IN THEIR ESTEEMED OPINION......... Prof NS Tibrewala (Mumbai) : “... occupies pride of the place as a standard textbook... an indispensable companion...” Prof PM Udani (Mumbai) : “An essential reading... a nice work.” Prof NR Bhandari (Bhopal) : “A great gift to the students, both undergraduates and postgraduates.” Prof DG Benakappa (Bangalore) : “Very comprehensive and up-to-date...highly recommended.” Prof N Sundravalli (Chennai) : “A work of special merit.” Prof AB Desai (Ahmedabad) : “...effectively worded and illustrated, and of great value.” Prof K Indira Bai (Annamalai) : “Comprehensive...extremely well written... ideal... strongly recommended.” Prof Meharban Singh (Noida) : “Very informative.” Prof GP Mathur (Kanpur) : “Very useful for undergraduates, postgraduates and practitioners.” Prof PK Misra (Lucknow) : “A very nice comprehensive textbook.” Prof K Kalra (Agra) : “Strongly recommended to undergraduates and postgraduates.” Prof Pinaki Banerjee (Kolkata) : “A very comprehensive book...ideal for students.” Prof SS Deshmukh (Nagpur) : “...fulfills a long awaited need... wonderful... very comprehensive.” Prof Rafiq Ahmed (Kolkata) : “A book of outstanding merit.” Prof KPS Sinha (Patna) : “A fine and appreciable work... clinical approach is commendable.” Prof SK Khetarpal (Amritsar) : “Concise, comprehensive, up-to-date and to the point....” Prof PS Mathur (Gwalior) : “Warmly recommended.” Prof P Chaturvedi (Sewagram) : “Very helpful to students.” Prof Birendra Kumar (Darbhanga): “A really very useful and precise volume for students.” Prof BK Garg (Meerut) : “Ideal for students.” Prof Shanta Karup (Kottayam) : “A very good work.” Prof Ananthakrishna (Chennai) : “Excellent...covers every aspect of pediatrics.” Prof NB Mathur (Sewagram) : “Highly useful...strongly recommended.” Prof AK Dikshit (Jamshedpur) : “The book fulfills a very long-standing need.” Prof AV Ramana (Warangal) : “Very useful for students as well as practitioners.” Prof SP Srivastava (Patna) : “Very up-to-date, comprehensive and appropriate for our students, both under- and postgraduates.....” Prof Neetu Raizada (Ludhiana) : “A highly recommended state-of-the-art textbook... an essential reading.” Prof B Sharda (Udaipur) : “Most comprehensive and state-of-the-art textbook...” Prof Madhuri Kulkarni (Mumbai) : “... tailor-made to the needs of the students.” Prof A Parthasarthy (Chennai) : “A prototype of Nelson Textbook of Pediatrics.... modelled as per requirements in India...” Prof AM Sur (Nagpur) : “... a boon for pediatric scholars in India in particular... warmly recommended.” Prof Utpal Kant Singh (Patna) : “...profusely illustrated, clinical-oriented, most uptodate and ideal to meet the needs of students in India in particular.” Prof BS Prajapati (Ahmedabad) : “An essential reading for all students of pediatrics... carries valuable information including much- sought-after statistical data... useful for teachers too.” Prof VN Tripathi (Kanpur) : “A meritorious work...most suitable for undergraduates in particular and postgraduates in general.” Prof Javed Chowdhary (Srinagar) : “A textbook of extraordinary merit...An essential reading for the undergraduates as well as postgraduates...” Prof Masood-ul-Hassan (Srinagar) : “Most uptodate, well-illustrated, clinical-oriented, very comprehensive and student-friendly textbook... warmly recommended.” Prof Praveen C Sobti (Ludhiana) : “For over 3 decades, Dr Suraj Gupte’s textbook has been popular with undergraduates and postgraduates alike. The book contains all that the students need to know about common childhood illnesses in the developing world. It is a thoroughly readable book.” Prof Vijay Sharma (Shimla) : “A highly recommended textbook of pediatrics..” Prof DB Sharma (Jammu) : “Tailor-made for the needs of students in India...strongly recommended.” Prof (Col) VS Puri (Jammu) : “An outstanding clinical-oriented textbook... most useful... warmly recommended.” Prof Pankaj Abrol (Rohtak) : “A very comprehensive and up-to-date textbook of Pediatrics... a nice Indian response to Nelson’s Textbook of Pediatrics... can easily compete with best textbooks of pediatrics... A “must” for all students of pediatrics in India.” Prof MMA Faridi (Delhi) : “There are many books around in the specialty but The Short Textbook of Pediatrics is unique...it makes the subject easy, interesting and understandable.” Prof Rekha Harish (Jammu) : “This textbook of extraordinary merit eminently meets the requirements of students, especially the undergraduates, and is warmly recommended...” Prof B Vishnu Bhat (Pondicherry) : “Well-written book covering all information needed by undergraduates and postgraduates in pediat- rics. Good reference book for practising pediatricians as well...” Prof Ajay Gaur (Gwalior) : “…a genuinely good book for the undergraduate and postgraduate students with the expertise of eminent academicians… The contents are well presented in a uniform style and in keeping with the standard protocols and guidelines.... .” Prof Ghanshyam Saini (Jammu) : “…an extraordinary work... a very useful tool for the undergraduates, postgraduates and academi- cians.” Prof RK Gupta (Jammu) : “An excellent textbook, full of latest updates… unique in itself, providing concise but comprehen- sive information …. invaluable in pediatric education for the undergraduates and postgraduates.’’ Prof E Chen (Malaysia) : “A complete textbook on tropical pediatrics…a “must possession” by each and every student of pediatrics in the region.” Prof Shaukat Sidiqui (Pakistan) : “Most valuable for the pediatric UGs, PGs, teaching faculty and practising pediatricians as also for the GPs treating infants, children and adolescents in the subcontinent…” Prof RN Koirala (Nepal) : “An exceptionally useful textbook of pediatrics, eminently meeting the needs of our students and their teachers…most suitable for our settings.” Prof JE Jaywardne (Sri Lanka) : “A warmly recommended pediatric textbook, focusing exactly on what is needed by our medical students, emerging pediatricians and teachers…” Prof AQ Bhashani (Bangladesh) : “The textboook is a spotlight on everything that we need to teach our students of pediatrics in Bangladesh and neighboring countries…” THE SHORT TEXTBOOK OF PEDIATRICS THE SHORT 11th TEXTBOOK OF Edition PEDIATRICS (Fourth Decade of Publication) Incorporating National and International Recommendations (MCI, IAP, NNF, WHO, UNICEF, IPA, ISTP, AAP, etc) Edited by Suraj Gupte MD, FIAP Professor and Head Postgraduate Department of Pediatrics Narayana Medical College/Narayana General and Superspeciality Hospitals Nellore 524 002, AP, South India E-mail: [email protected] [email protected] Honorary Director: Pediatric Education Network Editor: Recent Advances in Pediatrics (Series), Textbooks of Pediatric Emergencies, Neonatal Emergencies and Pediatric Nutrition, Pediatric Gastroenterology, Hepatology and Nutrition, Towards MRCPCH Part II (Theory Examination), Pediatric Yearbook (Series), Newer Horizons in Tropical Pediatrics, etc. Author: Differential Diagnosis in Pediatrics, Instructive Case Studies in Pediatrics, Pediatric Drug Directory, Infant Feeding, Speaking of Child Care, The Baby Book: The Parents’ Guide from Birth to Infancy Co-editor: Asian Journal of Maternity and Child Health (Manila, Philippines) Section and Guest Editor: Pediatric Today (New Delhi) Editorial Advisor: Asian Journal of Pediatric Practice (New Delhi) Editorial Advisory Board Member/Reviewer: Indian Journal of Pediatrics (New Delhi), Indian Pediatrics (New Delhi), Synopsis (Detroit, USA), Indian Journal of Pediatric Gastroenterology, Hepatology and Nutrition (Jaipur), Maternal and Child Nutrition (Preston, UK), Journal of Infectious Diseases (Turkey) Examiner: National Board of Examinations (NBE) for DNB, New Delhi; All India Institute of Medical Sciences (AIIMS), New Delhi; Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh; Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar; Indira Gandhi Open University (IGNOU), New Delhi Pediatric Faculty Selection Expert: All India Institute of Medical Sciences (AIIMS), Punjab Public Service Commission, Jammu and Kashmir Public Service Commission, Union Public Service Commission ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • Ahmedabad • Bengaluru • Chennai • Hyderabad • Kochi • Kolkata • Lucknow • Mumbai • Nagpur • St. Louis (USA) Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd Corporate Office 4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India, Phone: +91-11-43574357 Registered Office B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi - 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021 +91-11-23245672, Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683 e-mail: [email protected], Visit our website: www.jaypeebrothers.com Branches  2/B, Akruti Society, Jodhpur Gam Road Satellite Ahmedabad 380 015, Phones: +91-79-26926233, Rel: +91-79-32988717 Fax: +91-79-26927094, e-mail: [email protected]  202 Batavia Chambers, 8 Kumara Krupa Road, Kumara Park East Bengaluru 560 001, Phones: +91-80-22285971, +91-80-22382956 91-80-22372664, Rel: +91-80-32714073, Fax: +91-80-22281761 e-mail: [email protected]  282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza, Pantheon Road Chennai 600 008, Phones: +91-44-28193265, +91-44-28194897 Rel: +91-44-32972089, Fax: +91-44-28193231, e-mail: [email protected]  4-2-1067/1-3, 1st Floor, Balaji Building, Ramkote Cross Road, Hyderabad 500 095, Phones: +91-40-66610020, +91-40-24758498 Rel:+91-40-32940929 Fax:+91-40-24758499 e-mail: [email protected]  No. 41/3098, B & B1, Kuruvi Building, St. Vincent Road Kochi 682 018, Kerala, Phones: +91-484-4036109, +91-484-2395739 +91-484-2395740 e-mail: [email protected]  1-A Indian Mirror Street, Wellington Square Kolkata 700 013, Phones: +91-33-22651926, +91-33-22276404 +91-33-22276415, Rel: +91-33-32901926, Fax: +91-33-22656075 e-mail: [email protected]  Lekhraj Market III, B-2, Sector-4, Faizabad Road, Indira Nagar Lucknow 226 016 Phones: +91-522-3040553, +91-522-3040554 e-mail: [email protected]  106 Amit Industrial Estate, 61 Dr SS Rao Road, Near MGM Hospital, Parel Mumbai 400 012, Phones: +91-22-24124863, +91-22-24104532, Rel: +91-22-32926896, Fax: +91-22-24160828 e-mail: [email protected]  “KAMALPUSHPA” 38, Reshimbag, Opp. Mohota Science College, Umred Road Nagpur 440 009 (MS), Phone: Rel: +91-712-3245220, Fax: +91-712-2704275 e-mail: [email protected] USA Office 1745, Pheasant Run Drive, Maryland Heights (Missouri), MO 63043, USA, Ph: 001-636-6279734 e-mail: [email protected], [email protected] The Short Textbook of Pediatrics, 11th Edition © 2009, Suraj Gupte, Editor 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 editor and the publisher. This book has been published in good faith that the material provided by the contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editor will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under Delhi jurisdiction only. First Edition : 1977 Second Edition : 1979 Third Edition : 1982 Fourth Edition : 1983 Fifth Edition : 1985 Sixth Edition : 1989 Seventh Edition : 1995 Eighth Edition : 1998 Ninth (Millennium) Edition : 2001 Tenth (Silver Jubilee) Edition: 2004 Eleventh (Fourth Decade of Publication) Edition: 2009 ISBN 978-81-8448-469-4 Typeset at JPBMP typesetting unit Printed at Gopsons Papers Ltd., A-14, Sector 60, Noida To The fond memory of my parents whose inspiration, motivation, blessings and moral support continue to contribute a great deal to my academic endeavors and everybody striving to contribute to child health and welfare for a brighter future globally. Contributors RA Anderson Aniece Chowdhary Professor Professor and Head Department of Pediatric Gastroenterology, Hepatology and Department of ENT and Head and Neck Surgery Nutrition, Institute of Child and Adolescent Health Government Medical College/SMGS Hospital London, UK Jammu, Jammu and Kashmir, India Ch 24: Pediatric Gastroenterology Ch 38: Pediatric Ear, Nose and Throat (ENT) Problems Ch 25: Pediatric Hepatology Bhavna B Chowdhary Lalita Bahl Lecturer Ex-Professor and Head School of Medical Studies Department of Pediatrics Edinburgh, UK Indira Gandhi Medical College Ch 23: Pediatric Neurology Shimla, India Ch 44: Pediatric Laboratory Procedures Ch 16: Fluids, Electrolytes and Acid-base Balance and Its Distur- bances Javed Chowdhary Ch 46: Pediatric Drug Dosages Professor and Head Department of Pediatrics Surya Bhan Government Medical College Professor Srinagar, Jammu and Kashmir, India Department of Orthopedics Ch 17: Neonatology All India Institute of Medical Sciences New Delhi, India S Frank Ch 41: Pediatric Orthopedics Professor and Head Department of Immunology and Genetics B Vishnu Bhat Institute of Child and Adolescent Health Director-Professor London, UK Department of Pediatrics Ch 29: Pediatric Immunology Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India Ch 35: Genetics in Pediatric Practice Ch 36: Pediatric Neuromuscular Disorders EM Gomez Jagdish Chandra Associate Clinical Professor Professor Department of Infant and Child Nutrition Kalawati Saran Children’s Hospital Institute of Child and Adolescent Health Lady Hardinge Medical College London, UK New Delhi, India Ch 3: Growth and Development Ch 27: Pediatric Hematology Ch 12: Infant Feeding Ch 13: Protien-energy Malnutrition Mridula Chatterjee Professor and Head AM Graham Pediatric Department Clinical Professor North Bengal Medical College Center for Hemato-oncology Kadamtala, Siliguri, West Bengal, India Boston, Massachusetts, USA Ch 8: Pediatric Biostatistics and Informatics Ch 28: Pediatric Oncology x The Short Textbook of Pediatrics Devendra Gupta NE Parsons Professor and Head Clinical Professor Department of Pediatric Surgery Department of Dermatology All India Institute of Medical Sciences (AIIMS) Institute of Child and Adolescent Health New Delhi, India London, UK Ch 40: Pediatric Surgery Ch 31: Pediatric Dermatology Suraj Gupte AK Sahni Professor and Head Assistant Professor Postgraduate Department of Pediatrics Department of Adolescent Medicine Narayana Medical College/Narayana General and Institute of Child and Adolescent Health Superspeciality London, UK Hospitals, Nellore, South India Ch 7: Adolescence Chapters: All chapters as senior or coauthor DM Sharma BP Karunakara Assistant Professor Assistant Professor Department of Rheumatology Department of Pediatrics Institute of Child and Adolescent Health MS Ramaiah Medical College/Teaching Hospital London, UK Bangalore, Karnataka, India Ch 30: Pediatric Collagenosis Ch 22: Pediatric Cardiology RM Shore RK Kaushal Assistant Professor Professor and Head Department of Nephrology Department of Pediatrics Institute of Child and Adolescent Health Indira Gandhi Medical College London, UK Shimla Ch 26: Pediatric Nephrology Ch 32: Pediatric Accidental Poisoning Ch 33: Pediatric Envenomations Daljit Singh Principal AW Koff Dayanand Medical College Professor, Department of Pediatric Endocrinology Ludhiana, Punjab, India Institute of Child and Adolescent Health Ch 21: Pediatric Pulmonology London, UK Ch 34: Pediatric Endocrinology Karnail Singh ML Kulkarni Professor and Head Professor and Head Department of Pediatrics Department of Pediatrics Government Medical College JJM Medical College Amritsar, Punjab, India Davangere, Karnataka, India Ch 19: Pediatric Bacterial Infections Ch 29: Pediatric Immunology Ksh Chourjit Singh PP Maiya Ex-Professor and Head Professor and Head Department of Pediatrics Department of Pediatrics North-East Regional Medical College MS Ramaiah Medical College/Teaching Hospital Imphal, Manipur, India Bangalore, Karnataka, India Ch 18: Pediatric Viral Infections Ch 22: Pediatric Cardiology Tejinder Singh NK Nagpal Professor and Head Assistant Professor Department of Pediatrics Department of Dental and Orofacial Surgery Christian Medical College Institute of Child and Adolescent Health Ludhiana, Punjab, India London, UK Ch 6: Child Psychiatry and Behavioral Problems Ch 39: Pediatric Dental Problems Ch 9: Community Pediatrics Contributors xi Utpal Kant Singh Shashi Vani Professor and Head Professor and Head Department of Pediatrics Department of Pediatrics Nalanda Medical College PS Medical College Patna, Bihar Karamsad, Anand, Gujarat, India India Ch 11: Pediatric Nutritional Requirements Ch 20: Pediatric Parasitosis Ch 17: Neonatology Rita Smith Vasudev Vatwani (Brig) Director-Professor of Pediatrics Professor and Head Institute of Child and Adolescent Health Department of Pediatrics London, UK Dr DY Patil Medical College Ch 1: Pediatric History-taking and Clinical Examination Pimpri, Pune, Maharashtra, India Ch 43: Pediatric Practical Procedures Praveen C Sobti Professor and Head of the Unit Vijay Wali Department of Pediatrics Ex-Professor and Head Dayanand Medical College Department of Ophthalmology Ludhiana, Punjab Government Medical College India Jammu, Jammu and Kashmir, India Ch 27: Pediatric Hematology Ch 37: Pediatric Ophthalmology