In all high-income countries of the world, and increasingly in many low- and middle-income countries, injuries are the most common cause of death during childhood and adolescence beyond the 1st few mo of life ( Table 13.1 and Fig. 13.1 ). Injuries represent one of the most important causes of preventable pediatric morbidity and mortality in the United States. Identification of risk factors for injuries has…
Routine, scheduled care of well infants, children, and adolescents is an essential prevention effort for children and youth worldwide. Children's constantly changing development lends added value to regular and periodic encounters between children and their families and practitioners of pediatric healthcare. Health supervision visits from birth to age 21 yr are the platform for a young person's healthcare. The provision of well care in the medical home…
Pediatricians live and work in a multicultural world. Among the world's 7 billion people residing in over 200 countries, more than 6,000 languages are spoken. As the global population becomes more mobile, population diversity increases in all countries. In the United States, sources of ethnic and cultural diversity come from indigenous cultural groups such as Native Americans and Alaskan and Hawaiian natives, groups from U.S. territories…
More than 210,000 foreign-born children (≤16 yr old) enter the United States each year as asylees (asylum seekers), refugees, and immigrants, including international adoptees (see Chapter 8 ). This number does not include undocumented children living and working in the United States, the U.S.-born children of foreign-born parents, or the approximately 2.7 million nonimmigrant visitors ≤16 yr old who legally enter the United States annually with temporary visas.…
The placement of children in out-of-home care has served the needs of children in many societies worldwide throughout history. The institution of foster care was developed in the United States as a temporary resource for children during times of family crisis and is rooted in the principle that children fare best when raised in family settings. The mission of foster care is to provide for the…
Adoption is a social, emotional, and legal process that provides a new family for a child when the birth family is unable or unwilling to parent. In the United States, about 1 million children <18 yr of age are adopted; 2–4% of all American families have adopted. Annually across the globe, approximately 250,000 children are adopted, with 30,000 of these between nations. In the United States, approximately…
According to the World Health Organization (WHO), “Palliative care for children is the active total care of the child's body, mind and spirit and also involves giving support to the family. Optimally, this care begins when a life-threatening illness or condition is diagnosed and continues regardless of whether or not a child receives treatment directed at the underlying illness.” Provision of palliative care applies to children…
Pediatric ethics is the branch of bioethics that analyzes moral aspects of decisions made relating to the healthcare of children. In general terms, the autonomy -driven framework of adult medical ethics is replaced by a beneficent paternalism (or parentalism) in pediatrics. Pediatric ethics is distinctive because the pediatric clinician has an independent fiduciary obligation to act in a younger child's best interest that takes moral precedence…
Children may be harmed by the healthcare that aims to make them better. Such harms include central line–associated bloodstream infections (CLA-BSIs) and medication overdoses. In 1991 the Harvard Medical Practice Study reviewed a large sample of adult medical records from New York State and found that adverse events occurred in an estimated 3.7% of hospitalizations. Most events gave rise to serious disability, and 13.6% led to…
The Need for Improvement in Quality and Value Adults and children only receive recommended evidence-based care about half the time. The gap between knowledge and practice widens to a chasm in part because of variations in practice and disparities in care from doctor to doctor, institution to institution, geographic region to geographic region, and socioeconomic group to socioeconomic group. Furthermore, it is estimated that it takes…
Global Burden and Trends in Child Health The under-five mortality rate (U5MR) , also known as the child mortality rate , serves as a reliable gauge of child well-being. It measures the outcome of a country's health system and reflects a nation's social and economic development. The global U5MR fell by 53% between 1990 and 2015. Despite these gains, in 2016 an estimated 5.6 million children…
Health and illness are not distributed equally among all members in most societies. Differences exist in risk factors, prevalence and incidence, manifestations, severity, and outcome of health conditions, as well as in the availability and quality of healthcare. When these differences are modifiable and avoidable, they are referred to as disparities or inequities . The U.S. Department of Health and Human Services (DHHS) Healthy People 2020…
Pediatrics is the only discipline dedicated to all aspects of the care and well-being of infants, children, and adolescents, including their health—their physical, mental, social, and psychological growth and development—and their ability to achieve full potential as adults. Pediatricians must be concerned not only with specific organ systems, genetics, and biologic processes, but also with environmental, psychosocial, cultural, and political influences, all of which may have…
Many skin findings in childhood are benign and self-limited conditions. Other dermatologic complaints may be the first manifestation of a systemic disease or associated condition, recognition of which facilitates appropriate evaluation and treatment. History, Physical Examination, and Diagnostic Procedures History A careful and focused history is necessary to diagnose pediatric skin disorders. It may be helpful to examine the patient first and then proceed with a…
Rashes ( Table 60.1 ) Papules and Pustules—Diffuse or Scattered Erythema toxicum is a benign condition that occurs in 30–70% of White full-term infants. Erythema toxicum occurs less frequently in premature infants. The eruption is characterized by blotchy, erythematous macules or patches with central papules, pustules, or vesicles that give the infant a “flea-bitten” appearance ( Fig. 60.1 ). The lesions develop most commonly between the…
The presence of an acid–base or an electrolyte disorder may explain a patient’s symptoms or may lead to a specific diagnosis. Acid–Base Balance Normal acid–base balance is maintained by the lungs and kidneys. Carbon dioxide, a by-product of normal metabolism, is a weak acid. The lungs are able to prevent an increase in the partial pressure of carbon dioxide (P co 2 ) in the blood…
Polyuria and Urinary Incontinence Urinary incontinence is a normal developmental stage. When present beyond a certain age defined by parental and societal expectations, it can cause concern and anxiety in the patient and family. Urinary incontinence can also be a symptom of significant pathologic processes. The challenge to the clinician is identifying the child with an organic disorder among the many who are proceeding along a…
Hypoglycemia, although rare in children beyond the newborn period, is an acute, life-threatening medical emergency that may result in seizures, permanent brain injury, or even sudden death. Hypoglycemia may represent a serious underlying disorder due to hormonal deficiencies, metabolic defects, genetic disorders, drugs, or toxins. Therefore, to evaluate hypoglycemia either in a child or newborn, a comprehensive strategy for diagnosis and treatment is crucial. Hypoglycemia occurs…
Short stature (usually defined as height >2 standard deviations [SD] below the mean for age) and growth failure (a subnormal height velocity that leads to decline in growth percentiles, usually height velocity >1.5 SD below the mean for age) are symptoms, not diseases . Of the two, short stature is more likely to be noticed, but growth failure is more likely to be pathologic . Short…
Puberty is defined by both biologic and social standards. Puberty is the time when there is an increase in sex steroid production, resulting in physical changes such as breast development in females and testicular enlargement in males, as well as maturation of processes required for future fertility. Puberty, also known as adolescence, is the time when children make the transition to adult patterns of behavior, which…