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Integration of Genetics Into Pediatric Practice

Genetic testing involves analyzing genetic material to obtain information related to a person's health status using chromosomal (cytogenetic) analysis (see Chapter 98 ) or DNA-based testing. Diagnostic Testing Diagnostic genetic testing helps explain a set of signs and symptoms of a disease. The list of disorders for which specific genetic tests are available is extensive. The website provides a database of available tests that is…

Cold Injuries

The involvement of children and youth in snowmobiling, mountain climbing, winter hiking, and skiing places them at risk for cold injury. Cold injury may produce either local tissue damage, with the injury pattern depending on exposure to damp cold (frostnip, immersion foot, or trench foot), dry cold (which leads to local frostbite), or generalized systemic effects (hypothermia). Pathophysiology Ice crystals may form between or within cells,…

Burn Injuries

Burns are a leading cause of unintentional injury in children, second only to motor vehicle crashes. There has been a decline in the incidence of burn injury requiring medical care that has coincided with a stronger focus on burn treatment and prevention, increased fire and burn prevention education, greater availability of regional treatment centers, widespread use of smoke detectors, greater regulation of consumer products and occupational…

Drowning and Submersion Injury

Drowning is one of the leading causes of childhood morbidity and mortality in the world. Prevention is the most important step to reducing the impact of drowning injury, followed by early initiation of cardiopulmonary resuscitation (CPR) at the scene. Etiology Children are at risk of drowning when they are exposed to a water hazard in their environment. The World Congress of Drowning definition of drowning is…

Altitude-Associated Illness in Children (Acute Mountain Sickness)

High-altitude illness represents a spectrum of clinical entities with neurologic and pulmonary manifestations that overlap in their presentations and share common elements of pathophysiology. Acute mountain sickness (AMS) is the relatively benign and self-limited presentation, whereas high-altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE) have potentially life-threatening manifestations. Often overlooked by travelers as high-altitude destinations are cities such as La Paz, Bolivia (3,700 meters, approximately…

Respiratory Distress and Failure

The term respiratory distress is used to indicate signs and symptoms of abnormal respiratory pattern. A child with nasal flaring, tachypnea, chest wall retractions, stridor, grunting, dyspnea, and wheezing has respiratory distress. Taken together, the magnitude of these findings is used to judge clinical severity. Nasal flaring is nonspecific, but the other signs are useful in localizing the site of pathology (see Chapter 400 ). Respiratory…

Shock

Shock is an acute process characterized by the body's inability to deliver adequate oxygen to meet the metabolic demands of vital organs and tissues. Insufficient oxygen at the tissue level is unable to support normal aerobic cellular metabolism, resulting in a shift to less efficient anaerobic metabolism. As shock progresses, increases in tissue oxygen extraction are unable to compensate for this deficiency in oxygen delivery, leading…

Syncope

Syncope is defined as a sudden transient loss of consciousness with inability to maintain postural tone. The most common cause of syncope in the normal pediatric population is neurocardiogenic syncope (vasovagal syncope, fainting). Vasovagal syncope is classically associated with a prodrome that includes diaphoresis, warmth, pallor, or feeling lightheaded and is often triggered by a specific event or situation such as pain, medical procedures, or emotional…

Brain Death

Brain death is the irreversible cessation of all functions of the entire brain, including the brainstem. It is also known as death by neurologic criteria and is legally accepted as death in the United States. Epidemiology In children, brain death usually develops after traumatic brain injury (TBI, including brain injury from nonaccidental trauma) or asphyxial injury. Pathogenesis is multifactorial, with the end result being irreversible loss…

Neurologic Emergencies and Stabilization

Neurocritical Care Principles The brain has high metabolic demands, which are further increased during growth and development. Preservation of nutrient supply to the brain is the mainstay of care for children with evolving brain injuries. Intracranial dynamics describes the physics of the interactions of the contents—brain parenchyma, blood (arterial, venous, capillary), and cerebrospinal fluid (CSF)—within the cranium. Normally, brain parenchyma accounts for up to 85% of…

Care of Abrasions and Minor Lacerations

Lacerations and Cuts Lacerations are tears of the skin caused by blunt or shearing forces. A cut (or a stab ), in contrast, is an injury inflicted by a sharp object. Although distinguishing between the two can be important for forensic purposes, their evaluation and management are similar. In this chapter, lacerations include cuts and stabs. Epidemiology More than half of the 12 million wounds treated…

Spinal Cord Injuries in Children

See also Chapter 729 . Compared with adults, spine and spinal cord injuries are rare in children, particularly young children, because of both anatomic differences and etiologies of injury. The main mechanisms of injury to the spine are motor vehicle crashes, falls, sports, and violence, which affect young children less often (see Chapter 82 ). Several anatomic differences affect the pediatric spine. The head of a…

Acute Care of Multiple Trauma

Epidemiology Injury is a leading cause of death and disability in children throughout the world (see Chapter 13 ). Deaths represent only a small fraction of the total trauma burden. Approximately 140,000 children were treated in U.S. trauma centers in 2016 for serious injury. Many survivors of trauma have permanent or temporary functional limitations. Motor vehicle–related injuries and falls rank among the top 15 causes of…

Pediatric Emergencies and Resuscitation

Injuries are the leading cause of death in American children and young adults and account for more childhood deaths than all other causes combined (see Chapter 13 ). Rapid, effective bystander cardiopulmonary resuscitation (CPR) for children is associated with survival rates as high as 70%, with good neurologic outcome. However, bystander CPR is still provided for <50% of children who experience cardiac arrest outside medical settings.…

Triage of the Acutely Ill Child

Identifying the acutely ill child in the ambulatory setting is a challenge. Children presenting to pediatricians’ offices, urgent care practices, and emergency departments (EDs) may have a range of illnesses from simple viral infections to life-threatening emergencies. Although most children in this setting will have a benign course of illness, it is incumbent on the pediatric practitioner to quickly and accurately discern which children are likely…

Emergency Medical Services for Children

The overwhelming majority of the 27 million children who present annually for emergency care in the United States are seen at community hospital emergency departments (EDs). Visits to children's hospital EDs account for just 10% of initial emergency care encounters. This distribution suggests that the greatest opportunity to optimize care for acutely ill or injured pediatric patients, on a population basis, occurs broadly as part of…

Complementary Therapies and Integrative Medicine

Integrative medicine focuses on promoting physical, mental, emotional, spiritual, social, and educational well-being in the context of a medical home in a healthy family and community. The foundations of integrative medicine are health-promoting practices such as optimal nutrition and dietary supplements to prevent deficiencies, avoidance of addictive substances (e.g., nicotine, illicit drugs), physical activity, adequate sleep, a healthy environment, and supportive social relationships. Evidence-based complementary therapies…

Poisoning

Poisoning is the leading cause of injury-related death in the United States, surpassing that from motor vehicle crashes. Most these deaths are unintentional (i.e., not suicide). In adolescents, poisoning is the 3rd leading cause of injury-related death. Of the >2 million human poisoning exposures reported annually to the National Poison Data Systems (NPDS) of the American Association of Poison Control Centers (AAPCC), approximately 50% occur in…

Pediatric Pain Management

Pain is both a sensory and an emotional experience. When unrecognized and undertreated, pain extracts a significant physiologic, biochemical, and psychological toll on both the child and the family. Many disease processes and most interventional diagnostic or treatment procedures in pediatrics are associated with pain. Similarly, traumatic, developmental, cognitive, psychological, and social experiences can also trigger and maintain chronic pain. Definition and Categories of Pain The…