Diarrhea is the passage of unusually loose or watery stools, typically at least three times in a 24-hour period, and should be considered in a child who is passing stools more frequently than usual with a consistency looser than what is considered normal for that individual. Diarrhea is classified broadly by the duration of symptoms. Acute diarrhea is usually a self-limited illness that lasts for 2…
Acute abdominal pain is usually a self-limiting, benign condition that is commonly caused by gastroenteritis, constipation, or a viral illness. The challenge is to identify children who require immediate evaluation for potentially life-threatening conditions. Chronic abdominal pain is also a common complaint in pediatric practices, as it makes up 2–4% of pediatric visits. At least 20% of children seek attention for chronic abdominal pain by the…
Calories from food provide energy for the body’s maintenance functions of repair, regulation, metabolism, replacement of losses, and daily activity. Children have additional caloric requirements because they are growing. Children under the age of 3 years whose caloric needs are not met do not grow according to published norms and are said to have failure to thrive (FTT) or growth faltering. FTT raises serious concerns. It…
The first step in the evaluation of a child for hypertension is to define whether the child is in fact hypertensive. For children under 13 years of age, the normative data for blood pressure are interpreted based on gender, age, and height because all these are variables that influence blood pressure norms. The current hypertension definition and staging lead to seamless interfacing with the 2017 American…
What Is Shock: Pathophysiology Shock is a condition in which inadequate tissue perfusion results in an insufficient delivery of oxygen to meet the body’s metabolic needs. Tissue perfusion is dependent on cardiac output. Cardiac output (CO) is determined by the heart rate (HR) and the stroke volume (SV): CO = HR × SV. If either the heart rate or the stroke volume does not allow for…
A heart murmur is a sign, the audible turbulence of blood flow through the heart or the major vessels; symptoms associated with heart murmurs vary by the underlying cause, as well as the nature and severity of any cardiac lesion producing the murmur. While the majority of heart murmurs are normal or innocent, they must be distinguished from the pathologic murmurs of congenital or acquired cardiac…
Chest pain in children is a common complaint; however, it is rarely due to underlying cardiac illness. This underscores the importance of avoiding a false sense of safety in low-risk causes and maintaining vigilance for potential life-threatening etiologies. Chest pain can be the presenting complaint for a child describing chest tightness, burning, pressure, stabbing sensations, palpitations, and/or heartburn. It can be encountered in outpatient, emergency, and…
Dizziness is a common but very nonspecific chief complaint about which some elaboration by the patient is generally required for the physician to understand exactly what the patient is experiencing. The description of the sensation is critical in distinguishing whether it is caused by vertigo, disequilibrium, lightheadedness, presyncope, or ataxia ( Table 7.1 ). Although the differential diagnoses of these entities may overlap, there are conditions…
A brief resolved unexplained event (BRUE) is a term used to describe events occurring in infants younger than 1 year of age that are characterized by the observer as “brief” (lasting <1 minute but typically <20–30 seconds) and “resolved” (meaning the patient returned to baseline state of health after the event) and with a reassuring history, physical examination, and vital signs at the time of clinical…
Earache (otalgia) is pain that arises from a pathologic process in the external, middle, or inner ear or that is referred to the ear from another structure. Acute otitis media (AOM) is the most common cause of otalgia in children ( Table 5.1 ). At least 80% of children will experience one or more episodes of AOM in the first 3 years of life. The second…
The main function of the respiratory system is to supply oxygen to meet the body’s demands and remove excess carbon dioxide. Many processes are involved in ensuring that this occurs, including ventilation (gas delivery to and from the lungs), perfusion (blood supply to the lungs), and diffusion (the exchange of gases along the alveoli). Respiratory distress arises when there is impaired air exchange that leads to…
Introduction Cough is an important defense mechanism of the lungs and is a common symptom, particularly during winter months. In most patients, it is self-limited. However, cough can be ominous, indicating serious underlying disease, because of accompanying problems (hemoptysis) or because of serious consequences of the cough itself (e.g., syncope and hemorrhage), or cough may present as an uncommon disorder that mimics a common disease. Pathophysiology…
Most causes of sore throat are nonbacterial and neither require nor are alleviated by antibacterial therapy ( Tables 2.1, 2.2, and 2.3 ). Accurate diagnosis is essential. Acute streptococcal pharyngitis warrants proper diagnosis and prompt therapy to prevent serious suppurative and nonsuppurative sequelae. Life-threatening complications of oropharyngeal infections, whether caused by streptococci or other pathogens, may manifest initially with poorly differentiated symptoms of mouth pain and…
Chapter 197 Orthopedics Assessment Orthopedic rough guide to developmental milestones Sit independently at 6 months Pull to stand at 10 months Cruising at 12 months Walk at 18 months Lower extremity angular profile Genu varum (bowlegs) at birth and begin to straighten out by 18 months Genu valgum (knock knees)—maximum at 4 years old and resolves by 5–8 years of age Pathologic genu verum: Blount disease…
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Shoulder The shoulder actually comprises four joints: Glenohumeral joint (commonly referred to as the shoulder joint) Acromioclavicular joint Sternoclavicular joint Scapulothoracic joint The glenohumeral joint has minimal geometric stability because the relatively small glenoid fossa articulates with the proportionately larger head of the humerus. The low level of intrinsic stability allows for a large range of motion. The rotator cuff muscles help give the glenohumeral joint…
Spinal Deformities A simplified classification of the common spinal abnormalities, scoliosis and kyphosis, is presented in Table 202.1 . TABLE 202.1 Classification of Spinal Deformities Modified from the Terminology Committee of the Scoliosis Research Society, 1975. SCOLIOSIS Idiopathic Infantile Juvenile Adolescent Congenital Failure of formation Wedge vertebrae Hemivertebrae Failure of segmentation Unilateral bar Bilateral bar Mixed Neuromuscular Neuropathic diseases Upper motor neuron disease Cerebral palsy Spinocerebellar…
In newborns and non–weight-bearing infants, the difference between posturing and deformity is important. Posturing is the habitual position in which the infant holds the foot; passive range of motion is normal. Deformity produces an appearance similar to posturing, but passive motion is restricted. Most pediatric foot disorders are painless. Foot pain is more common in older children ( Table 201.1 ). Table 201.1 Differential Diagnosis of…
Torsional (in-toeing and out-toeing) and angular (physiologic bowlegs and knock knees) variations in the legs are common reasons that parents seek medical attention for their child. Most of these concerns are physiologic and resolve with normal growth. Understanding the natural history allows physicians to reassure the family and to identify non-physiologic disorders that necessitate further intervention. Physiologic disturbances are referred to as variations; pathologic disturbances are…
The hip is a ball (femoral head) and socket (acetabulum) joint that is important for skeletal stability. The femoral head and acetabulum are interdependent for normal growth and development. The femoral neck and head, which contain the capital femoral epiphysis, are intraarticular. The blood supply to this region is unique because the blood vessels are extraosseous and lie on the surface of the femoral neck, entering…