B E R K O W I T Z’S B e r k B E R K O W I T Z’S o w i t A PRIMARY CARE APPROACH, 5th Edition z ’ s Edited by Carol D. Berkowitz, MD, FAAP P Selected as a Doody’s Core Title! NEW in the 5th Edition! e “This is an excellent reference that should be on the bookshelf The completely updated Berkowitz’s Pediatrics features new and d of any medical student interested in pediatrics, pediatric expanded chapters on i a resident, or pediatrician. It provides basic information (cid:127) E-medicine t in a quick and easy to use format.” (cid:127) Autoimmune connective tissue diseases r (cid:127) Hospital medicine i —Doody’s Book Reviews™ (of 4th edition) c (cid:127) Surgical approach to acute abdominal pain s (cid:127) Simulation in pediatric health care (cid:127) What symptoms should you check for? : (cid:127) Palpitations A (cid:127) What diagnoses should you consider? (cid:127) What tests should you order? P (cid:127) What is your best management strategy? Consistent problem-solving format r Each clinical chapter walks you through Look here fi rst when you need on-target i (cid:127) Epidemiology (cid:127) Evaluation m answers fast! (cid:127) Clinical presentation (cid:127) Management a Berkowitz’s Pediatrics is custom-built for confi dent, effi cient primary (cid:127) Pathophysiology (cid:127) Prognosis r care problem-solving. Th e revised and expanded fi fth edition provides (cid:127) Diff erential diagnosis y clear, concise guidance on all the issues—clinical and psychosocial— you’re most likely to encounter. Th is new fi fth edition brings you state-of-the-art expertise and C Here is practical, hands-on help on everything from concerns like insight by Carol D. Berkowitz, MD, FAAP, past president of the a temper tantrums, thumb sucking, and tattoos to devastating condi- American Academy of Pediatrics. She is currently executive vice chair r A P R I M A R Y C A R E A P P R O A C H tions like HIV, childhood cancer, kidney disease, and diabetes. in the Department of Pediatrics at Harbor-UCLA Medical Center and e distinguished professor of clinical pediatrics at the David Geff en School Quick and easy access to state-of-the-art A of Medicine at UCLA. pediatric primary care… p 5th Edition For other pediatric resources, visit the American Academy of (cid:127) Outcome-centric focus— Chapters open with a case presentation p Pediatrics Bookstore at www.aap.org/bookstore. and list of focal questions and close with the case resolution. r (cid:127) Ready-reference organization—Disease/disorder signs and o symptoms are grouped by body system for fast lookup. a (cid:127) Superb color fi gures—Illustrated clinical presentations and treat- c Carol D. Berkowitz, MD, FAAP ment procedures. h (cid:127) Expert recommendations—Edited by a leading primary care authority, with contributions from top-tier practitioners. (cid:127) Valuable guidance on psychosocial issues — Behavioral concerns: sleep disturbances, colic, toilet training, crying, enuresis, discipline, self-esteem, and more — Health maintenance: health promotion, well-child care, illness and injury prevention, nutrition, newborn screening, develop- mental surveillance, and more — “People skills”: talking with parents, children, and adolescents; encouraging family and community participation; and more AAP B E r k o w i t z ’ s Pediatrics A P R I M A R Y C A R E A P P R O A C H 5th Edition Carol D. Berkowitz, MD, FAAP Distinguished Professor of Clinical Pediatrics David Geffen School of Medicine at University of California Los Angeles Executive Vice Chair Department of Pediatrics Harbor-UCLA Medical Center Torrance, CA American Academy of Pediatrics 141 Northwest Point Blvd Elk Grove Village, IL 60007-1019 Berkowitz_FM_i-xviii.indd 1 5/19/14 9:45 AM American Academy of Pediatrics Department of Marketing and Publications Staff Maureen DeRosa, MPA Director, Department of Marketing and Publications Mark Grimes Director, Division of Product Development Alain Park Senior Product Development Editor Carrie Peters Editorial Assistant Sandi King, MS Director, Division of Publishing and Production Services Theresa Wiener Manager, Publications Production and Manufacturing Jason Crase Manager, Editorial Services Houston Adams Digital Content and Production Specialist Julia Lee Director, Division of Marketing and Sales Linda Smessaert Brand Manager, Clinical and Professional Publications Library of Congress Control Number: 2013949728 ISBN: 978-1-58110-846-0 eISBN: 978-1-58110-851-4 MA0699 The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of care. Variations, taking into account individual circumstances, may be appropriate. Brand names are furnished for identification purposes only. No endorsement of the manufacturers or products mentioned is implied. Every effort has been made to ensure that the drug selection and dosages set forth in this text are in accordance with the current recommendations and practice at the time of publication. It is the responsibility of the health care professional to check the package insert of each drug for any change in indications and dosages and for added warnings and precautions. The publishers have made every effort to trace the copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. Berkowitz’s Pediatrics: A Primary Care Approach, 5th Edition Copyright © 2014 American Academy of Pediatrics. All Rights Reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information retrieval system, without written permission from the Publisher (e-mail permissions editor at [email protected]). Copyright © 2000, 1996 W.B. Saunders Company Printed in the United States of America. 9-347/0614 1 2 3 4 5 6 7 8 9 10 Berkowitz_FM_i-xviii.indd 2 5/19/14 9:45 AM Preface The expansion of immunizations has reduced or eliminated many of the infectious diseases that confronted the children and adolescents for whom pediatric clinicians cared. New and more challenging morbidities, including obesity, violence, and mental health concerns, confront pediatric patients, their families, and their health care professionals. This fifth edition of Berkowitz’s Pediatrics: A Primary Care Approach examines a series of emerging entities that pediatricians are expected to be knowledgeable about and able to address. The edition also updates information about the ever-changing health care scene. Because we interface with other disciplines and are increasingly working as members of health care teams, we must be equipped to understand the principles of their practices and communicate effectively with them. And lastly, our multicultural society includes children from all parts of the world and from all kinds of families, and we need to be prepared to address their needs. My thanks to all the contributors and to the staff of the American Academy of Pediatrics, especially Alain Park, Jason Crase, Carrie Peters, Linda Smessaert, and Theresa Wiener, and my assistant, Claudette Hoskins, for all their help. Carol D. Berkowitz Berkowitz_FM_i-xviii.indd 3 5/19/14 9:45 AM Berkowitz_FM_i-xviii.indd 4 5/19/14 9:45 AM Contributors Sudhir K. Anand, MD Carol D. Berkowitz, MD Emeritus Professor of Clinical Pediatrics Distinguished Professor of Clinical Pediatrics David Geffen School of Medicine at University of California Los Angeles David Geffen School of Medicine at University of California Los Angeles Chief, Division of Pediatric Nephrology Executive Vice Chair, Department of Pediatrics Harbor-UCLA Medical Center Harbor-UCLA Medical Center Torrance, CA Torrance, CA David Atkinson, MD Karen C. Bodnar, MD, IBCLC Associate Professor of Clinical Pediatrics Assistant Clinical Professor of Pediatrics David Geffen School of Medicine at University of California Los Angeles Harbor-UCLA Medical Center Division of Pediatric Cardiology Torrance, CA Harbor-UCLA Medical Center Emily Borman-Shoap, MD Torrance, CA Assistant Professor of Pediatrics Sarah J. Atunah-Jay, MD, MPH Pediatric Residency Program Director T32 Research Fellow, Division of Medicine University of Minnesota The Warren Alpert School of Medicine Minneapolis, MN Brown University Iris Wagman Borowsky, MD, PhD Providence, RI Associate Professor and Director Justine Bacchetta, MD, PhD Division of General Pediatrics and Adolescent Health Department of Pediatrics Department of Pediatrics David Geffen School of Medicine at University of California Los Angeles University of Minnesota Los Angeles, CA Minneapolis, MN Andrew J. Barnes, MD, MPH Calla R. Brown, MD Assistant Professor of Developmental-Behavioral Pediatrics Resident, Departments of Internal Medicine and Pediatrics Division of Academic General Pediatrics University of Minnesota University of Minnesota Minneapolis, MN Minneapolis, MN Casey Buitenhuys, MD Lindsay S. Baron, MD Clinical Instructor of Medicine Attending Physician, Pediatric and General Radiology David Geffen School of Medicine at University of California Los Angeles Lowell General Hospital Fellow, Pediatric Emergency Medicine Lowell, MA Harbor-UCLA Medical Center Torrance, CA Maneesh Batra, MD, MPH Associate Professor of Pediatrics David B. Burbulys, MD University of Washington School of Medicine Professor of Medicine Seattle, WA David Geffen School of Medicine at University of California Los Angeles Associate Director, Emergency Medicine Residency Program Andrew K. Battenberg, MD Harbor-UCLA Medical Center Resident, Department of Orthopaedic Surgery Torrance, CA Harbor-UCLA Medical Center Torrance, CA Berkowitz_FM_i-xviii.indd 5 5/19/14 9:45 AM VI contributors Jonnie Burton-Mota, MD Nima Eftekhary, MD Assistant Clinical Professor of Pediatrics Resident Physician, Department of Orthopaedic Surgery Division of Pediatric Hospital Medicine New York University Hospital for Joint Diseases Harbor-UCLA Medical Center New York, NY Torrance, CA Melissa K. Egge, MD Kelly Callahan, MD, MPT Santa Clara Valley Medical Center Assistant Professor of Pediatrics San Jose, CA David Geffen School of Medicine at University of California Los Angeles W. Suzanne Eidson-Ton, MD, MS Harbor-UCLA Medical Center Health Sciences Associate Clinical Professor of Family and Torrance, CA Community Medicine Gangadarshni Chandramohan, MD, MS University of California Davis School of Medicine Associate Professor of Pediatrics Sacramento, CA David Geffen School of Medicine at University of California Los Angeles Nwando Eze, MD Division of Pediatric Nephrology Department of Pediatrics Harbor-UCLA Medical Center Orange, CA Torrance, CA Andrea Fang, MD Grant P. Christman, MD Pediatric Emergency Medicine Fellow and Health Sciences Assistant Professor of Clinical Pediatrics Clinical Instructor Keck School of Medicine of the University of Southern California Harbor-UCLA Medical Center Division of Hospital Medicine Torrance, CA Children’s Hospital Los Angeles Los Angeles, CA Marianne Gausche-Hill, MD Professor of Clinical Medicine Noah Craft, MD, PhD David Geffen School of Medicine at University of California Los Angeles Los Angeles Biomedical Research Institute Vice Chair and Chief, Division of Pediatric Emergency Medicine Torrance, CA Director, Pediatric Emergency Medicine and EMS Fellowships Medicine-Pediatrics Resident Harbor-UCLA Medical Center University of Minnesota Torrance, CA Minneapolis, MN George Gershman, MD Catherine A. DeRidder, MD Professor of Pediatrics Assistant Professor of Clinical Pediatrics David Geffen School of Medicine at University of California Los Angeles Keck School of Medicine of the University of Southern California Chief, Division of Pediatric Gastroenterology and Nutrition, Department Los Angeles County & University of Southern California Medical Center of Pediatrics Los Angeles, CA Harbor-UCLA Medical Center Alejandro Diaz, MD Torrance, CA La Maestra Community Health Centers Rick Goldstein, MD San Diego, CA Attending Physician in Pediatric Palliative Care Sabrina D. Diaz, MA, MMFT Dana-Farber Cancer Institute Los Angeles Biomedical Research Institute Boston Children’s Hospital Harbor-UCLA Medical Center Harvard Medical School Torrance, CA Boston, MA Steven Donohoe, BS Geeta Grover, MD David Geffen School of Medicine at University of California Los Angeles Developmental and Behavioral Pediatrician Los Angeles, CA The Center for Autism and Neurodevelopmental Disorders Santa Ana, CA Robin Winkler Doroshow, MD, MMS, MEd Children’s Hospital of Orange County, Orange, CA Associate Professor of Pediatrics Associate Clinical Professor of Pediatrics The George Washington University School of Medicine and Health Sciences Irvine College of Medicine Pediatric Cardiologist University of California, Irvine Children’s National Medical Center Irvine, CA Associate Professor of Pediatrics Georgetown University School of Medicine Director, Division of Pediatric Cardiology Georgetown University Hospital Washington, DC Berkowitz_FM_i-xviii.indd 6 5/19/14 9:45 AM contributors VII H. Mollie Greves Grow, MD, MPH Elaine S. Kamil, MD Assistant Professor of Pediatrics Health Sciences Professor of Pediatrics University of Washington David Geffen School of Medicine at University of California Los Angeles Research Faculty Director, Pediatric Nephrology Seattle Children’s Research Institute Cedars-Sinai Medical Center Los Angeles, CA Mark Hanudel, MD Pediatric Nephrology Khalid M. Khan, MD UCLA Medical Center Department of Pediatrics Los Angeles, CA Georgetown University Medical Center Washington, DC Thomas R. Hawn, MD, PhD Professor, Department of Medicine Jane S. Kim, MD Division of Allergy and Infectious Diseases Assistant Professor, Pediatric Radiology University of Washington School of Medicine Department of Diagnostic Radiology & Nuclear Medicine Seattle, WA University of Maryland Medical Center Baltimore, MD Kenneth R. Huff, MD Professor of Pediatrics and Neurology Kenny Yat-Choi Kwong, MD David Geffen School of Medicine at University of California Los Angeles Chief, Division of Allergy-Immunology Chief, Division of Neurology, Department of Pediatrics Associate Clinical Professor of Pediatrics Harbor-UCLA Medical Center Department of Pediatrics Torrance, CA Harbor-UCLA Medical Center Torrance, CA Lynn Hunt, MD Clinical Professor of Pediatrics Kathy K. Langevin, MD, MPH University of California, Irvine Assistant Clinical Professor, Dermatology Santa Ana, CA David Geffen School of Medicine at University of California Los Angeles Los Angeles, CA Stanley H. Inkelis, MD Professor of Pediatrics Joseph L. Lasky III, MD David Geffen School of Medicine at University of California Los Angeles Clinical Associate Professor, Pediatrics and Neurosurgery Director, Pediatric Emergency Medicine David Geffen School of Medicine at University of California Los Angeles Harbor-UCLA Medical Center Chief, Pediatric Hematology/Oncology Torrance, CA Harbor-UCLA Medical Center/Los Angeles Biomedical Research Institute Torrance, CA Walter Jimenez, MD Institute for Cancer Care Steve L. Lee, MD Mercy Medical Center Associate Professor of Surgery and Pediatrics Baltimore, MD David Geffen School of Medicine at University of California Los Angeles Chief of Pediatric Surgery Jesse Joad, MD, MS Harbor-UCLA Medical Center Professor of Pediatrics Torrance, CA Associate Dean Diversity and Faculty Life Emerita University of California, Davis Charlotte W. Lewis, MD, MPH Davis, CA Associate Professor, Department of Pediatrics Divisions of General Pediatrics and Craniofacial Medicine Doron D. Kahana, MD Adjunct Associate Professor, Pediatric Dentistry Assistant Clinical Professor of Pediatrics University of Washington School of Medicine David Geffen School of Medicine at University of California Los Angeles Seattle, WA Division of Pediatric Gastroenterology, Hepatology & Nutrition Harbor-UCLA Medical Center Catherine S. Mao, MD Torrance, CA Associate Professor of Clinical Pediatrics David Geffen School of Medicine at University of California Los Angeles Tom Kallay, MD Division of Pediatric Endocrinology Associate Professor of Pediatrics Harbor-UCLA Medical Center/Los Angeles Biomedical Research Institute David Geffen School of Medicine at University of California Los Angeles Torrance, CA Director, Simulation and Skills Center, Division of Pediatric Critical Care Harbor-UCLA Medical Center Torrance, CA Berkowitz_FM_i-xviii.indd 7 5/19/14 9:45 AM VIII contributors Kevin Madden, MD Joseph Ravera, MD Fellow, Harvard Palliative Medicine Fellowship Program Fellow in Pediatric Emergency Medicine Dana-Farber Cancer Institute Harbor-UCLA Medical Center Boston Children’s Hospital Torrance, CA Harvard Medical School Nasser Redjal, MD Boston, MA Professor of Clinical Pediatrics and Allergy/Immunology Deborah McCurdy, MD David Geffen School of Medicine at University of California Los Angeles Professor, Department of Pediatrics Director, Allergy/Immunology Managed Care Division of Allergy, Immunology, Rheumatology Harbor-UCLA Medical Center David Geffen School of Medicine at University of California Los Angeles Torrance, CA Los Angeles, CA Katherine E. Remick, MD ChrisAnna M. Mink, MD Clinical Instructor of Pediatrics Clinical Professor of Pediatrics David Geffen School of Medicine at University of California Los Angeles David Geffen School of Medicine at University of California Los Angeles Fellow, Pediatric Emergency Medicine Department of Pediatrics Harbor-UCLA Medical Center Harbor-UCLA Medical Center Torrance, CA Torrance, CA Teresa Rosales, MD Julie E. Noble, MD Clinical Professor of Ophthalmology Clinical Professor of Pediatrics David Geffen School of Medicine at University of California Los Angeles David Geffen School of Medicine at University of California Los Angeles Jules Stein Eye Institute Director, Pediatric Managed Care Pediatric Ophthalmologist, Private Practice Director, Low Risk Nursery Long Beach, CA Harbor-UCLA Medical Center Timothy K. Ruttan, MD Torrance, CA Dell Children’s Medical Center of Central Texas Suzinne Pak-Gorstein, MD, PhD, MPH Pediatric Emergency Medicine Assistant Professor, Department of Pediatrics University of Texas Southwestern at Austin University of Washington School of Medicine Austin, TX Codirector, Global Health Pathways Isidro B. Salusky, MD Seattle Children’s Hospital Professor of Pediatrics Seattle, WA David Geffen School of Medicine at University of California Los Angeles Eduard H. Panosyan, MD Director, Pediatric Dialysis Program Assistant Clinical Professor of Pediatrics Program Director, General Clinical Research Center David Geffen School of Medicine at University of California Los Angeles University of California Los Angeles Division of Pediatric Hematology/Oncology Los Angeles, CA Harbor-UCLA Medical Center Nefthi Sandeep, MD Los Angeles Biomedical Research Institute Fellow, Division of Pediatric Cardiology, Department of Pediatrics Torrance, CA Children’s National Medical Center Miriam F. Parsa, MD, MPH Washington, DC Assistant Clinical Professor, Department of Pediatrics, Division of Research Fellow Rheumatology National Heart, Lung, and Blood Institute David Geffen School of Medicine at University of California Los Angeles National Institutes of Health Los Angeles, CA Bethesda, MD Bonnie R. Rachman, MD Lucinda S. Santos, MHA Professor of Pediatrics Los Angeles Biomedical Research Institute at Harbor-UCLA David Geffen School of Medicine at University of California Los Angeles Torrance, CA Division of Pediatric Critical Care Harbor-UCLA Medical Center Torrance, CA Christian B. Ramers, MD, MPH Assistant Medical Director, Research /Special Populations Family Health Centers of San Diego San Diego, CA Berkowitz_FM_i-xviii.indd 8 5/19/14 9:45 AM contributors Ix Eric R. Schmitt, MD, MPH Sara T. Stewart, MD Assistant Clinical Professor of Emergency Medicine Associate Professor of Pediatrics University of California, San Francisco, Fresno Medical David Geffen School of Medicine at University of California Los Angeles Education Program Harbor-UCLA Medical Center Attending Physician, Department of Emergency Medicine Torrance, CA Community Regional Medical Center Benjamin H. Taragin, MD Fresno, CA Associate Professor of Radiology and Pediatrics Attending Physician, Department of Emergency Medicine Director, Pediatric Radiology Children’s Hospital of Central California Division of Radiology Madera, CA Children’s Hospital at Montefiore Erica Sibinga, MD, MHS Montefiore Medical Center of The Albert Einstein College of Medicine Assistant Professor of Pediatrics Bronx, NY Johns Hopkins School of Medicine Alan Tomines, MD Baltimore, MD Associate Clinical Professor of Pediatrics and Health Services Monica Sifuentes, MD David Geffen School of Medicine at University of California Los Angeles Professor of Clinical Pediatrics and UCLA Fielding School of Public Health David Geffen School of Medicine at University of California Los Angeles Harbor-UCLA Medical Center Associate Program Director, Vice Chair of Education, Department Torrance, CA of Pediatrics Hendry Ton, MD, MS Harbor-UCLA Medical Center Health Sciences Associate Clinical Professor of Psychiatry and Torrance, CA Behavioral Sciences Lynne M. Smith, MD University of California Davis School of Medicine Professor of Clinical Pediatrics Davis, CA David Geffen School of Medicine at University of California Los Angeles Derek Wong, MD Vice Chair for Academy Affairs, Department of Pediatrics, Division Assistant Professor of Clinical Pediatrics of Neonatology David Geffen School of Medicine at University of California Los Angeles Harbor-UCLA Medical Center Division of Medical Genetics Torrance, CA Harbor-UCLA Medical Center Blanca Solis, MD Torrance, CA Associate Physician Jennifer K. Yee, MD Primary Care Network Assistant Professor of Pediatrics University of California, Davis David Geffen School of Medicine at University of California Los Angeles Davis, CA Division of Pediatric Endocrinology Robin Steinberg-Epstein, MD Harbor-UCLA Medical Center Director of Developmental and Behavioral Pediatrics and Clinical Torrance, CA Professor of Pediatrics Ki-Young Yoo, MD University of California, Irvine School of Medicine and Children’s Hospital Assistant Clinical Professor, Division of Dermatology, Department of Orange County of Medicine Developmental Behavioral Pediatrician David Geffen School of Medicine at University of California Los Angeles For OC Kids Neurodevelopmental Center Los Angeles, CA Kenneth W. Steinhoff, MD Kelly D. Young, MD, MS Associate Clinical Professor, Department of Pediatrics Health Sciences Clinical Professor of Pediatrics Child Psychiatrist David Geffen School of Medicine at University of California Los Angeles Child Development Center, Department of Pediatrics Department of Emergency Medicine University of California, Irvine Harbor-UCLA Medical Center Irvine, CA Torrance, CA Miriam T. Stewart, BA David P. Zamorano, MD Johns Hopkins School of Medicine Assistant Professor, Department of Orthopaedic Surgery Baltimore, MD California School of Medicine, Irvine Irvine, CA Berkowitz_FM_i-xviii.indd 9 5/19/14 9:45 AM