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000WATERSTON_prelims_5L 22/9/05 2:42 PM Page i

Paediatrics
A core text on child health
Second Edition

Edited by
Tony Waterston
Consultant Paediatrician
Newcastle General Hospital
Newcastle upon Tyne

Peter J Helms
Professor of Child Health
University of Aberdeen
Royal Aberdeen Children’s Hospital

and
Martin Ward Platt
Consultant Paediatrician
Royal Victoria Infirmary, Newcastle upon Tyne

Forewords by
Sir David Hall
Professor of Community Paediatrics
University of Sheffield

and
Jane Naish
Policy Adviser
Royal College of Nursing

Radcliffe Publishing
Oxford • Seattle
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2006 by Tony Waterston, Peter J Helms and Martin Ward Platt
CRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Version Date: 20160525

International Standard Book Number-13: 978-1-138-03131-9 (eBook - PDF)

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001WATERSTON_contents_3L 22/9/05 2:40 PM Page iii

Contents
Forewords v
Preface to the second edition vii
About the editors viii
List of contributors ix

1 Clinical skills 1
2 Causes of child death and ill health 23
3 Infectious disease and immunology 37
4 Gastrointestinal disorders and nutrition 49
5 Respiratory disorders 67
6 Ear, nose and throat problems 83
7 Eye disorders 95
8 Neurological disorders 105
9 Orthopaedic disorders 119
10 Disability 135
11 Genetics 153
12 Emotional and behavioural problems 165
13 Accidents and poisoning 189
14 Child abuse and neglect 205
15 Growth and the endocrine system 221
16 Haematology and oncology 235
17 The newborn 261
18 General surgical conditions 281
19 Skin disorders 289
001WATERSTON_contents_3L 22/9/05 2:40 PM Page iv

iv Contents

20 Renal disease 305

21 Heart disease 319
22 Prevention of illness and promotion of good health 331
23 Looking forward to adult life 345

Answers to the self-assessment questions 353

Index 358
002WATERSTON_forewdHall_4L 22/9/05 2:43 PM Page v

Foreword

An invitation to write a second edition is always pre-occupy us, our discipline has turned its atten-
welcomed by authors – even if it does need tion to other problems – psychosomatic disease
nearly as much work as the first – because it resulting from stress, family break-up or bullying,
suggests that the book has met the needs of those abuse and neglect in an almost infinite variety of
who bought it. Writing a foreword needs much forms, and mental health problems. Taken to-
less work, but the task has prompted me to look gether, in the developed world these will in the
back over the years and reflect how much future probably account for more wasted and
paediatrics has changed in the 35 years since I blighted lives than all childhood physical illness
first invested in a (second-hand) textbook of put together. These socially induced ‘diseases’
paediatrics. For instance, thanks to preventive have always been with us, both here in the UK
medicine, in this book measles now merits just and around the world, but it is only as children’s
two paragraphs, the devastating complications of physical health improves, and the economy sup-
intrauterine rubella infection get one line and ports more health professionals, that they are
rhesus disease (which kept my generation out of beginning to receive the attention they deserve.
bed on many a night) is now stated to ‘have If this is your first paediatric textbook, you will
almost disappeared’. These are wonderful achieve- find that it offers an admirable balance between
ments and it is a privilege to have lived through these many different perspectives of the problems
an era of such dramatic progress. Yet the need for and the healthcare needs of children and young
enthusiastic dedicated paediatricians is greater people. It shows how each illness has physical,
than ever. As old diseases disappear, new chal- psychological and social dimensions – good
lenges come on the scene. The neonatologists paediatrics requires that all three be addressed
have made great strides, through the application and none be neglected. To provide the best
of basic sciences and randomised trials – who possible care for children there must be no
would ever have thought that babies of less than artificial boundaries between care in hospital and
26 weeks’ gestation could survive at all, let alone care at home or at school and no territorial dis-
survive intact to lead useful lives? Cardiac sur- putes between disciplines. If you are already
gery, oncology, genetics – every specialty has experienced in paediatrics, this book will give an
seen astonishing progress. There have been ad- excellent refresher course on topics in which you
vances in less glamorous areas as well, like pain may have become just a little out of date (it does
control and the support of families with disabled happen occasionally), and will be a valuable aide
children. to planning a balanced curriculum for students.
And yet… there is also a little sadness in read-
ing through the chapter headings in this book. Sir David Hall
Complex long-term illness and disability are Professor of Community Paediatrics
actually more prevalent as we become more University of Sheffield
expert at sustaining life. With little malnutrition September 2005
and fewer life-threatening infectious illnesses to
003WATERSTON_forewd_Naish_4L 22/9/05 2:44 PM Page vi

Foreword

It is a pleasure to join Professor David Hall in inter-professional teamwork but also the inclu-
writing a foreword to the second edition of this sion of the patient and their carers within the
book. As David highlights, the scope and focus healthcare team as partners and co-decision
for paediatrics has changed dramatically within a makers. Teamwork will become increasingly
relatively short period of time. New problems pivotal to achieving successful future outcomes
and issues within paediatrics have emerged, not in paediatrics, since we are likely to see changes
least in the field of public health within which and different configurations within the health
there is (still) an unacceptable health inequalities service in the future with a plethora of healthcare
gap between the health of poorer children and providers. Yet it is well documented that what
young people and their better off peers. There is children and families want and need is seamless
a pressing need to develop health professionals care that is tailored to their needs rather than
with the knowledge and expertise to tackle the those of professional groups or healthcare insti-
many issues within children’s public health, at tutions.
both a strategic and policy level as well as in This book provides a useful basis from which to
practice and at a practical level. This is a complex view new perspectives in paediatrics (such as
enterprise but one of the key challenges facing public health), coupled with its more traditional
paediatrics for the future. underpinnings including holistic care for the
Changes have also taken place in the boun- child and family, and teamwork to provide that
daries between the different professions within care. It will be a valuable learning tool and refer-
the field of paediatrics, a trend that is set to con- ence point for the many professionals engaged
tinue for the future. The question of which pro- in paediatric work, including nurses, midwives,
fessional group does what has become less health visitors, doctors, physiotherapists and social
important than questions of which individual has workers.
the right competencies and who is best placed to
lead or deliver care for particular children and Jane Naish
their families. Teamwork has always featured in Policy Adviser
the field of paediatrics and child health which Royal College of Nursing
has been a leader in the development of not only September 2005
004WATERSTON_Pref_2L 23/9/05 3:10 PM Page vii

Preface to the
second edition
The second edition has further developed the problems has been extended. However, we have
problem-based style which has proved popular retained the original concept of the core curri-
with readers and which reflects actual clinical culum with its focus on common and important
practice. We have made three main changes in conditions, rather than a catalogue of conditions
the new edition. First, we have emphasised clini- more appropriate to postgraduate reference texts.
cal skills, and this is reflected in the new opening Despite reducing the size of the book we have
chapter. Secondly, we have changed the format of retained the integration of child health and child
the case studies so that each one is self-contained disease, and our new publishers have maintained
and can easily be read on its own, while acting as the high quality of illustrations and summary
an aide-mémoire to the student on common features throughout the text.
clinical presentations. Thirdly, we have added
self-assessment questions at the end of each sec- Tony Waterston
tion for students to use as a means of revision. Peter J Helms
All of the chapters have been updated and Martin Ward Platt
the coverage of common and important clinical September 2005
005WATERSTON_About_6L 22/9/05 3:03 PM Page viii

About the editors

Tony Waterston works as a general paediatrician specialising in community child health in inner city
Newcastle. He has a special interest in poverty and child health, children’s rights and international child
health.

Peter J Helms is Professor of Child Health at the University of Aberdeen and Consultant Paediatrician in
the Royal Aberdeen Children’s Hospital. He has a special interest in respiratory health and disease.

Martin Ward Platt has been a consultant paediatrician in Newcastle upon Tyne since 1990, specialis-
ing in neonatal medicine but delivering clinical care to children of all ages; he is also Honorary Senior
Lecturer in Child Health at Newcastle University. He has been involved in organising and delivering
teaching of paediatrics and child health at all stages of the undergraduate medical curriculum.
006WATERSTON_Cont_4L 22/9/05 3:06 PM Page ix

List of contributors

Ian Auchterlonie Derek King

Consultant Paediatrician Consultant Haematologist/Oncologist
Royal Aberdeen Children’s Hospital Aberdeen Royal Infirmary
Michael Bisset Camille Lazaro
Consultant Paediatrician Senior Lecturer in Forensic Paediatrics
Royal Aberdeen Children’s Hospital University of Newcastle upon Tyne
Philip Booth David Meikle
Consultant Neonatologist Consultant ENT Surgeon
Aberdeen Maternity Hospital Freeman Hospital
Newcastle upon Tyne
William Church
Consultant Ophthalmologist Jean Robson
Aberdeen Royal Infirmary Retired Associate Specialist in
Orthopaedics
Gaynor Cole
Freeman Hospital
Consultant Paediatric Neurologist
Newcastle upon Tyne
Robert Jones & Agnes Hunt Hospital
Oswestry Chris Scott
Consultant Ophthalmologist
John Dean
Aberdeen Royal Infirmary
Consultant Clinical Geneticist
Royal Aberdeen Children’s Hospital Peter Smail
Retired Consultant Paediatrician
James Ferguson
Royal Aberdeen Children’s Hospital
Consultant in Accident and Emergency
Aberdeen Royal Infirmary Marion White
Consultant Dermatologist
Leonora Harding
Aberdeen Royal Infirmary
Head of Clinical Psychology Services
Stratheden Hospital George Youngson
Cupar Professor of Paediatric Surgery
University of Aberdeen
David Kindley
Royal Aberdeen Children’s Hospital
Consultant Paediatrician
Director, Raeden Centre
Aberdeen
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