HUTCHISON'S PAEDIATRICS
Edited by Krishna M Goel MD, DCH, FRCP (Lond, Edin and Glas), Hon FRCPCH
Formerly Honorary Senior Lecturer of Child Health University of Glasgow and Consultant Paediatrician at the Royal Hospital for Sick Children
Yorkhill, Glasgow, Scotland, UK
Devendra K Gupta MS, MCh, FAMS, FRCS (Hon), DSc (Honoris Causa)
Professor and Head Department of Paediatric Surgery All India Institute of Medical Sciences Ansari Nagar
New Delhi, India
Foreword Meharban Singh
Jitendar P Vij
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Hutchison's Paediatrics
© 2009, Krishna M Goel, Devendra K Gupta
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2009
9788184485868
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset & Packagings Ltd., New Delhi
4Contributors
- Alison M Cairns
- msc, bds, mfds, frcs (edin), m paed dent (rcpsg)
- Clinical Lecturer in Paediatric Dentistry
- University of Glasgow, Dental Hospital and School
- Glasgow, Scotland, UK
- Anne Devenny
- mbchb, mrcp (uk), frcpch
- Paediatric Respiratory Consultant
- Royal Hospital for Sick Children
- Glasgow, Scotland, UK
- Benjamin Joseph
- mbbs, ms orth, mch orth
- Professor of Orthopaedics and Head of Paediatric Orthopaedic Service
- Kasturba Medical College, Manipal
- Karnataka, India
- Christina Halsey
- bm, bch, ba (hons), mrcp, mrcpath
- Leukaemia Research Fund Clinical Research Fellow
- Royal Hospital for Sick Children
- Glasgow, Scotland, UK
- Craig McWilliam
- md, frcp, frcpath
- Consultant Microbiologist
- Royal Hospital for Sick Children
- Glasgow, Scotland, UK
- David James
- mbchb, dip ed, dch, dpm, frcpsych, frcp (glas)
- Retired Child Psychiatrist
- Formerly at Department of Child and Family Psychiatry
- Royal Hospital for Sick Children
- Glasgow, Scotland, UK
- Devendra K Gupta
- ms, mch, fams, fams (hon), frcs (hon), dsc (honoris causa)
- Professor and Head, Department of Pediatric Surgery
- All India Institute of Medical Sciences
- Ansari Nagar, New Delhi, India
- Elizabeth A Chalmers
- mbchb, md, mrcp, frcpath
- Consultant Paediatric Haematologist
- Royal Hospital for Sick Children
- Glasgow, Scotland, UK
- James Wallace
- bsc, mr pharma, frcpch (hon)
- Chief Pharmacist
- Yorkhill Hospitals, Glasgow
- Scotland, UK
- Jugesh Chhatwal
- md, dch
- Professor and Head of Paediatrics
- Christian Medical College, Ludhiana
- Punjab, India
- Kirsteen J Thompson
- frcs (edin), ophthalmologist
- 45, Station Road, Milngavie, Scotland, UK
- Krishna M Goel
- md, dch, frcp (lond, edin and glas), hon frcpch
- Formerly Honorary Senior Lecturer of Child Health
- University of Glasgow and Consultant Paediatrician
- Royal Hospital for Sick Children
- Glasgow, Scotland, UK
- Louis Low
- mbchb, mrcp (uk), frcp (lond, edin and glas), frcpch
- Professor of Paediatrics
- The University of Hong Kong
- Queen Mary Hospital, Pokfulam
- Hong Kong
- Margo Whiteford
- bsc, frcp
- Consultant Clinical Geneticist
- Ferguson-Smith Centre for Clinical Genetics
- Yorkhill Hospital, Glasgow
- Scotland, UK
- Mary Mealyea
- mbchb, diploma in dermatology
- Associate Specialist in Paediatric Dermatology
- Royal Hospital for Sick Children
- Glasgow, Scotland, UK
- Michael Morton
- mphil, ma, mbchb, frcpsych, frcpch
- Consultant Child and Adolescent Psychiatrist
- Department of Child and Family Psychiatry
- Royal Hospital for Sick Children
- N Doraiswamy
- ms, frcs (edin and glas), fics, fiss, ffaem, frcpch
- Consultant Surgeon (Retired)
- Royal Hospital for Sick Children
- Glasgow, Scotland, UK
- Paul Galea
- md, dch, frcp (glas), frcpch
- Consultant Paediatrician
- Royal Hospital for Sick Children, Glasgow, Scotland, UK
- Peter Galloway
- bsc, dch, frcp (edin and glas), frcpath
- Consultant Clinical Biochemist
- Royal Hospital for Sick Children
- Glasgow, Scotland, UK
- Phyllis Kilbourn
- International Director, Crisis Care Training International
- International Office, PO Box 517
- Fort Mill, South Carolina, USA
- Prabhakar D Moses
- mbbs, md (paed), mrcp (uk), frcp (edin), fcams
- Professor and Head of Child Health Unit 111
- Christian Medical College
- Vellore, Tamil Nadu, India
- Richard Welbury
- bds (hons), mbbs, phd, fdsrcs, fdsrcps, frcpch
- Professor of Paediatric Dentistry
- University of Glasgow Dental Hospital and School
- Glasgow, Scotland, UK
- Robert Carachi
- md, phd, frcs (glas, eng), febps
- Professor of Surgical Paediatrics
- University of Glasgow
- Royal Hospital for Sick Children
- Glasgow, Scotland, UK
- Rosie Hague
- md, mrcp (uk), frcpch
- Consultant Paediatric Id/Immunology
- Yorkhill NHS Trust
- Royal Hospital for Sick Children, Glasgow, Scotland, UK
- Rosemary Sabatino
- Trainer and Educator
- Crisis Care Training International
- International Office
- PO Box 517, Fort Mill, South Carolina, USA
- Sandra J Butler
- bsc (hons), mbchb, mrcpch, frcr
- Consultant Paediatric Radiologist
- Royal Hospital for Sick Children
- Glasgow, Scotland, UK
- Sanjay V Maroo
- mbchb, m-med, frcr
- Consultant Paediatric Radiologist
- Royal Hospital for Sick Children
- Glasgow, Scotland, UK
- Sarada David
- ms do
- Professor and Head
- Department of Ophthalmology
- Christian Medical College
- Vellore, Tamil Nadu, India
- Shilpa Sharma
- mbbs, ms, mch, dnb
- Senior Research Associate
- Department of Paediatric Surgery
- All India Institute of Medical Sciences
- Ansari Nagar, New Delhi, India
- Syed Rehan Ali
- mb, dch, mrcpi
- Consultant and Senior Instructor in Neonatal Medicine
- Department of Paediatrics and Child Health
- Aga Khan University Hospital
- Karachi, Pakistan
- Tahmeed Ahmed
- mbbs, phd
- Head, Nutrition Programme Scientist, Clinical Sciences Division
- International Centre for Diarrhoeal Diseases Research, B
- Dhaka, Bangladesh
- Trevor Richens
- mbbs, bsc (hons), mrcp (lond)
- Consultant Paediatric Cardiologist
- Royal Hospital for Sick Children, Glasgow
- Scotland, UK
- Zulfiqar Ahmed Bhutta
- mbbs, frcp, frcpch, fcps, phd
- The Husein Lalji Dewraj Professor and Chairman
- Department of Pediatrics and Child Health
- The Aga Khan University and Medical Center
- Karachi, Pakistan
Children constitute the foundation of the human race and the basic aim of paediatrics is to ensure that every child is assisted to achieve his/her optimal genetic potential for physical growth and mental development. There is increasing evidence that seeds of most adult diseases are sown in childhood, and effective health care of children is, therefore, crucial to ensure that every child is assisted to become a strong, healthy and productive adult. The art and understanding of health problems of children have undergone rapid advances with a dual challenge of delivery of primary or essential health care at their doorsteps, to the most intensive care in a tertiary care setting with various grades of care in-between.
The scope of paediatrics has now become broader, encompassing the vital period of adolescence. Above all, paediatrics is now being recognized as a separate independent discipline in undergraduate medical curriculum in most countries.
Hutchison's Paediatrics has been created by taking excerpts as rennet from “Children's Medicine and Surgery” edited by Cockburn, Carachi, Goel and Young, which have been amplified with outstanding contributions of core contents by eminent international paediatric experts under the authoritative patronage of legendary Hutchison.
Editors Krishna M Goel and Devendra K Gupta deserve our accolades for creating a comprehensive Textbook of Paediatrics covering practically all the medical and surgical conditions of children from birth through adolescence. The contributors have provided state-of-the-art information and their own personal experiences pertaining to the fields of their expertise. Each chapter has laid emphasis on anatomical and physiological background, etiopathogenesis, clinical spectrum, diagnosis and management in a lucid manner. The text is amply supported by illustrations, line diagrams, charts, tables and photographs. The format, composing and quality of production are commendable.
I have no doubt that Hutchison's Paediatrics would fulfill the felt needs of graduate and postgraduate students in paediatrics and paediatric surgery as well as paediatricians and family physicians because of cultural, ethnic, social, economic and ecological similarities.
Meharban Singh
md, fams, fiap, fimsa, faap
Ex-President
National Neonatology Forum of India and Indian Academy of Paediatrics
Former Professor and Head
Department of Paediatrics
All India Institute of Medical Sciences
New Delhi, India
7Preface
The patterns of childhood disease throughout the world are changing with advancing knowledge, altering standards of living, life style and rising levels of medical care. The origins of physical and mental health and disease lie predominantly in the early development of the child. Most of the abnormalities affecting the health and behaviour of children are determined prenatally or in the first few years of life by genetic and environmental factors. The range of contributors indicates that they are all experts in their particular fields. The authors have summarised the current knowledge of causation and have indicated where health education and prevention might reduce the burden of childhood ill health. We seek in this book to provide practical advice about the diagnosis, investigation and management of the full spectrum of childhood disorders, both medical and surgical. We have tried to indicate and where appropriate to describe, techniques and laboratory investigations which are necessary for advanced diagnosis and up-to-date therapy. Attention is directed to the special problems which arise in the developing countries.
It is intended in a true apprenticeship fashion of pedagogy to provide a manageable, readable and practical account of clinical paediatrics for medical undergraduates, for postgraduates specialising in paediatrics and for general practitioners whose daily work is concerned with care of children in health and sickness. The authors had to be selective in deciding what to exclude in order to keep the book manageable and practical.
We would like to express our immense gratitude to our colleagues who have provided us with help and advice in writing this book. The willingness with which they gave us their time in spite of many other commitments leaves us permanently in their debt.
We are especially grateful to the parents and to the many children and their families who contributed to our knowledge and understanding of paediatrics and willingly gave permission to reproduce photographs of their children. Also a book such as this cannot be written without reproducing material reported in the medical literature. We acknowledge here with gratitude the permission granted free of charge by individual publishers to reproduce material for which they hold the copyright.
Our deepest thanks go to Professor Forrester Cockburn, Professor Dan Young and Professor Robert Carachi, who most kindly passed on to us their rights of the book entitled ‘Children's Medicine and Surgery’ from which some material has been used.
We particularly wish to thank the Hutchison family for allowing us to use the name of the late Professor James Holmes Hutchison, the author of ‘Practical Paediatric Problems’ to enable us to title this book Hutchison's Paediatrics. Even today Hutchison's name is highly respected in the paediatric world.
Finally, we would like to express our thanks to Jean Hyslop, Medical Artist, who created the line drawings and art work and helped to integrate the text with the illustrations.
Krishna M Goel
Devendra K Gupta