment Management References Additional Resources 26 Endocrine and Metabolic Disorders Anatomy and Physiology Pathophysiology Assessment History Physical Examination Diagnostic Studies Management Strategies General Measures Genetic Counseling Medications Dietary Considerations Patient and Family Education Disorders of Endocrine Function Growth Disorders Growth Hormone Deficiency Clinical Findings Differential Diagnosis Constitutional Growth Delay Clinical Findings Management Growth Excess Pubertal Disorders Early Puberty/Precocious Puberty Clinical Findings Management Delayed Puberty Clinical Findings Adrenal Disorders Anatomy and Physiology Adrenal Insufficiency Clinical Findings Hyperadrenal States Clinical Findings Differential Diagnosis Disorders of Sex Development Clinical Findings Management Thyroid Disorders Anatomy and Physiology Hypothyroidism Clinical Findings Management Hyperthyroidism Clinical Findings Diabetes Mellitus Type 1 Diabetes Clinical Findings Complications Type 2 Diabetes Clinical Findings Differential Diagnosis Complications Obesity Diagnostic Studies Management Posterior Pituitary Gland Disorders Introduction to Inborn Errors of Metabolism Classification of Inborn Errors of Metabolism Pathophysiology Assessment of Inborn Errors of Metabolism Clinical Findings History Management Metabolic Emergencies Complications Specific Metabolic Disorders of Children Disorders of Carbohydrate Metabolism Glycogen Storage Diseases Galactosemia Urea Cycle Disorders Clinical Findings and Diagnostic Studies Amino Acid Metabolism Disorders: Aminoacidopathies and Organic Acidurias and Acidemias Phenylketonuria Classic Homocystinuria Disorders of Fatty Acid Oxidation Medium-Chain Acyl-Coenzyme A Dehydrogenase Deficiency Lysosomal Storage Disorders Dyslipidemia: Hypercholesterolemia and Hyperlipidemia Clinical Findings Management References Additional Resources Organizations and Resources for Endocrine and Metabolic Disease 27 Hematologic Disorders Anatomy and Physiology Erythrocytes Hemoglobin Erythrocyte Development Structural Variations Normal Values Antigenic Properties of Red Blood Cells Leukocytes Granular Leukocytes (Polymorphonuclear Leukocytes, Polys) Neutrophils, Basophils, and Eosinophils Agranulocytes—Leukocytes Lymphocytes Monocytes Platelet Cells and Coagulation Factors Pathophysiology Assessment of Disorders of Erythrocytes History Physical Examination Pancytopenia Erythrocyte Disorders Anemia Classification of the Anemias Epidemiology Workup for Anemia Microcytic Anemia Iron Deficiency Anemia Effects of Iron Deficiency Clinical Findings History Physical Examination Differential Diagnosis Management Iron Requirements Complications Patient and Family Education Thalassemias Alpha-Thalassemias Management Beta-Thalassemia Minor/Minima Clinical Findings Management Beta-Thalassemia, Intermedia Beta-Thalassemia Major Clinical Findings Management Complications Megaloblastic Anemias Clinical Findings History Management Normocytic Anemias Transient Erythroblastopenia of Childhood Clinical Findings History Differential Diagnosis Management Hemolytic Anemia Sickle Cell Anemia and Trait Clinical Findings Physical Examination Differential Diagnosis Management Complications Patient and Family Education Hereditary Spherocytosis Clinical Findings Diagnostic Studies Management Complications Glucose-6-Phosphate Dehydrogenase Deficiency Clinical Findings History Management Patient and Family Education Platelet and Coagulation Disorders Overview of Diagnostic Studies Immune or Idiopathic Thrombocytopenic Purpura Clinical Findings Diagnostic Studies Differential Diagnosis Management Complications Hemophilia A and B and von Willebrand Disease Clinical Findings Management Complications Thrombophilia White Blood Cell Disorders White Blood Cell Count White Blood Cell Dysfunction Alterations of Granulocytes Lymphocytosis Cancer Leukemias Clinical Findings Diagnostic Studies Management Lymphomas Non-Hodgkin Lymphoma Clinical Findings Hodgkin Lymphoma Clinical Findings Diagnostic Studies Late Effects of Childhood Cancers References Additional Resources 28 Neurologic Disorders Anatomy and Physiology Anatomy Autonomic Nervous System Physiology Pathophysiology and Defense Mechanisms Assessment of the Nervous System History History of Present Illness Medical History Family Disease History Developmental History Functional Health Social Context Review All Systems Physical Examination Specifics of the Neurologic Examination Behavior and Mental Status Autonomic Nervous System Diagnostic Studies Management Strategies Involving Anticipatory Guidance Neurologic Development Educational Needs Referrals for Other Key Assessments Medications Specific Neurologic Problems of Children Neurodegenerative Disorders Rett Syndrome Multiple Sclerosis Clinical Findings Management Nondegenerative Disorders Benign Paroxysmal Vertigo Cerebral Palsy Clinical Findings Complications Prevention and Screening Bell Palsy Clinical Findings Epilepsy and Seizure Disorders Clinical Findings Differential Diagnosis Complications Febrile Seizures Clinical Findings Prophylaxis for Recurrent Febrile Seizures Brachial Palsy Clinical Findings Prognosis Guillain-Barré Syndrome Clinical Findings Headaches Clinical Findings Differential Diagnosis Complications Head Injury Clinical Findings Differential Diagnosis Complications Prevention Disturbances of Head Growth Macrocephaly Central Nervous System Infections Clinical Findings The Hypotonic Infant Reye Syndrome Tethered Cord Arnold-Chiari Malformation Myelomeningocele Clinical Findings Myasthenia Gravis Clinical Findings References Additional Resources 29 Eye Disorders Standards for Visual Screening and Care Development, Physiology, and Pathophysiology of the Eye Development of the Ocular Structures Anatomy and Physiology of the Eye Pathophysiology of the Eyes Assessment History Physical Examination Screening Tests Conducting Screening Tests Red Reflex Visual Acuity Testing Color Vision Testing Peripheral Vision Testing Testing for Ocular Mobility and Alignment Assessment of Visual Loss Diagnostic Studies Photoscreening and Autorefractors Laboratory and Imaging Studies Fluorescein Staining Management Strategies Referral for Ophthalmologic and Specialty Management Occlusion Corrective Lenses Ophthalmic Medications Topical Antibiotics Ophthalmic Corticosteroids Other Topical Preparations Systemic Medications Eye Injury Prevention Sunglasses Sports Protection Laser Pointers Computer Use Vision Therapy, Lenses, and Prisms Visual Disorders Refractive Errors and Amblyopia Clinical Findings Management Strabismus Clinical Findings Diagnostic Techniques Management Complications Blepharoptosis Management Nystagmus Clinical Findings Management and Prognosis Cataracts Clinical Findings Management Complications Prognosis and Prevention Glaucoma Clinical Findings Management Complications and Prognosis Retinopathy of Prematurity Clinical Findings Management Complications Prevention Retinoblastoma Clinical Findings Management Complications and Prognosis Infections Conjunctivitis Conjunctivitis in the Newborn (Ophthalmia Neonatorum) Clinical Findings Management Inclusion Conjunctivitis (Chlamydia) Clinical Findings Complications Bacterial Conjunctivitis Clinical Findings Patient Education Viral Conjunctivitis Clinical Findings Allergic Conjunctivitis Clinical Findings Blepharitis Clinical Findings Differential Diagnosis Management Hordeolum Clinical Findings Differential Diagnosis Management Chalazion Clinical Findings Management Complications Nasolacrimal Duct Conditions: Dacryostenosis and Dacryocystitis Clinical Findings Diagnostic Studies Differential Diagnosis Management Periorbital Cellulitis Clinical Findings Diagnostic Studies Differential Diagnosis Management Complications Keratitis and Corneal Ulcers Clinical Findings Management Inflammation of the Uveal Tract Clinical Findings Management Complications Trachoma Clinical Findings Management The Injured Eye Corneal Abrasion Clinical Findings Management Foreign Body Clinical Findings Diagnostic Studies Management Complications Burns Clinical Findings Management Lacerations of the Orbit Clinical Findings Management Traumatic Hyphema Clinical Findings Management Complications Retinal Detachment Clinical Findings Management Orbital Hematoma and Contusion of the Globe Clinical Findings Management Complications Orbital Fractures Clinical Findings Diagnostic Studies Management Pterygium Subconjunctival Hemorrhage Eyelid Contusion (“Black Eye”) Deformities of the Eyelids Entropion Ectropion Euryblepharon References Additional Resources 30 Ear Disorders Standards for Hearing Screening Development, Anatomy, and Physiology Pathophysiology and Defense Mechanisms Assessment History Physical Examination Common Diagnostic Studies Management Strategies Medications Education and Counseling Removal of Cerumen Follow-Up and Referral Pressure-Equalizing Tubes Prevention of Noise-Induced Hearing Loss Specific Ear Problems in Children Otitis Externa Clinical Findings History Differential Diagnosis Management Complications Prevention Foreign Body in the Ear Canal Clinical Findings History Management Complications Acute Otitis Media Clinical Findings History Diagnostic Studies Differential Diagnosis Management Management of Persistent and Recurrent Acute Otitis Media Other Issues in Treating Acute Otitis Media Complications Prevention and Education Otitis Media with Effusion Clinical Findings History Differential Diagnosis Management Prevention and Education Perforated Tympanic Membrane Clinical Findings History, Physical Examination, and Diagnostic Studies Differential Diagnosis Management Medications Other Treatment Considerations Cholesteatoma Clinical Findings History and Physical Examination Differential Diagnosis Management and Complications Mastoiditis Clinical Findings History, Physical Examination, and Diagnostic Studies Differential Diagnosis Management Prevention Sensorineural and Conductive Hearing Loss Clinical Findings History Physical Examination Differential Diagnosis Management Complications Prevention References 31 Cardiovascular Disorders Anatomy and Physiology Fetal Circulation Neonatal Circulation Normal Cardiac Structure and Function Conduction System Assessment of the Cardiovascular System History Physical Examination Vital Signs General Appearance and Growth Parameters Palpation Auscultation of Heart Sounds Murmurs Criteria for Describing a Heart Murmur Innocent or Functional Murmurs Common Diagnostic Studies Primary Health Care Management Strategies Referral Genetic Testing Family Support Congenital Heart Disease: General Information Specific Congenital Heart Diseases Congestive Heart Failure Left-to-Right Shunting Congenital Heart Disease (Acyanotic) Atrial Septal Defect Clinical Findings Management Ventricular Septal Defect Clinical Findings Management Atrioventricular Septal Defect (Atrioventricular Canal Defect or Endocardial Cushion Defect) Clinical Findings Management Patent Ductus Arteriosus Clinical Findings Right-to-Left Shunting Congenital Heart Disease (Cyanotic) Transposition of the Great Arteries Clinical Findings Tetralogy of Fallot Clinical Findings Tricuspid Atresia, Hypoplastic Left Heart Syndrome, and Other Single Ventricle Defects Clinical Findings Obstructive Cardiac Lesions Aortic Stenosis and Insufficiency Clinical Findings Pulmonic Stenosis Clinical Findings Management Coarctation of the Aorta Clinical Findings Management Long-Term Complications for Children and Young Adults with Congenital Heart Disease: Transitioning to Adult Care Sudden Cardiac Death Clinical Findings Diagnostic Studies Management Acquired Heart Disease Chest Pain Clinical Findings History Physical Examination Differential Diagnosis Management Hypertension Clinical Findings History Physical Examination Management Complications Patient and Family Education Infective Endocarditis Clinical Findings History and Physical Examination Differential Diagnosis Management and Complications Patient and Family Education Myocarditis and Cardiomyopathy Clinical Findings History Differential Diagnosis Management Complications and Prognosis Pericarditis Heart Conduction Disturbances Cardiac Arrhythmias Clinical Findings Diagnostic Studies Management and Complications Syncope Clinical Findings History Physical Examination Diagnostic Studies Management and Differential Diagnosis References Additional Resources Genetic Tests, Information About Genetic Defects or Syndromes, and Resources for Families 32 Respiratory Disorders Anatomy and Physiology Upper Respiratory Tract Lower Respiratory Tract Pathophysiology Involved in Airway Disease Obstructive Processes Restrictive Processes Defense Systems Assessment of the Respiratory System History Physical Examination Diagnostic Studies Basic Respiratory Management Strategies General Measures Medications Patient and Parent Education Indications for Tonsillectomy and Adenoidectomy Upper Respiratory Tract Disorders The Common Cold Pathophysiology Clinical Findings History Differential Diagnosis Management Complications Pharyngitis, Tonsillitis, and Tonsillopharyngitis Acute Viral Pharyngitis, Tonsillitis, or Tonsillopharyngitis Clinical Findings History Management Acute Bacterial Pharyngitis and Tonsillitis Clinical Findings History Management Complications Rhinosinusitis Clinical Findings Diagnostic Studies Differential Diagnosis Management Complications Prevention Diphtheria Clinical Findings History Differential Diagnosis Management Complications and Prevention Pertussis Clinical Findings Diagnostic Studies Differential Diagnosis Management Care of Exposed Children Complications Prevention Recurrent Epistaxis Clinical Findings History Diagnostic Studies Differential Diagnosis Management Prevention Nasal Foreign Body Clinical Findings History Differential Diagnosis Management Extrathoracic Airway Disorders Croup (Laryngotracheitis and Spasmodic Croup) Clinical Findings History Differential Diagnosis Management Indications for Hospitalization Complications Acute Spasmodic Croup Epiglottitis Clinical Findings History Management Complications Prevention Intrathoracic Airway Disorders Bronchiolitis Clinical Findings History Differential Diagnosis Management Complications Prevention Foreign Body Aspiration Laryngeal Foreign Body Clinical Findings Tracheal Foreign Body Bronchial Foreign Body Clinical Findings Management Bronchitis Clinical Findings History Differential Diagnosis Management Complications Valley Fever (Coccidioidomycosis) Clinical Findings in Infants and Children History Differential Diagnosis Management Indications for Hospitalization Prevention Nonbacterial and Bacterial Pneumonia Clinical Findings in Infants and Young Children History Physical Examination Diagnostic Studies Differential Diagnosis Management Prognosis Complications Prevention Cystic Fibrosis Clinical Findings Diagnostic Studies Management Pectus Deformity Clinical Findings Management References Additional Resources 33 Gastrointestinal Disorders Anatomy and Physiology Pathophysiology Assessment History Physical Examination Common Diagnostic Studies Management Strategies Medications Probiotics and Prebiotics Nutrition and Activity Counseling and Education Upper Gastrointestinal Tract Disorders Dysphagia Clinical Findings History Differential Diagnosis Management Vomiting and Dehydration Dehydration Clinical Findings History Diagnostic Studies Differential Diagnosis Management Vomiting Dehydration Complications Patient and Family Education Cyclic Vomiting Syndrome Clinical Findings History Differential Diagnosis Management Well Phase: Prevention and Prophylaxis Referral Complications Patient and Family Education Abdominal Migraine Clinical Findings History Differential Diagnosis Management Prognosis Gastroesophageal Reflux Disease Clinical Findings History Differential Diagnosis Management Pharmacologic Lifestyle Surgical Complications Patient and Family Education Eosinophilic Esophagitis Clinical Findings History and Physical Examination Management Peptic Ulcer Disease Clinical Findings History Diagnostic Studies Laboratory Studies Studies to Detect Helicobacter Pylori Differential Diagnosis Management Complications Patient and Family Education Lower Gastrointestinal Tract Disorders Infantile Colic Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Foreign Body Ingestion Esophageal Foreign Bodies Abdominal Foreign Bodies Clinical Findings History, Physical Examination, and Laboratory Studies Imaging Studies Management Esophageal Foreign Bodies Complications Appendicitis Clinical Findings History Physical Examination Differential Diagnosis Management Complications Intussusception Clinical Findings History Differential Diagnosis Management Complications Childhood Functional Abdominal Pain and Functional Abdominal Pain Syndrome Clinical Findings History Physical Examination Differential Diagnosis Management Prognosis and Complications Irritable Bowel Syndrome Clinical Findings History Differential Diagnosis Management Malabsorption Syndromes: Celiac Disease, Lactose Intolerance, Cow’s-Milk Protein Intolerance or Allergy Clinical Findings General History for Malabsorption Syndromes Disease-Specific Physical Examination Diagnostic Studies Specific Tests for Celiac Disease Specific Tests for Lactose Intolerance Cow’s-Milk Protein Intolerance and Cow’s-Milk Allergy Differential Diagnosis Management Celiac Disease Complications and Prognosis Celiac Disease Polyps Clinical Findings History Management Complications Anal Fissure Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Inflammatory Bowel Disease Crohn Disease Clinical Findings History Differential Diagnosis Management Complications Prevention and Prognosis Ulcerative Colitis Clinical Findings History Physical Examination Differential Diagnosis Management Complications Prevention and Prognosis Failure to Thrive Clinical Findings and Risk Factors History Physical Examination Diagnostic Studies Differential Diagnosis Management Prognosis Lower Gastrointestinal Tract Infections and Infestations Acute Diarrhea Clinical Findings History Diagnostic Studies Differential Diagnosis Management Complications Prevention Chronic Diarrhea Clinical Findings History Diagnostic Studies Differential Diagnosis Management Complications Intestinal Parasites Clinical Findings, Management, and Differential Diagnosis Patient and Family Education Congenital Gastrointestinal Conditions References Additional Resources 34 Dental and Oral Disorders Standards and Guidelines for Dental Care in the United States Access to Dental Care in the United States Normal Growth and Development The Teeth Pattern of Tooth Eruption Teething Performing the Oral Examination Clinical Findings Oral Mucosa Saliva Teeth Aberrations in Primary Tooth Eruption and Gums Natal and Neonatal Teeth Delayed Tooth Eruption Preeruption Cysts Congenital Epulis Bohn Nodules Professional Dental Care Fear of the Dentist Choosing a Dentist The First Dental Visit Dental Health Education Preventive Intervention and Management Strategies Bacterial Diseases of the Mouth Tooth Decay (Cavities, Dental Caries, or Baby Bottle Tooth Decay) Clinical Findings Management and Prevention Strategies Active Decay Fluoride Varnish Fluoride in Water, Infant Formulas, and Fluoride Supplementation Toothpaste Topical Iodine Periodontal Diseases Gingivitis Aggressive Periodontitis Periodontitis as a Manifestation of Systemic Disease (Prepubertal Periodontitis) Necrotizing Periodontal Disease Pyogenic Granuloma Viral Diseases of the Mouth Herpes Stomatitis Idiopathic Oral Conditions Ankyloglossia (“Tongue-Tie”) Aphthous Ulcers Benign Migratory Glossitis Bruxism/Grinding Dental Erosion Diastema Gingival Hyperplasia Halitosis Malocclusion Mucocele Non-Nutritive Sucking Pericoronitis Associated with Partially Erupted Wisdom Teeth Ranula Temporomandibular Joint Disorder Clinical Findings and Differential Diagnosis Management Traumatic Injuries to Oral Structures Clinical Findings History Management and Complications Patient and Family Education Lifestyle Choices that Affect Dental Health Piercings and Intraoral Tattoos Smokeless Tobacco and Betel Nut Use Tooth Whitening (Bleaching) Dental Care of Children with Special Health Care Needs Management Strategies References Additional Resources Dental Health Information Fluoride Varnish Toothpaste and Toothbrushes Professsional References 35 Genitourinary Disorders Standards of Care Anatomy and Physiology Pathophysiology and Defense Mechanisms Assessment of the Genitourinary System History Physical Examination Diagnostic Studies Management Strategies Education and Counseling Medication, Diet, and Activity Referral Genitourinary Tract Disorders Urinary Tract Infection and Pyelonephritis Clinical Findings History Diagnostic Studies Differential Diagnosis Management Infants 2 to 24 Months Old Patient and Family Education, Prevention, and Prognosis Vesicoureteral Reflux Clinical Findings History Diagnostic Studies Management Patient and Family Education, Prevention, and Prognosis Hematuria Clinical Findings History Physical Examination Differential Diagnosis Management Patient and Family Education, Prevention, and Prognosis Proteinuria Clinical Findings History Differential Diagnosis Management Patient and Family Education, Prevention, and Prognosis Nephrotic Syndrome Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education, Prevention, and Prognosis Nephritis and Glomerulonephritis Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education, Prevention, and Prognosis Renal Tubular Acidosis Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education, Prevention, and Prognosis Nephrolithiasis and Urolithiasis Clinical Findings History Differential Diagnosis Management Patient and Family Education, Prevention, and Prognosis Wilms Tumor Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education, Prevention, and Prognosis Common Genitourinary Conditions in Males Hypospadias Clinical Findings History Management Complications Patient and Family Education, Prevention, and Prognosis Cryptorchidism (Undescended Testes) Clinical Findings History Diagnostic Studies Differential Diagnosis Management Complications Patient and Family Education, Prevention, and Prognosis Hydrocele Clinical Findings History Differential Diagnosis Management Patient and Family Education, Prevention, and Prognosis Spermatocele Clinical Findings Differential Diagnosis Management Patient and Family Education, Prevention, and Prognosis Varicocele Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education, Prevention, and Prognosis Inguinal Hernia Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education, Prevention, and Prognosis Testicular Masses Clinical Findings History Differential Diagnosis Management Patient and Family Education, Prevention, and Prognosis Phimosis and Paraphimosis Clinical Findings History Management Patient and Family Education, Prevention, and Prognosis Balanitis and Balanoposthitis Clinical Findings Management Patient and Family Education, Prevention, and Prognosis Scrotal Trauma Clinical Findings Differential Diagnosis Management Patient and Family Education, Prevention, and Prognosis Testicular Torsion Clinical Findings History Differential Diagnosis Management Patient and Family Education, Prevention, and Prognosis Torsion of the Appendix Testis Clinical Findings Differential Diagnosis Management Epididymitis Clinical Findings History Differential Diagnosis Management Patient and Family Education, Prevention, and Prognosis References Additional Resources 36 Gynecologic Disorders Standards of Care Anatomy and Physiology Puberty Menstrual Cycle The Follicular Phase Ovulation The Luteal Phase Luteal-Follicular Transition Pathophysiology and Defense Mechanisms of the Gynecologic System Assessment of the Gynecologic System: Health Supervision Visits for Female Adolescents History Physical Examination Prepubertal Child Adolescent Diagnostic Studies Cervical Cancer Screening Management Strategies Anticipatory Guidance, Counseling, and Education Adolescent Pregnancy Prevention Contraception Contraceptive Counseling and Education Initial Screening to Assess for Appropriate Contraception History Hormonal Methods of Contraception (Coitus-Independent Methods) Oral Contraceptive Pills Other Methods of Hormonal Contraception Barrier Methods of Contraception (Coitus-Dependent Methods) Condoms Diaphragm Female Condom Less Useful Contraceptive Methods for Adolescents Specific Gynecologic Conditions of Children Labial Adhesions Clinical Findings History Differential Diagnosis and Complications Management Patient and Family Education Vulvovaginitis Clinical Findings History Differential Diagnosis Management Prepubertal Nonspecific Etiology Bacterial Infection Complications Patient and Family Education, Prognosis, and Prevention Normal Gynecologic Variations Mittelschmerz Clinical Findings History and Physical Examination Differential Diagnosis Management Dysmenorrhea Clinical Findings History Differential Diagnosis Management Primary Dysmenorrhea Secondary Dysmenorrhea Patient and Family Education and Prevention Adolescent Pregnancy Clinical Findings History Differential Diagnosis Management and Education Complications Specific Gynecologic Problems of Adolescents Breast Concerns: Mastalgia, Cysts, and Fibrocystic Changes Clinical Findings History Physical Examination Differential Diagnosis Management Amenorrhea Clinical Findings History Diagnostic Studies Differential Diagnosis Management Abnormal Uterine Bleeding Clinical Findings History Physical Examination Differential Diagnosis Management Mild Abnormal Uterine Bleeding Severe Abnormal Uterine Bleeding Complications Patient and Family Education and Prognosis Endometriosis Clinical Findings History Differential Diagnosis Management Complications Prognosis and Prevention Vaginitis and Vaginal Discharge Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education, Prognosis, and Prevention Sexually Transmitted Infections Clinical Findings History Physical Examination Differential Diagnosis Management Complications Patient Education and Family Education Pelvic Inflammatory Disease Clinical Findings History Differential Diagnosis Management Complications Prevention References Additional Resources 37 Dermatologic Disorders Anatomy and Physiology Pathophysiology and Defense Mechanisms Special Dermatologic Considerations in Children with Dark Skin or from Diverse Cultural or Ethnic Groups Cutaneous Reaction Patterns Normal Variations and Common Problems Cultural or Ethnic Practices with Skin Sequelae Assessment of the Skin and Subcutaneous Tissue History Physical Examination Diagnostic Studies Management Strategies Hydration and Lubrication Bathing Environmental Considerations Skin Care Agents Soaps, Oils, and Colloids Wet Dressings Occlusive Dressings Other Considerations Sunscreens and Sunblocks Medications General Considerations Antibacterial Agents Antifungal Agents Antiviral Agents Antiacne Agents Anti-Inflammatory Agents Antipruritic Agents Topical Calcineurin Inhibitors Scabicides and Pediculicides Hair and Scalp Preparations Patient and Family Education Bacterial Infections of the Skin and Subcutaneous Tissue Impetigo Clinical Findings History Diagnostic Studies Differential Diagnosis Management Complications Patient and Family Education Cellulitis Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Folliculitis and Furuncle Clinical Findings History Physical Examination Differential Diagnosis Management Complications Patient and Family Education Fungal Infections of the Skin Candidiasis (Moniliasis) Clinical Findings History Diagnostic Studies Differential Diagnosis Management Complications Patient and Family Education Tinea Capitis Tinea Corporis Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Tinea Cruris Clinical Findings History Differential Diagnosis Management Tinea Pedis Clinical Findings History Differential Diagnosis Management Complications Tinea Versicolor Clinical Findings History Differential Diagnosis Management Patient and Family Education Viral Infections of the Skin Herpes Simplex Clinical Findings History Diagnostic Studies Differential Diagnosis Management Complications Patient and Family Education Herpes Zoster Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Molluscum Contagiosum Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Warts Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Infestations of the Skin Pediculosis Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Scabies Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Allergic and Inflammatory Reactions of the Skin Acne Vulgaris Clinical Findings History Differential Diagnosis Management Complications Atopic Dermatitis Contact Dermatitis Clinical Findings History Differential Diagnosis Management Diaper Dermatitis Clinical Findings History Physical Examination Differential Diagnosis Management Complications Seborrheic Dermatitis Clinical Findings History Differential Diagnosis Management Complications Drug Eruptions Clinical Findings History Physical Examination Diagnostic Studies Differential Diagnosis Management Complications Patient and Family Education Vascular Reactions of the Skin Urticaria and Angioedema Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Erythema Multiforme, Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Papulosquamous Eruptions of the Skin Pityriasis Rosea Clinical Findings History Diagnostic Studies Differential Diagnosis Management Patient and Family Education Psoriasis Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Lichen Striatus Clinical Findings History Differential Diagnosis Management Patient and Family Education Keratosis Pilaris Clinical Findings History Differential Diagnosis Management Patient and Family Education Congenital Lesions of the Skin Vascular and Pigmented Nevi Clinical Findings History Physical Examination Differential Diagnosis Management Complications Patient and Family Education Cutaneous Manifestations of Underlying Disease Acanthosis Nigricans Clinical Findings Differential Diagnosis Management Patient and Family Education Lentigines Other Common Dermatologic Issues in Pediatrics Vitiligo and Hypopigmentation Disorders Clinical Findings History Differential Diagnosis Management Complications Hair and Nail Disorders Tinea Capitis Clinical Findings History Diagnostic Studies Differential Diagnosis Management Complications Patient and Family Education Traumatic Alopecia Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Alopecia Areata Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education Onychomycosis Clinical Findings History Differential Diagnosis Management Patient and Family Education Paronychia Clinical Findings History Differential Diagnosis Management Body Art Tattoos and Body Piercing Clinical Findings History Differential Diagnosis Management Complications Patient and Family Education References Additional Resources 38 Musculoskeletal Disorders Anatomy and Physiology Pathophysiology and Defense Mechanisms Pathophysiology Systemic Problems Genetic Problems Intrauterine Compression Deformations Injuries Defense Mechanisms Fracture Healing Growth Plate Fractures Shaft Fractures Assessment of the Orthopedic System History Physical Examination Inspection and Palpation Range of Motion Examination Gait Examination Posture Special Examinations Hip Examinations Galeazzi Maneuver Barlow Maneuver Ortolani Maneuver Klisic Test Trendelenburg Sign Medial (Internal) and Lateral (External) Rotations Back Examination Adams Test or the Adams Forward Bend Test Diagnostic Studies Management Strategies Counseling Anticipatory Guidance: Musculoskeletal Development Shoes Care of Children in Casts and Splints Physical and Occupational Therapy Orthopedic Problems Specific to Children Arm Problems Annular Ligament Displacement Clinical Findings Complications Brachial Plexus Injuries Clinical Findings Shoulder Problems Clavicle Fracture Clinical Findings Rib Problems Costochondritis and Sternochondritis Clinical Findings Differential Diagnosis Back Problems Back Pain Clinical Findings Scoliosis Clinical Findings Differential Diagnosis Idiopathic Scoliosis Complications Kyphosis Management Lumbar Lordosis Management Hip Problems Developmental Dysplasia of the Hip Clinical Findings Complications Legg-Calvé-Perthes Disease Clinical Findings Differential Diagnosis Slipped Capital Femoral Epiphysis Clinical Findings Femoral Anteversion Clinical Findings Knee Problems Genu Varum Clinical Findings Genu Valgum Clinical Findings Differential Diagnosis Osgood-Schlatter Disease Clinical Findings Tibial Torsion Clinical Findings Complications Popliteal Cysts Clinical Findings Knee Injuries Foot Problems Pes Planus History Patient Education Metatarsus Adductus Clinical Findings Talipes Equinovarus Clinical Findings Overriding Toes In-Toeing and Out-Toeing Rotational Problems Clinical Findings Other Common Musculoskeletal System Findings Needing Attention Toe Walking Clinical Findings History Management Ganglions of the Hands Clinical Findings Management Leg Aches of Childhood Clinical Findings History Differential Diagnosis Management Limps Clinical Findings History Differential Diagnosis Management Overuse Syndromes of Childhood and Adolescence Clinical Findings History Differential Diagnosis Management Muscle Diseases Clinical Findings History Physical Examination Management References Additional Resources 39 Perinatal Disorders Standards of Care Anatomy and Physiology Pathophysiology High-Risk Pregnancy Acquired Health Problems Genetic Problems Perinatal Complications and Injuries Assessment of the Neonate History Physical Examination Immediately After Birth Apgar Score Lungs After Stabilization Diagnostic Studies Management Strategies Initial Care Establishing Feeding Anticipatory Guidance Before Discharge Physical Care Umbilical Cord Bathing, Oils, and Powders Early Discharge and Follow-up Premature Infants and Newborns with Special Needs Common Neonatal Conditions Skin Conditions Milia Sebaceous Hyperplasia Erythema Toxicum Transient Neonatal Pustular Melanosis Sucking Blisters Cutis Marmorata Harlequin Color Change Mongolian Spots, Café au Lait Spots, Salmon Patch (Nevus Simplex), and Port-Wine Stain (Nevus Flammeus, Port-Wine Nevus) Nevus Sebaceous Skin Dimpling Preauricular Sinus Tracts and Pits Amniotic Constriction Bands Supernumerary Nipples Branchial Cleft and Thyroglossal Cysts and Sinuses Head, Face, and Eye Conditions Caput Succedaneum Clinical Findings Cephalhematoma Clinical Findings Craniotabes Clinical Findings Cleft Lip and Palate Clinical Findings Congenital Cataracts, Glaucoma, and Retinopathy of Prematurity Cardiac Conditions Respiratory Conditions Respiratory Distress Syndrome Clinical Findings Management, Prognosis, and Prevention Transient Tachypnea of the Newborn Clinical Findings Meconium Aspiration Syndrome Clinical Findings Management, Prognosis, and Prevention Gastrointestinal and Abdominal Conditions Esophageal Atresia and Tracheoesophageal Fistula Clinical Findings Duodenal Atresia Clinical Findings Volvulus Clinical Findings Pyloric Stenosis Clinical Findings Hirschsprung Disease (Congenital Aganglionic Megacolon) Clinical Findings Differential Diagnosis Imperforate Anus Clinical Findings Omphalocele and Gastroschisis Clinical Findings Necrotizing Enterocolitis Clinical Findings Meconium Ileus Clinical Findings Diaphragmatic Hernia Clinical Findings Management and Prognosis Hydrocele and Inguinal Hernia Umbilical Hernia Clinical Findings Renal Conditions Acute Renal Failure Clinical Findings Management and Prognosis Hydronephrosis Clinical Findings Cystic Kidney Disease Clinical Findings Renal Artery or Vein Thrombosis Clinical Findings Neuroblastoma Clinical Findings Renal Agenesis Clinical Findings Endocrine Conditions Congenital Hypothyroidism and Congenital Adrenal Hyperplasia Metabolic Conditions Hypoglycemia Clinical Findings Infant of a Diabetic Mother Clinical Findings Orthopedic Conditions Fractured Clavicle and Brachial Palsy Polydactyly and Syndactyly Clinical Findings Central Nervous System Conditions Congenital Hydrocephalus Clinical Findings Intraventricular Hemorrhage Clinical Findings Hypoxic-Ischemic Insults Clinical Findings Myelomeningocele Clinical Findings Management, Prognosis, and Prevention Hematologic Conditions Polycythemia Clinical Findings Hemorrhagic Disease in the Newborn Clinical Findings Anemia Clinical Findings Blood in Vomitus or Stool Clinical Findings Jaundice Clinical Findings Management and Prevention Infections of the Newborn Toxoplasmosis Clinical Findings Congenital Rubella Clinical Findings Cytomegalovirus Clinical Findings Group B Streptococcus Clinical Findings Differential Diagnosis Listeriosis Clinical Findings Congenital Varicella Clinical Findings Sexually Transmitted Infections Gonorrhea Clinical Findings Chlamydia Clinical Findings Syphilis Clinical Findings Herpes Simplex Virus Clinical Findings Human Immunodeficiency Virus Neonatal Abstinence Syndrome Cocaine (Crack) Exposure Clinical Findings Heroin and Methadone Exposure Clinical Findings Fetal Alcohol Syndrome Sudden Infant Death Syndrome and Apparent Life-Threatening Events Clinical Findings History Physical Examination Differential Diagnosis Management and Prevention References Additional Resources 40 Common Injuries Principles of Injury Control Approach to Trauma Common Pediatric Injuries Trauma to the Skin and Soft Tissue Abrasions Description and Epidemiology Puncture Wounds Description and Epidemiology Differential Diagnosis Patient and Parent Education Ingrown Toenail and Nail Hematoma Description and Epidemiology Lacerations Description and Epidemiology Assessment Patient and Parent Education Burns Description and Epidemiology Assessment Differential Diagnosis Patient and Parent Education Contusions and Hematomas Description and Epidemiology Bites and Stings Animal and Child Bites Description and Epidemiology Complications Hymenoptera Description and Epidemiology Differential Diagnosis Mosquitoes, Fleas, and Chiggers (Red Bug or Harvest Mites) Description and Epidemiology Assessment Ticks Description and Epidemiology Assessment Spiders and Scorpions Description and Epidemiology Differential Diagnosis Snakebites Description and Epidemiology Management Heat and Cold Injuries Frostbite Description and Epidemiology Patient and Parent Education Hypothermia Description and Epidemiology Patient and Parent Education Hyperthermia: Common Heat-Related Illness Description and Epidemiology Differential Diagnosis Motor Vehicle Trauma Description and Epidemiology References Additional Resources 41 Genetics Disorders Basic Principles of Genetics Deoxyribonucleic Acid Chromosomes Genes Mutations Point Mutations Nucleotide Repeat Expansions Copy Number Variations Chromosome Mutations Genetic Disorders Monogenetic Disorders Chromosome Disorders Multifactorial Disorders Teratogens Mitochondrial Disorders Patterns of Inheritance Terminology Mendelian Inheritance Patterns Autosomal Dominant Autosomal Recessive X-Linked Inheritance X-Linked Dominant X-Linked Recessive Nontraditional Inheritance Patterns Mitochondrial Inheritance Codominant Inheritance Genomic Imprinting Uniparental Disomy Epigenetics Genetic Implications for Pediatric Primary Care Assessment Family Health History and Pedigree Three-Generation Pedigree Genetic Red Flags from the History Physical Findings Indicating Genetic Disorders Minor and Major Anomalies Diagnostic Studies Screening Newborn Screening Prenatal Screening Diagnostic Genetic Testing Carrier Testing Other Testing Primary Care Management of Children with Genetic Disorders Genetics Referral Primary Care for Children with Genetic Disorders Ethical Issues References Additional Resources Resources for Newborn Screening Resources to Hone Physical Assessment Skills 42 Environmental Health Issues Principles for Understanding Children’s Environmental Health Children’s Increased Risk for Environment-Related Illness The Dynamics of Environmental Health Hazards Epidemiologic Model: Assessment of Risk Toxicologic Principles Exposure Absorption Distribution Metabolism Tissue Sensitivity Toxic Effects Primary Care Approach to Children’s Environmental Health Clinical Findings History Physical Examination Diagnostic Studies Management of Environmental Conditions Common Environmental Agents and Adverse Effects General Pediatric Poisoning Clinical Findings History Differential Diagnosis Management Patient and Family Education Heavy Metals Lead Clinical Findings Patient and Family Education Mercury Clinical Findings Management Arsenic Clinical Findings Management Ambient Air Pollution: Indoor and Outdoor Environmental Tobacco Smoke Clinical Findings Carbon Monoxide Clinical Findings Radon Clinical Findings Management Particulate Matter Clinical Findings Ammonia Volatile Organic Compounds Molds Clinical Findings Asbestos Clinical Findings Hypochlorites, Pesticides, Endocrine Disruptors, and Noise Sodium and Calcium Hypochlorite: Laundry Detergent Pesticides Clinical Findings Endocrine Disruptors Polychlorinated Biphenyls Phthalates Noise Clinical Findings References Additional Resources 43 Complementary Health Therapies in Pediatric Primary Care Standards and Guidelines Complementary Therapies Used in Infants, Children, and Adolescents Why Parents Seek Complementary Therapies for Their Children Patient Disclosure about Use of Complementary and Alternative Medicine Moving toward an Integrated Health Care Model in Pediatrics Increasing Acceptance of Integrative Health Care Scientific Observation and Complementary Medicine Media Marketing of Complementary Medicine Integrating Complementary Medicine into a Primary Care Practice Common Principles of Integrative Care Talking with Patients about the Use of Complementary and Alternative Medicine Role of Diet in a Complementary Practitioner’s Approach Safety and Regulatory Issues Safety and Efficacy of Dietary Supplements Professional Oversight Continuing Education Opportunities Specific Complementary Therapies for Children and Adolescents References Additional Resources Index A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Inside Back Cover