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Nelson
TEXTBOOK of
PEDIATRICS
Nelson
TEXTBOOK of
PEDIATRICS
EDITION 20

Robert M. Kliegman, MD
Professor and Chair Emeritus
Department of Pediatrics
Medical College of Wisconsin
Milwaukee, Wisconsin

Bonita F. Stanton, MD Nina F. Schor, MD, PhD

Vice-Dean of Research William H. Eilinger Professor and Chair
Professor of Pediatrics Department of Pediatrics
Wayne State University School of Medicine Professor
Detroit, Michigan Department of Neurology
Pediatrician-in-Chief
Joseph W. St Geme III, MD Golisano Children’s Hospital
Chair, Department of Pediatrics University of Rochester Medical Center
Professor of Pediatrics and Microbiology Rochester, New York
Perelman School of Medicine at the University of
Pennsylvania Editor Emeritus
Physician-in-Chief
Leonard and Madlyn Abramson Endowed Chair in Richard E. Behrman, MD
Pediatrics Nonprofit Healthcare and Educational
Children’s Hospital of Philadelphia Consultants to Medical Institutions
Philadelphia, Pennsylvania Santa Barbara, California
1600 John F. Kennedy Blvd.
Ste. 1800
Philadelphia, PA 19103-2899

NELSON TEXTBOOK OF PEDIATRICS, TWENTIETH EDITION ISBN: 978-1-4557-7566-8

International Edition ISBN: 978-0-323-35307-6

Copyright © 2016 by Elsevier, Inc.

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 storage and retrieval
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This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Notices

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our understanding, changes in research methods, professional practices, or medical treatment may become
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Practitioners and researchers must always rely on their own experience and knowledge in evaluating
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With respect to any drug or pharmaceutical products identified, readers are advised to check the most
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Previous editions copyrighted 2011, 2007, 2004, 2000, 1996, 1992, 1987, 1983, 1979, 1975, 1969, 1964, 1959

International Standard Book Number: 978-1-4557-7566-8

Content Strategy Director: Mary Gatsch

Executive Content Strategist: Kate Dimock
Content Development Specialist: Jennifer Shreiner
Publishing Services Manager: Patricia Tannian
Senior Project Manager: John Casey

Printed in Canada

Last digit is the print number: 9 8 7 6 5 4 3 2 1

To the Child’s Physician and especially to those who through their expressed confidence
in past editions of this book have provided the stimulus for this revision.
Waldo E. Nelson, 9/e, 1969

This is as true in 2015 as it was in 1969.

R.M. Kliegman, 20/e, 2015
Contributors
Mark J. Abzug, MD Michael A. Alexander, MD Alia Y. Antoon, MD
Professor of Pediatrics Professor of Pediatrics and Rehabilitation Medicine Assistant Clinical Professor
Division of Pediatric Infectious Diseases Thomas Jefferson Medical College Department of Pediatrics
University of Colorado School of Medicine Philadelphia, Pennsylvania; Harvard Medical School
Children’s Hospital Colorado Emeritus Medical Staff Chief of Pediatrics
Aurora, Colorado Alfred I. duPont Hospital for Children Shriners Hospital for Children
Nonpolio Enteroviruses Wilmington, Delaware Boston, Massachusetts
Evaluation of the Child for Rehabilitative Services Burn Injuries
David R. Adams, MD, PhD Cold Injuries
National Human Genome Research Institute Omar Ali, MD
National Institutes of Health Assistant Professor Susan D. Apkon, MD
Bethesda, Maryland Department of Pediatrics Associate Professor
Genetic Approaches to Rare and Undiagnosed Medical College of Wisconsin Department of Rehabilitation Medicine
Diseases Division of Endocrinology University of Washington School of Medicine
Children’s Hospital of Wisconsin Director, Rehabilitation Medicine
Stewart L. Adelson, MD Milwaukee, Wisconsin Seattle Children’s Hospital
Assistant Clinical Professor Hyperpituitarism, Tall Stature, and Overgrowth Seattle, Washington
Department of Psychiatry Syndromes Ambulation Assistance
Columbia University College of Physicians and Hypofunction of the Testes
Surgeons Pseudoprecocity Resulting from Tumors of the Testes Stacy P. Ardoin, MD, MHS
Adjunct Clinical Assistant Professor Gynecomastia Associate Professor of Clinical Medicine
Weill Cornell Medical College of Cornell Adult and Pediatric Rheumatology
University Namasivayam Ambalavanan, MD The Ohio State University Wexner Medical Center
New York, New York Professor of Pediatrics Nationwide Children’s Hospital
Gay, Lesbian, and Bisexual Adolescents Division of Neonatology Columbus, Ohio
University of Alabama, Birmingham Systemic Lupus Erythematosus
John J. Aiken, MD, FACS, FAAP Birmingham, Alabama Vasculitis Syndromes
Professor of Surgery High-Risk Pregnancies
Division of Pediatric General and Thoracic Surgery The Fetus Monica I. Ardura, DO, MSCS
Medical College of Wisconsin Nervous System Disorders Assistant Professor of Pediatrics
The Children’s Hospital of Wisconsin Hypoxia-Ischemic Encephalopathy Section of Infectious Disease and Immunology
Milwaukee, Wisconsin Respiratory Tract Disorders The Ohio State University College of Medicine
Acute Appendicitis Jaundice and Hyperbilirubinemia in the Newborn Nationwide Children’s Hospital
Inguinal Hernias Kernicterus Columbus, Ohio
Epigastric Hernia Genitourinary System Hansen Disease (Mycobacterium leprae)
The Umbilicus
Begum Akay, MD Metabolic Disturbances Michelle M. Ariss, MD
Assistant Professor of Surgery The Endocrine System Assistant Professor
Division of Pediatric Surgery Department of Ophthalmology
Oakland University William Beaumont School of Karl E. Anderson, MD, FACP University of Missouri—Kansas City School of
Medicine Professor Medicine
Beaumont Health Departments of Preventive Medicine, Community Children’s Mercy Hospital
Royal Oak, Michigan Health, Internal Medicine, and Pharmacology Kansas City, Missouri
Surgical Conditions of the Anus and Rectum and Toxicology Growth and Development (Eye)
Director, Porphyria Laboratory and Center Examination of the Eye
Cezmi A. Akdis, MD University of Texas Medical Branch Abnormalities of Refraction and Accommodation
Professor of Immunology Galveston, Texas Disorders of Vision
Swiss Institute of Allergy and Asthma Research The Porphyrias Abnormalities of Pupil and Iris
Christine Kühne Center for Allergy Research and Disorders of Eye Movement and Alignment
Education Peter M. Anderson, MD, PhD Abnormalities of the Lids
Davos, Switzerland; Curtis Distinguished Professor Disorders of the Lacrimal System
Medical Faculty, University of Zurich Department of Pediatrics Disorders of the Conjunctiva
Zurich, Switzerland University of Texas MD Anderson Cancer Center Abnormalities of the Cornea
Allergy and the Immunologic Basis of Atopic Disease Houston, Texas Abnormalities of the Lens
Neoplasms of the Kidney Disorders of the Uveal Tract
Evaline A. Alessandrini, MD, MSCE Disorders of the Retina and Vitreous
Professor of Clinical Pediatrics Kelly K. Anthony, PhD, PLLC Abnormalities of the Optic Nerve
University of Cincinnati College of Medicine Assistant Professor Childhood Glaucoma
Division of Emergency Medicine Department of Psychiatry and Behavioral Sciences Orbital Abnormalities
Director, Quality Scholars Program in Health Care Duke University Medical Center Orbital Infections
Transformation Durham, North Carolina Injuries to the Eye
Cincinnati Children’s Hospital Medical Center Musculoskeletal Pain Syndromes
Cincinnati, Ohio Thaís Armangué, MD
Emergency Medical Services for Children: Outcomes Clinical Fellow and Predoctoral Researcher
and Risk Adjustment ICREA-IDIBAPS Neuroimmunology Program
Hospital Clinic
Barcelona, Spain
Autoimmune Encephalitis

vi

Carola A.S. Arndt, MD
Professor of Pediatrics
Department of Pediatrics and Adolescent Medicine
Division of Pediatric Hematology-Oncology
Mayo Clinic
Rochester, Minnesota
Soft Tissue Sarcomas
Neoplasms of Bone
Stephen S. Arnon, MD, MPH
Chief, Infant Botulism Treatment and Prevention
Program Branch
Division of Communicable Disease Control
Center for Infectious Diseases
California Department of Public Health
Richmond, California
Botulism (Clostridium botulinum)
Tetanus (Clostridium tetani)
Stephen C. Aronoff, MD, MBA
Professor and Waldo E. Nelson Chair
Department of Pediatrics
Temple University School of Medicine
Philadelphia, Pennsylvania
Cryptococcus neoformans
Histoplasmosis (Histoplasma capsulatum)
Paracoccidioides brasiliensis
Sporotrichosis (Sporothrix schenckii)
Zygomycosis (Mucormycosis)
Nonbacterial Food Poisoning
David M. Asher, MD
Supervisory Medical Officer
Chief, Laboratory of Bacterial and Transmissible
Spongiform Encephalopathy Agents
Center for Biologics Evaluation and Research
(CBER)
United States Food and Drug Administration
Silver Spring, Maryland
Transmissible Spongiform Encephalopathies
Ann Ashworth, PhD, Hon FRCPCH
Professor Emeritus
Department of Population Health
Nutrition Group
London School of Hygiene and Tropical Medicine
London, United Kingdom
Nutrition, Food Security, and Health
Barbara L. Asselin, MD
Professor of Pediatrics and Oncology
Department of Pediatrics
University of Rochester School of Medicine
Golisano Children’s Hospital
Rochester, New York
Epidemiology of Childhood and Adolescent Cancer
Joann L. Ater, MD
Associate Professor
Department of Pediatrics
University of Texas MD Anderson Cancer Center
Houston, Texas
Brain Tumors in Childhood
Neuroblastoma
Erika F. Augustine, MD
Assistant Professor of Neurology and Pediatrics
Division of Child Neurology
University of Rochester Medical Center
Rochester, New York
Dystonia
Marilyn C. Augustyn, MD
Professor of Pediatrics
Boston University School of Medicine
Boston Medical Center
Boston, Massachusetts
Impact of Violence on Children
Contributors vii
Ellis D. Avner, MD Christina Bales, MD
Professor Assistant Professor of Pediatrics
Departments of Pediatrics and Physiology University of Pennsylvania Perelman School of
Medical College of Wisconsin Medicine
Milwaukee, Wisconsin Attending Physician
Introduction to Glomerular Diseases Division of Gastroenterology, Hepatology, and
Clinical Evaluation of the Child with Hematuria Nutrition
Isolated Glomerular Diseases with Recurrent Gross The Children’s Hospital of Philadelphia
Hematuria Philadelphia, Pennsylvania
Glomerulonephritis Associated with Infections Intestinal Atresia, Stenosis, and Malrotation
Membranous Nephropathy
Membranoproliferative Glomerulonephritis William F. Balistreri, MD
Glomerulonephritis Associated with Systemic Lupus Medical Director Emeritus, Pediatric Liver Care
Erythematosus Center
Henoch-Schönlein Purpura Nephritis Division of Pediatric Gastroenterology, Hepatology,
Rapidly Progressive (Crescentic) Glomerulonephritis and Nutrition
Goodpasture Disease Cincinnati Children’s Hospital Medical Center
Hemolytic-Uremic Syndrome Cincinnati, Ohio
Upper Urinary Tract Causes of Hematuria Morphogenesis of the Liver and Biliary System
Hematologic Diseases Causing Hematuria Manifestations of Liver Disease
Anatomic Abnormalities Associated with Hematuria Cholestasis
Lower Urinary Tract Causes of Hematuria Metabolic Diseases of the Liver
Introduction to the Child with Proteinuria Viral Hepatitis
Transient Proteinuria Liver Disease Associated with Systemic Disorders
Orthostatic (Postural) Proteinuria Mitochondrial Hepatopathies
Fixed Proteinuria
Nephrotic Syndrome Robert S. Baltimore, MD
Tubular Function Professor of Pediatrics and Epidemiology
Renal Tubular Acidosis Clinical Professor of Nursing
Nephrogenic Diabetes Insipidus Associate Director of Hospital Epidemiology (for
Bartter and Gitelman Syndromes and Other Pediatrics)
Inherited Tubular Transport Abnormalities Yale-New Haven Hospital
Tubulointerstitial Nephritis New Haven, Connecticut
Toxic Nephropathy Listeria monocytogenes
Cortical Necrosis Pseudomonas, Burkholderia, and
Renal Failure Stenotrophomonas
Carlos A. Bacino, MD Manisha Balwani, MBBS, MS
Professor of Molecular and Human Genetics Assistant Professor
Baylor College of Medicine Departments of Medicine and Genetics and
Chief, Genetics Service Genomic Sciences
Director, Pediatric Genetics Clinic Icahn School of Medicine at Mount Sinai
Texas Children’s Hospital New York, New York
Houston, Texas The Porphyrias
Cytogenetics
Christine E. Barron, MD
Robert N. Baldassano, MD Associate Clinical Professor
Colman Family Chair in Pediatric Inflammatory Department of Pediatrics
Bowel Disease and Professor of Pediatrics Brown University Alpert Medical School
University of Pennsylvania Perelman School of Rhode Island Hospital
Medicine Providence, Rhode Island
Director, Center for Pediatric Inflammatory Bowel Adolescent Rape
Disease
The Children’s Hospital of Philadelphia Karyl S. Barron, MD
Philadelphia, Pennsylvania Deputy Director
Inflammatory Bowel Disease Division of Intramural Research
Eosinophilic Gastroenteritis National Institute of Allergy and Infectious
Diseases
Keith D. Baldwin, MD, MSPT, MPH National Institutes of Health
Assistant Professor Bethesda, Maryland
Department of Orthopaedic Surgery Amyloidosis
University of Pennsylvania Perelman School of
Medicine Dorsey M. Bass, MD
Neuromuscular Orthopaedics and Orthopaedic Associate Professor of Pediatrics
Trauma Division of Pediatric Gastroenterology
Children’s Hospital of Philadelphia Stanford University School of Medicine
Philadelphia, Pennsylvania Palo Alto, California
Growth and Development Rotaviruses, Caliciviruses, and Astroviruses
Evaluation of the Child
Torsional and Angular Deformities
Common Fractures
viii Contributors

Mark L. Batshaw, MD Susanne M. Benseler, MD, PhD Joshua A. Blatter, MD, MPH
Professor and Chairman Associate Professor, Faculty of Medicine Instructor in Pediatrics
Department of Pediatrics University of Calgary Division of Pediatric Allergy, Immunology, and
Associate Dean, Academic Affairs Pediatric Rheumatologist, Section Chief Pulmonary Medicine
George Washington University Rheumatology Associate Director, Pediatric Lung Transplantation
School of Medicine and Health Sciences Alberta Children’s Hospital Center
Executive Vice-President Calgary, Alberta, Canada Washington University School of Medicine in
Chief Academic Officer and Physician-in-Chief Central Nervous System Vasculitis St. Louis
Children’s National Medical Center St. Louis, Missouri
Washington, DC Daniel Bernstein, MD Congenital Disorders of the Lung
Intellectual Disability Alfred Woodley Salter and Mabel Smith Salter
Endowed Professor in Pediatrics Archie Bleyer, MD, FRCP (Glasg)
Nerissa S. Bauer, MD, MPH Stanford University School of Medicine Clinical Research Professor
Assistant Professor Director, Division of Pediatric Cardiology Knight Cancer Center
Department of General and Community Pediatrics Lucile Packard Children’s Hospital Oregon Health & Science University
Section of Children’s Health Services Research Palo Alto, California Chair, Institutional Review Board for St. Charles
Indiana University School of Medicine Cardiac Development Health System
Indianapolis, Indiana The Fetal to Neonatal Circulatory Transition Portland, Oregon;
Developmental-Behavioral Screening and History and Physical Examination Professor of Pediatrics
Surveillance Laboratory Evaluation University of Texas MD Anderson Cancer Center
Epidemiology and Genetic Basis of Congenital Heart Houston, Texas
Michelle L. Bayer, MD Disease Principles of Treatment (Cancer and Benign Tumors)
Resident Physician Evaluation and Screening of the Infant or Child with The Leukemias
Department of Dermatology Congenital Heart Disease Congenital Disorders of the Lung
Medical College of Wisconsin Acyanotic Congenital Heart Disease: Left-to-Right
Children’s Hospital of Wisconsin Shunt Lesions Steven R. Boas, MD, FAAP, FACSM
Milwaukee, Wisconsin Acyanotic Congenital Heart Disease: Obstructive Director, The Cystic Fibrosis Center of Chicago
Disorders of the Mucous Membranes Lesions President and CEO, The Cystic Fibrosis Institute
Acyanotic Congenital Heart Disease: Regurgitant Glenview, Illinois;
Richard E. Behrman, MD Lesions Clinical Associate Professor of Pediatrics
Nonprofit Healthcare and Educational Consultants Cyanotic Congenital Heart Disease: Evaluation of Northwestern University Feinberg School of
to Medical Institutions the Critically Ill Neonate with Cyanosis and Medicine
Santa Barbara, California Respiratory Distress Chicago, Illinois
Overview of Pediatrics Cyanotic Congenital Heart Lesions: Lesions Emphysema and Overinflation
Associated with Decreased Pulmonary Blood α1-Antitrypsin Deficiency and Emphysema
Michael J. Bell, MD Flow Other Distal Airway Diseases
Professor Cyanotic Congenital Heart Disease: Lesions Skeletal Diseases Influencing Pulmonary Function
Departments of Critical Care Medicine, Neurologic Associated with Increased Pulmonary Blood Flow
Surgery, and Pediatrics Other Congenital Heart and Vascular Walter O. Bockting, PhD
University of Pittsburgh School of Medicine Malformations Professor of Medical Psychology (in Psychiatry and
Director, Pediatric Neurocritical Care Pulmonary Hypertension Nursing)
Director, Pediatric Neurotrauma Center General Principles of Treatment of Congenital Heart Research Scientist, New York State Psychiatric
University of Pittsburgh Medical Center Disease Institute
Pittsburgh, Pennsylvania Infective Endocarditis Division of Gender, Sexuality, and Health
Neurologic Emergencies and Stabilization Rheumatic Heart Disease Department of Psychiatry
Heart Failure Columbia University College of Physicians and
John W. Belmont, MD, PhD Pediatric Heart and Heart-Lung Transplantation Surgeons
Professor Diseases of the Blood Vessels (Aneurysms and New York, New York
Departments of Molecular and Human Genetics, Fistulas) Sexual Identity Development
Pediatrics, and Pathology and Immunology
Baylor College of Medicine Zulfiqar Ahmed Bhutta, MBBS, PhD, Neal F. Boerkoel, MD, PhD
Houston, Texas FRCPCH, FAAP National Human Genome Research Institute
Genetics of Common Disorders Professor of Paediatrics, Nutritional Sciences, and National Institutes of Health
Public Health Bethesda, Maryland
Daniel K. Benjamin Jr., MD, PhD, University of Toronto Faculty of Medicine Genetic Approaches to Rare and Undiagnosed
MPH Robert Harding Chair in Global Child Health and Diseases
Professor of Pediatrics Policy
Division of Pediatric Infectious Diseases Co-Director, SickKids Centre for Global Child Natalija Bogdanovic, MD
Faculty Associate Director, Duke Clinical Research Health Department of Psychiatry
Institute The Hospital for Sick Children Boston Medical Center
Duke University Medical Center Toronto, Ontario, Canada; Boston, Massachusetts
Durham, North Carolina Founding Director, Centre of Excellence in Women Mood Disorders
Principles of Antifungal Therapy and Child Health
Candida The Aga Khan University, South Central Asia and Mark Boguniewicz, MD
East Africa Professor of Pediatrics
Michael J. Bennett, PhD, FRCPath, Karachi, Pakistan Division of Pediatric Allergy-Immunology
FACB Innovations in Addressing Child Health and University of Colorado School of Medicine
Professor of Pathology and Laboratory Medicine Survival in Low-Income Settings National Jewish Health
University of Pennsylvania Perelman School of Salmonella Denver, Colorado
Medicine Acute Gastroenteritis in Children Ocular Allergies
Director, Michael J. Palmieri Metabolic Disease Adverse Reactions to Drugs
Laboratory Samra S. Blanchard, MD
Children’s Hospital of Philadelphia Associate Professor of Pediatrics Daniel J. Bonthius, MD, PhD
Philadelphia, Pennsylvania University of Maryland School of Medicine Professor of Pediatrics and Neurology
Disorders of Mitochondrial Fatty Acid ß-Oxidation Baltimore, Maryland University of Iowa School of Medicine
Peptic Ulcer Disease in Children Iowa City, Iowa
Lymphocytic Choriomeningitis Virus
 Contributors ix

Brett J. Bordini Cynthia Etzler Budek, MS, APN/NP, Miguel M. Cabada, MD, MSc
Assistant Professor CPNP-AC/PC Research Associate, Tropical Medicine Institute
Department of Pediatrics Pediatric Nurse Practitioner Universidad Peruana Cayetano Heredia
Medical College of Wisconsin Department of Pulmonary and Critical Care Lima, Peru;
Pediatric Hospitalist Medicine Adjunct Instructor of Medicine
Children’s Hospital of Wisconsin Transitional Care/Pulmonary Habilitation Unit Division of Infectious Diseases
Milwaukee, Wisconsin Ann & Robert H. Lurie Children’s Hospital of University of Texas Medical Branch at Galveston
Plastic Bronchitis Chicago Galveston, Texas
Chicago, Illinois Echinococcosis (Echinococcus granulosus and
Kenneth M. Boyer, MD Chronic Severe Respiratory Insufficiency Echinococcus multilocularis)
Woman’s Board Professor and Chairman
Rush Medical College of Rush University E. Stephen Buescher, MD Derya Caglar, MD
Chicago, Illinois Professor of Pediatrics Assistant Professor
Toxoplasmosis (Toxoplasma gondii) Eastern Virginia Medical School Department of Pediatrics
Medical Director, Infection Control University of Washington School of Medicine
Amanda M. Brandow, DO, MS Medical Director, Clinical Microbiology Attending Physician
Associate Professor of Pediatrics Laboratory Division of Emergency Medicine
Division of Pediatric Hematology/Oncology Children’s Hospital of the King’s Daughters Seattle Children’s Hospital
Medical College of Wisconsin Norfolk, Virginia Seattle, Washington
Milwaukee, Wisconsin Diphtheria (Corynebacterium diphtheriae) Drowning and Submersion Injury
Polycythemia
Non-Clonal Polycythemia Supinda Bunyavanich, MD, MPH Mitchell S. Cairo, MD
Anatomy and Function of the Spleen Assistant Professor Professor
Splenomegaly Departments of Pediatrics and Genetics and Departments of Pediatrics, Medicine, Pathology,
Hyposplenism, Splenic Trauma, and Splenectomy Genomic Sciences Microbiology and Immunology and Cell
Jaffe Food Allergy Institute Biology and Anatomy
†David Branski, MD Mindich Child Heath and Development Institute New York Medical College
Professor Emeritus Ichan School of Medicine at Mount Sinai Chief, Division of Pediatric Hematology, Oncology,
The Hebrew University–Hadassah School of New York, New York and Stem Cell Transplantation
Medicine Diagnosis of Allergic Disease Maria Fareri Children’s Hospital at Westchester
Jerusalem, Israel Principles of Treatment of Allergic Disease Medical Center
Disorders of Malabsorption New York Medical College
Chronic Diarrhea Carey-Ann D. Burnham, PhD Valhalla, New York
Assistant Professor of Pathology and Immunology Lymphoma
David T. Breault, MD, PhD Assistant Professor of Pediatrics
Assistant Professor of Pediatrics Washington University School of Medicine in St. Lauren E. Camarda, MD
Harvard Medical School Louis Instructor in Pediatrics
Division of Endocrinology Medical Director, Clinical Microbiology Northwestern University Feinberg School of
Boston Children’s Hospital Barnes-Jewish Hospital Medicine
Boston, Massachusetts St. Louis, Missouri Division of Pediatric Pulmonary Medicine
Diabetes Insipidus Diagnostic Microbiology Ann & Robert H. Lurie Children’s Hospital of
Other Abnormalities of Arginine Vasopressin Chicago
Metabolism and Action Gale R. Burstein, MD, MPH Chicago, Illinois
Clinical Professor Wheezing, Bronchiolitis, and Bronchitis
William J. Britt, MD Department of Pediatrics
Charles A. Alford Professor of Pediatric Infectious State University of New York at Buffalo Bruce M. Camitta, MD
Diseases School of Medicine and Biomedical Sciences Rebecca Jean Slye Professor of Pediatrics
Professor of Pediatrics and Microbiology and Commissioner Division of Pediatric Hematology/Oncology
Neurobiology Erie County Department of Health Medical College of Wisconsin
University of Alabama Birmingham School of Buffalo, New York Midwest Children’s Cancer Center
Medicine Adolescent Physical and Social Development Milwaukee, Wisconsin
Birmingham, Alabama The Epidemiology of Adolescent Health Problems Polycythemia
Cytomegalovirus Delivery of Healthcare to Adolescents Non-Clonal Polycythemia
The Breast Anatomy and Function of the Spleen
Angela R. Bryan, MD Menstrual Problems Splenomegaly
Fellow in Pediatric Rheumatology Contraception Hyposplenism, Splenic Trauma, and Splenectomy
Duke University Health System Sexually Transmitted Infections Anatomy and Function of the Lymphatic System
Durham, North Carolina Abnormalities of Lymphatic Vessels
Juvenile Idiopathic Arthritis Amaya L. Bustinduy, MD, MPH, FAAP, Lymphadenopathy
FRCPCH
Rebecca H. Buckley, MD Paediatric Infectious Diseases Research Group Angela J.P. Campbell, MD, MPH
J. Buren Sidbury Professor of Pediatrics (PIDRG) Medical Officer
Professor of Immunology St. George’s University of London Epidemiology and Prevention Branch, Influenza
Duke University School of Medicine London, United Kingdom Division
Durham, North Carolina Schistosomiasis (Schistosoma) National Center for Immunization and Respiratory
Evaluation of Suspected Immunodeficiency Flukes (Liver, Lung, and Intestinal) Diseases
The T-, B-, and NK-Cell Systems Centers for Disease Control and Prevention
T Lymphocytes, B Lymphocytes, and Natural Killer Atlanta, Georgia
Cells Influenza Viruses
Primary Defects of Antibody Production Parainfluenza Viruses
Primary Defects of Cellular Immunity
Primary Combined Antibody and Cellular
Immunodeficiencies

†Deceased
x Contributors

Waldemar A. Carlo, MD Jennifer I. Chapman, MD Christine B. Cho, MD

Edwin M. Dixon Professor of Pediatrics Assistant Professor of Pediatrics Assistant Professor of Pediatrics
Director, Division of Neonatology George Washington University School of Medicine Division of Pediatric Allergy and Clinical
University of Alabama, Birmingham Hospital and Health Sciences Immunology
Birmingham, Alabama Program Director, Pediatric Emergency Medicine National Jewish Health
Overview of Mortality and Morbidity Fellowship University of Colorado School of Medicine
The Newborn Infant Children’s National Medical Center Denver, Colorado
High-Risk Pregnancies Washington, DC Ocular Allergies
The Fetus Principles Applicable to the Developing World Adverse Reactions to Drugs
The High-Risk Infant
Clinical Manifestations of Diseases in the Newborn Ira M. Cheifetz, MD, FCCM, FAARC Robert D. Christensen, MD
Period Professor of Pediatrics and Anesthesiology Professor and Presidential Endowed Chair
Nervous System Disorders Chief, Pediatric Critical Care Medicine Divisions of Neonatology and Hematology/
Delivery Room Emergencies Duke University School of Medicine Oncology
Respiratory Tract Disorders Chief Medical Officer, Children’s Services Department of Pediatrics
Digestive System Disorders Associate Chief Medical Officer, Duke Hospital University of Utah School of Medicine
Blood Disorders Duke Children’s Hospital Director of Neonatology Research
Genitourinary System Durham, North Carolina Intermountain Healthcare
The Umbilicus Pediatric Emergencies and Resuscitation Salt Lake City, Utah
Metabolic Disturbances Shock Development of the Hematopoietic System
The Endocrine System
Wassim Chemaitilly, MD Andrew Chu, MD
Robert B. Carrigan, MD Director, Endocrinology Division Attending Physician
Assistant Clinical Professor St. Jude Children’s Research Hospital Division of Gastroenterology
Department of Orthopaedic Surgery Memphis, Tennessee Children’s Hospital of Pittsburgh of UPMC
University of Pennsylvania Perelman School of Physiology of Puberty Pittsburgh, Pennsylvania
Medicine Disorders of Pubertal Development Superior Mesenteric Artery Syndrome (Wilkie
Pediatric Hand Surgeon Syndrome, Cast Syndrome, Arteriomesenteric
Children’s Hospital of Philadelphia Yuan-Tsong Chen, MD, PhD Duodenal Compression Syndrome)
Philadelphia, Pennsylvania Professor Ileus, Adhesions, Intussusception, and Closed-Loop
The Upper Limb Departments of Pediatrics and Genetics Obstructions
Duke University Medical Center
Mary T. Caserta, MD Durham, North Carolina Michael J. Chusid, MD
Professor of Pediatrics Defects in Metabolism of Carbohydrates Professor of Pediatrics
Division of Pediatric Infectious Diseases Chief, Pediatric Infectious Diseases
University of Rochester School of Medicine and Russell W. Chesney, MD Medical College of Wisconsin
Dentistry Le Bonheur Professor and Former Chair Medical Director, Infectious Diseases
Rochester, New York Department of Pediatrics Children’s Hospital of Wisconsin
Roseola (Human Herpesviruses 6 and 7) University of Tennessee Health Science Center Milwaukee, Wisconsin
Human Herpesvirus 8 Children’s Foundation Research Institute Infection Prevention and Control
Memphis, Tennessee Other Anaerobic Infections
Denise Casey, MD Rickets Associated with Renal Tubular Acidosis
Medical Officer Bone Structure, Growth, and Hormonal Regulation Col. Theodore J. Cieslak, MD, FAAP,
Pediatric Oncology, Neuro-Oncology, and Rare Primary Chondrodystrophy (Metaphyseal Dysplasia) FIDSA
Tumors Team Hypophosphatasia Pediatric Infectious Diseases
Office of Hematology and Oncology Products Hyperphosphatasia San Antonio Military Medical Center
Food and Drug Administration Osteoporosis Department of Pediatrics
U.S. Department of Health and Human Services Fort Sam Houston, Texas
Silver Spring, Maryland Jennifer A. Chiriboga, PhD Biologic and Chemical Terrorism
Hereditary Spherocytosis Pediatric and School Psychologist
Assistant Professor Jeff A. Clark, MD
Ellen Gould Chadwick, MD Department of Counseling, Psychology, and Associate Professor
Irene Heinz Given and John LaPorte Given Chair Special Education Department of Pediatrics
in Pediatrics Duquesne University School of Psychology Wayne State University School of Medicine
Professor and Associate Chair for Education Pittsburgh, Pennsylvania Pediatric ICU Fellowship Director
Department of Pediatrics Anxiety Disorders Children’s Hospital of Michigan
Northwestern University Feinberg School of Detroit, Michigan
Medicine Yvonne E. Chiu, MD Respiratory Distress and Failure
Associate Director, Section of Pediatric, Assistant Professor of Dermatology and Pediatrics Respiratory Pathophysiology and Regulation
Adolescent, and Maternal HIV Infection Medical College of Wisconsin
Ann & Robert H. Lurie Children’s Hospital of Milwaukee, Wisconsin Thomas G. Cleary, MD
Chicago Morphology of the Skin Professor of Pediatrics (Retired)
Chicago, Illinois Evaluation of the Patient University of Texas Health Sciences Center
Acquired Immunodeficiency Syndrome (Human Eczematous Disorders Houston, Texas
Immunodeficiency Virus) Photosensitivity Shigella
Diseases of the Epidermis Escherichia coli
Lisa J. Chamberlain, MD, MPH
Assistant Professor of Pediatrics John David Clemens, MD
Stanford University School of Medicine Director
Center for Health Policy International Vaccine Institute
Center for Primary Care and Outcomes Research Seoul, South Korea
Stanford, California International Immunization Practices
Chronic Illness in Childhood
 Contributors xi

Bria M. Coates, MD Joseph A. Congeni, MD Robert S. Daum, MD, CM

Instructor in Pediatrics Director, Sports Medicine Center Professor of Pediatrics, Microbiology, and
Northwestern University Feinberg School of Akron Children’s Hospital Molecular Medicine
Medicine Akron, Ohio; University of Chicago Pritzker School of Medicine
Division of Pediatric Critical Care Medicine Associate Professor of Pediatrics and Sports Department of Pediatric Infectious Diseases
Ann & Robert H. Lurie Children’s Hospital of Medicine The University of Chicago Medicine Comer
Chicago Northeast Ohio Medical University Children’s Hospital
Chicago, Illinois Rootstown, Ohio; Chicago, Illinois
Wheezing, Bronchiolitis, and Bronchitis Clinical Associate Professor of Pediatrics and Haemophilus influenzae
Sports Medicine
Thomas D. Coates, MD Ohio University College of Osteopathic Medicine Loren T. Davidson, MD
Professor of Pediatrics and Pathology Athens, Ohio Assistant Clinical Professor
University of Southern California Keck School of Sports-Related Traumatic Brain Injury (Concussion) Department of Physical Medicine and
Medicine Cervical Spinal Injuries Rehabilitation
Head, Section of Hematology University of California, Davis
Children’s Center for Cancer and Blood Diseases Christine M. Conroy, BS Davis, California;
Children’s Hospital of Los Angeles Villanova University Director, Spinal Cord Injury
Los Angeles, California Villanova, Pennsylvania Shriner’s Hospital for Children
Neutrophils Arthrogryposis Sacramento, California
Disorders of Phagocyte Function Spasticity
Amber R. Cooper, MD, MSCI
Joanna S. Cohen, MD Assistant Professor Richard S. Davidson, MD
Adjunct Assistant Professor of Emergency Division of Reproductive Endocrinology and Clinical Professor
Medicine Infertility Department of Orthopaedic Surgery
George Washington University School of Medicine Department of Obstetrics and Gynecology University of Pennsylvania Perelman School of
Division of Pediatric Emergency Medicine Washington University School of Medicine in St. Medicine
Children’s National Medical Center Louis Attending Orthopaedic Surgeon
Washington, DC St. Louis, Missouri Children’s Hospital of Philadelphia
Care of Abrasions and Minor Lacerations Vulvovaginal and Müllerian Anomalies Philadelphia, Pennsylvania
The Foot and Toes
Mitchell B. Cohen, MD Ronina A. Covar, MD Leg-Length Discrepancy
Professor and Chair, Department of Pediatrics Associate Professor Arthrogryposis
University of Alabama at Birmingham Department of Pediatrics
Physician-in-Chief, Children’s of Alabama National Jewish Health H. Dele Davies, MD, MS, MHCM
Birmingham, Alabama University of Colorado School of Medicine Vice-Chancellor for Academic Affairs
Clostridium difficile Infection Denver, Colorado Dean for Graduate Studies
Childhood Asthma University of Nebraska Medical Center
Michael Cohen-Wolkowiez, MD Omaha, Nebraska
Associate Professor of Pediatrics James E. Crowe Jr., MD Chancroid (Haemophilus ducreyi)
Division of Pediatric Infectious Diseases Professor of Pediatrics and Microbiology and Syphilis (Treponema pallidum)
Duke University School of Medicine Immunology Nonvenereal Treponemal Infections
Durham, North Carolina Ingram Professor of Research Leptospira
Principles of Antifungal Therapy Director, Vanderbilt Vaccine Center Relapsing Fever (Borrelia)
Vanderbilt University Medical Center
Robert A. Colbert, MD, PhD Nashville, Tennessee Najat C. Daw, MD
Deputy Clinical Director Respiratory Syncytial Virus Professor
National Institute of Arthritis and Musculoskeletal Human Metapneumovirus Division of Pediatrics
and Skin Diseases University of Texas MD Anderson Cancer Center
Chief, Pediatric Translational Branch Steve J. Czinn, MD Houston, Texas
National Institutes of Health Professor and Chair Neoplasms of the Kidney
Bethesda, Maryland Department of Pediatrics
Ankylosing Spondylitis and Other University of Maryland School of Medicine Peter S. Dayan, MD
Spondyloarthritides Baltimore, Maryland Assistant Professor of Clinical Pediatrics
Reactive and Postinfectious Arthritis Peptic Ulcer Disease in Children Columbia University College of Physicians and
Surgeons
F. Sessions Cole III, MD Josep O. Dalmau, MD, PhD Associate Director and Fellowship Director
Assistant Vice-Chancellor for Children’s Health Research Professor ICREA-IDIBAPS Division of Pediatric Emergency Medicine
Park J. White Professor of Pediatrics Department of Neurology Morgan Stanley Children’s Hospital of New
Professor of Cell Biology and Physiology Hospital Clinic York–Presbyterian
Washington University School of Medicine in St. Barcelona, Spain; New York, New York
Louis Adjunct Professor of Neurology Acute Care of the Victim of Multiple Trauma
Chief Medical Officer University of Pennsylvania Perelman School of
Vice-Chairman, Department of Pediatrics Medicine Michael R. DeBaun, MD, MPH
Director of Newborn Medicine Philadelphia, Pennsylvania Professor of Pediatrics and Medicine
St. Louis Children’s Hospital Autoimmune Encephalitis J.C. Peterson Chair in Pediatric Pulmonology
St. Louis, Missouri Vice-Chair for Clinical Research
Diffuse Lung Diseases in Childhood Toni Darville, MD Pediatrics Director, Vanderbilt-Maherry Center of
Professor of Pediatrics and Microbiology and Excellence in Sickle Cell Disease
John L. Colombo, MD Immunology Vanderbilt University
Professor of Pediatrics University of North Carolina at Chapel Hill School Nashville, Tennessee
University of Nebraska College of Medicine of Medicine Hemoglobinopathies
Division of Pediatric Pulmonology Vice-Chair for Pediatric Research
Nebraska Regional Cystic Fibrosis Center Chief, Division of Pediatric Infectious Diseases
University of Nebraska Medical Center NC Children’s Hospital
Omaha, Nebraska Chapel Hill, North Carolina
Aspiration Syndromes Neisseria gonorrhoeae (Gonococcus)
Chronic Recurrent Aspiration
xii Contributors
David R. DeMaso, MD
George P. Gardner and Olga E. Monks Professor of
Child Psychiatry
Professor of Pediatrics
Harvard Medical School
Psychiatrist-in-Chief and Chairman of Psychiatry
The Leon Eisenberg Chair in Psychiatry
Boston Children’s Hospital
Boston, Massachusetts
Assessment and Interviewing
Psychological Treatment of Children and Adolescents
Psychopharmacology
Psychotherapy
Psychiatric Hospitalization
Somatic Symptom and Related Disorders
Rumination and Pica
Motor Disorders and Habits
Mood Disorders
Suicide and Attempted Suicide
Disruptive, Impulse-Control, and Conduct Disorders
Autism Spectrum Disorder
Childhood Psychoses
Mark R. Denison, MD
Craig-Weaver Professor of Pediatrics
Division of Pediatric Infectious Disease
Vanderbilt University Medical Center
Nashville, Tennessee
Coronaviruses
Arlene E. Dent, MD, PhD
Assistant Professor of Pediatrics
Division of Infectious Diseases
Case Western Reserve University School of
Medicine
Cleveland, Ohio
Ascariasis (Ascaris lumbricoides)
Trichuriasis (Trichuris trichiura)
Enterobiasis (Enterobius vermicularis)
Strongyloidiasis (Strongyloides stercoralis)
Lymphatic Filariasis (Brugia malayi, Brugia timori,
and Wuchereria bancrofti)
Other Tissue Nematodes
Toxocariasis (Visceral and Ocular Larva Migrans)
Trichinosis (Trichinella spiralis)
Robert J. Desnick, MD, PhD
Dean for Genetics and Genomic Medicine
Professor and Chair Emeritus, Genetics and
Genomic Sciences
Professor, Departments of Pediatrics, Oncological
Sciences, and Obstetrics, Gynecology, and
Reproductive Science
Icahn School of Medicine at Mount Sinai
New York, New York
Lipidoses (Lysosomal Storage Disorders)
Mucolipidoses
Disorders of Glycoprotein Degradation and
Structure
The Porphyrias
Gabrielle A. deVeber, MD, MHSc
Professor of Paediatrics
Director, Children’s Stroke Program
University of Toronto Faculty of Medicine
Staff Neurologist
Senior Scientist, Child Health Evaluative Sciences
The Hospital for Sick Children
Toronto, Ontario, Canada
Pediatric Stroke
Anil Dhawan, MD
Consultant Paediatric Hepatologist
Pediatric Liver Centre
King’s College London School of Medicine
King’s College Hospital NSH Foundation Trust
London, United Kingdom
Liver and Biliary Disorders Causing Malabsorption
André A.S. Dick, MD, MPH, FACS Kelly A. Dougherty, PhD
Assistant Professor of Surgery Assistant Professor of Pediatrics
Division of Transplantation University of Pennsylvania Perelman School of
University of Washington School of Medicine Medicine
Division of Transplant Surgery Division of Gastroenterology, Hepatology, and
Seattle Children’s Hospital Nutrition
Seattle, Washington Children’s Hospital of Philadelphia
Intestinal Transplantation in Children with Philadelphia, Pennsylvania
Intestinal Failure Nutritional Requirements
Brianne Z. Dickey, MD Alexander Doyle, MBBS
Resident Physician HHMI Postdoctoral Research Fellow
Department of Dermatology Institute of Genetic Medicine
Medical College of Wisconsin Johns Hopkins University School of Medicine
Milwaukee, Wisconsin Baltimore, Maryland
Morphology of the Skin Marfan Syndrome
Evaluation of the Patient
Eczematous Disorders Daniel A. Doyle, MD
Photosensitivity Chief, Division of Endocrinology
Diseases of the Epidermis Alfred I. duPont Hospital for Children
Nemours Children’s Health System
Harry C. Dietz III, MD Wilmington, Delaware
Victor A. McKusick Professor of Medicine and Hormones and Peptides of Calcium Homeostasis
Genetics and Bone Metabolism
Departments of Pediatrics, Medicine, and Hypoparathyroidism
Molecular Biology and Genetics Pseudohypoparathyroidism (Albright Hereditary
Investigator, Howard Hughes Medical Institute Osteodystrophy)
Director, William S. Smilow Center for Marfan Hyperparathyroidism
Syndrome Research
Institute of Genetic Medicine Jefferson J. Doyle, MBBChir, MHS,
Johns Hopkins University School of Medicine MA
Baltimore, Maryland Postdoctoral Research Fellow
Marfan Syndrome Institute of Genetic Medicine
Johns Hopkins University School of Medicine
Lydia J. Donoghue, MD Baltimore, Maryland
Director, Trauma Center Marfan Syndrome
Children’s Hospital of Michigan
Detroit, Michigan Patrick C. Drayna, MD
Tumors of the Digestive Tract Assistant Professor of Pediatrics
Division of Pediatric Emergency Medicine
Patricia A. Donohoue, MD Medical College of Wisconsin
Professor of Pediatrics Children’s Hospital of Wisconsin
Chief, Section of Endocrinology and Diabetes Milwaukee, Wisconsin
Medical College of Wisconsin Evaluation of the Sick Child in the Office and Clinic
Program Director, Endocrine and Diabetes
Children’s Hospital of Wisconsin Stephen C. Dreskin, MD, PhD
Milwaukee, Wisconsin Professor of Medicine and Immunology
Development and Function of the Gonads Division of Allergy and Clinical Immunology
Hypofunction of the Testes Department of Medicine
Pseudoprecocity Resulting from Tumors of the Testes University of Colorado School of Medicine
Gynecomastia Aurora, Colorado
Hypofunction of the Ovaries Urticaria (Hives) and Angioedema
Pseudoprecocity Resulting from Lesions of the Ovary
Disorders of Sex Development Beth A. Drolet, MD
Professor of Dermatology
Mary K. Donovan, RN, CS, PNP Medical College of Wisconsin
Pediatric Nurse Practitioner and Care Coordinator Children’s Hospital of Wisconsin
Shriners Hospital for Children Milwaukee, Wisconsin
Shriners Burns Hospital Principles of Therapy (Skin)
Boston, Massachusetts Hyperpigmented Lesions
Burn Injuries Diseases of Subcutaneous Tissue
Cold Injuries Disorders of the Mucous Membranes
Cutaneous Bacterial Infections
John P. Dormans, MD Cutaneous Fungal Infections
Professor and The Richard M. Armstrong Jr. Cutaneous Viral Infections
Endowed Chair Arthropod Bites and Infestations
Department of Orthopaedic Surgery
University of Pennsylvania Perelman School of
Medicine
Chief, Division of Orthopaedic Surgery
Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania
Growth and Development
Evaluation of the Child
The Hip
Common Fractures

Yigal Dror, MD, FRCP(C)
Professor of Paediatrics
University of Toronto Faculty of Medicine
Head, Hematology Section Director, Marrow
Failure and Myelodysplasia Program
The Hospital for Sick Children
Toronto, Ontario, Canada
The Inherited Pancytopenias
Howard Dubowitz, MD, MS, FAAP
Professor of Pediatrics
Chief, Division of Child Protection
Director, Center for Families
Department of Pediatrics
University of Maryland School of Medicine
Baltimore, Maryland
Abused and Neglected Children
J. Stephen Dumler, MD
Professor of Pathology and Microbiology and
Immunology
University of Maryland School of Medicine
Baltimore, Maryland
Spotted Fever Group Rickettsioses
Scrub Typhus (Orientia tsutsugamushi)
Typhus Group Rickettsioses
Ehrlichioses and Anaplasmosis
Q Fever (Coxiella burnetii)
Aubrey N. Duncan, MD
Resident Physician
Department of Pediatrics
University of Rochester Medical Center
Rochester, New York
Deformational Plagiocephaly
Janet Duncan, MSN, CPNP
Department of Psychosocial Oncology and
Palliative Care
Boston Children’s Hospital
Dana-Farber Cancer Institute
Boston, Massachusetts
Pediatric Palliative Care
Paula M. Duncan, MD
Professor
Department of Pediatrics
University of Vermont College of Medicine
Burlington, Vermont
Maximizing Children’s Health: Screening,
Anticipatory Guidance, and Counseling
Jeffrey A. Dvergsten, MD
Assistant Professor of Pediatrics
Duke University School of Medicine
Division of Pediatric Rheumatology
Duke University Health System
Durham, North Carolina
Treatment of Rheumatic Diseases
Michael G. Earing, MD
Professor of Internal Medicine and Pediatrics
Division of Adult Cardiovascular Medicine and
Division of Pediatric Cardiology
Medical College of Wisconsin
Director, Wisconsin Adult Congenital Heart
Disease Program (WAtCH)
Children’s Hospital of Wisconsin
Milwaukee, Wisconsin
Congenital Heart Disease in Adults
Matthew D. Eberly, MD
Assistant Professor of Pediatrics
Uniformed Services University of the Health
Sciences
Bethesda, Maryland
Primary Amebic Meningoencephalitis
Contributors xiii
Elizabeth A. Edgerton, MD, MPH Susan Feigelman, MD
Assistant Professor Professor, Department of Pediatrics
Departments of Pediatrics and Preventive and University of Maryland School of Medicine
Community Health Baltimore, Maryland
George Washington University School of Medicine Overview and Assessment of Variability
Division of Emergency Medicine Assessment of Fetal Growth and Development
Children’s National Medical Center The First Year
Washington, DC The Second Year
Interfacility Transport of the Seriously Ill or Injured The Preschool Years
Pediatric Patient Middle Childhood
Marie E. Egan, MD Marianne E. Felice, MD
Associate Professor of Pediatrics (Respiratory) and Professor
of Cellular and Molecular Physiology Departments of Pediatrics and Obstetrics and
Director, Cystic Fibrosis Center Gynecology
Yale School of Medicine University of Massachusetts Medical School
New Haven, Connecticut Principle Investigator, National Children’s Study
Cystic Fibrosis UMass Study Center
Worcester, Massachusetts
Jack S. Elder, MD, FACS Adolescent Pregnancy
Chief of Pediatric Urology Adolescent Rape
Massachusetts General Hospital
Boston, Massachusetts Eric I. Felner, MD, MSCR
Congenital Anomalies and Dysgenesis of the Kidneys Associate Professor of Pediatrics
Urinary Tract Infections Division of Pediatric Endocrinology
Vesicoureteral Reflux Director, Pediatric Endocrinology Fellowship
Obstruction of the Urinary Tract Program
Anomalies of the Bladder Director, Pediatric Clerkships
Neuropathic Bladder Emory University School of Medicine
Enuresis and Voiding Dysfunction Atlanta, Georgia
Anomalies of the Penis and Urethra Hormones of the Hypothalamus and Pituitary
Disorders and Anomalies of the Scrotal Contents Hypopituitarism
Trauma to the Genitourinary Tract
Urinary Lithiasis Edward C. Fels, MD
Pediatric and Adult Rheumatology
Dianne S. Elfenbein, MD Rheumatology Associates, PA
Professor of Pediatrics Portland, Maine
Director, Division of Adolescent Medicine Vasculitis Syndromes
St. Louis University School of Medicine
St. Louis, Missouri Kora N. Felsch, MD
Adolescent Pregnancy Hospitalist
Cardinal Glennon Children’s Medical Center
Stephen C. Eppes, MD, FAAP St. Louis, Missouri
Professor of Pediatrics Breast Concerns
Jefferson Medical College of Thomas Jefferson
University Thomas W. Ferkol Jr., MD
Philadelphia, Pennsylvania; Alexis Hartmann Professor of Pediatrics
Director, Pediatric Infectious Diseases Director, Division of Pediatric Allergy,
Christiana Care Health System Immunology, and Pulmonary Medicine
Wilmington, Delaware Washington University School of Medicine in
Lyme Disease (Borrelia burgdorferi) St. Louis
St. Louis, Missouri
Jessica Ericson, MD Primary Ciliary Dyskinesia (Immotile Cilia
Pediatric Infectious Diseases Fellow Syndrome, Kartagener Syndrome)
Duke University Medical Center
Durham, North Carolina Can H. Ficicioglu, MD, PhD
Candida Associate Professor
Department of Pediatrics
Alessio Fasano, MD University of Pennsylvania Perelman School of
Visiting Professor of Pediatrics Medicine
Harvard Medical School Director, Newborn Metabolic Screening Program
Chief, Division of Pediatric Gastroenterology and Children’s Hospital of Philadelphia
Nutrition Philadelphia, Pennsylvania
Associate Chief, Department of Pediatrics, Basic, Phenylalanine
Clinical, and Translational Research
Director, Center for Celiac Research Jonathan D. Finder, MD
MassGeneral Hospital for Children Professor of Pediatrics
Boston, Massachusetts University of Pittsburgh School of Medicine
Celiac Disease (Gluten-Sensitive Enteropathy) Attending Pediatric Pulmonologist
Division of Pediatric Pulmonology
Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Bronchomalacia and Tracheomalacia
Congenital Disorders of the Lung
xiv Contributors

Kristin N. Fiorino, MD Megan Culler Freeman, PhD Sheila S. Galbraith, MD

Assistant Professor of Clinical Pediatrics
University of Pennsylvania Perelman School of
Medicine
Attending Physician
Division of Gastroenterology, Hepatology, and
Nutrition
The Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania
Motility Disorders and Hirschsprung Disease
Philip R. Fischer, MD
Professor of Pediatrics
Mayo Clinic
Rochester, Minnesota
Adult Tapeworm Infections
Cysticercosis
Echinococcosis (Echinococcus granulosus and
Echinococcus multilocularis)
Veronica H. Flood, MD
Associate Professor of Pediatrics
Division of Pediatric Hematology/Oncology
Medical College of Wisconsin
Milwaukee, Wisconsin
Hereditary Clotting Factor Deficiencies (Bleeding
Disorders)
von Willebrand Disease
Thrombocytopenia from Acquired Disorders Causing
Decreased Production
Patricia M. Flynn, MD
Deputy Clinical Director
Arthur Ashe Chair in Pediatric AIDS Research
Director, Clinical Research, Infectious Diseases
St. Jude Children’s Research Hospital
Professor of Pediatrics and Preventive Medicine
University of Tennessee College of Medicine
Memphis, Tennessee
Infection Associated with Medical Devices
Cryptosporidium, Isospora, Cyclospora, and
Microsporidia
Joel A. Forman, MD
Associate Professor of Pediatrics and Preventive
Medicine
Vice-Chair for Education
Department of Pediatrics
Icahn School of Medicine at Mount Sinai
New York, New York
Chemical Pollutants
Michael M. Frank, MD
Samuel L. Katz Professor of Pediatrics, Medicine,
and Immunology
Duke University School of Medicine
Durham, North Carolina
Urticaria (Hives) and Angioedema
Melvin H. Freedman, MD, FRCP(C),
FAAP
Professor Emeritus of Pediatrics
University of Toronto Faculty of Medicine
Honorary Consultant, Hematology/Oncology
The Hospital for Sick Children
Toronto, Ontario, Canada
The Inherited Pancytopenias
Departments of Pediatrics and Pathology,
Microbiology, and Immunology
Vanderbilt University School of Medicine
Nashville, Tennessee
Coronaviruses
Melissa J. Frei-Jones, MD, MSCI
Assistant Professor of Pediatrics
Division of Pediatric Hematology/Oncology
University of Texas Health Sciences Center
Santa Rosa Children’s Hospital
San Antonio, Texas
Hemoglobinopathies
Deborah Friedman, MD
Assistant Clinical Professor of Pediatrics
Case Western Reserve University School of
Medicine
Cleveland, Ohio
Neonatal Lupus
Erika Friehling, MD
Assistant Professor of Pediatrics
University of Pittsburgh School of Medicine
Division of Pediatric Hematology/Oncology
Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Principles of Diagnosis (Cancer and Benign
Tumors)
Principles of Treatment (Cancer and Benign
Tumors)
The Leukemias
Donald P. Frush, MD
Professor of Radiology
Chief, Division of Pediatric Radiology
Duke University Medical Center
Durham, North Carolina
Biologic Effects of Radiation on Children
James T. Gaensbauer, MD, MSc
Assistant Professor of Pediatrics
University of Colorado School of Medicine
Divisions of Hospital Medicine and Infectious
Diseases
Children’s Hospital Colorado
Aurora, Colorado
Staphylococcus
Sheila Gahagan, MD, MPH
Professor and Chief
Academic General Pediatrics, Child Development,
and Community Health
Martin Stein Endowed Chair, Developmental-
Behavioral Pediatrics
University of California, San Diego
La Jolla, California
Overweight and Obesity
William A. Gahl, MD, PhD
Clinical Director, National Human Genome
Research Institute
Director, NIH Undiagnosed Diseases Program
National Institutes of Health
Bethesda, Maryland
Genetic Approaches to Rare and Undiagnosed
Diseases
Associate Professor of Dermatology
Medical College of Wisconsin
Children’s Hospital of Wisconsin
Milwaukee, Wisconsin
Hypopigmented Lesions
Diseases of the Dermis
Acne
William B. Gallentine, DO
Assistant Professor of Pediatrics
Duke University School of Medicine
Division of Pediatric Neurology
Duke University Health System
Durham, North Carolina
Central Nervous System Vasculitis
Paula M. Gardiner, MD, MPH
Assistant Professor
Department of Family Medicine
Boston University School of Medicine
Assistant Director, Integrative Medicine
Boston Medical Center
Boston, Massachusetts
Complementary Therapies and Integrative Medicine
Luigi R. Garibaldi, MD
Professor of Pediatrics
University of Pittsburgh School of Medicine
Clinical Director
Division of Pediatric Endocrinology
Children’s Hospital of UPMC
Pittsburgh, Pennsylvania
Physiology of Puberty
Disorders of Pubertal Development
Gregory M. Gauthier, MD, MS
Assistant Professor of Medicine
Division of Infectious Diseases
University of Wisconsin School of Medicine
Madison, Wisconsin
Blastomycosis (Blastomyces dermatitidis)
K. Michael Gibson, PhD
Allen I. White Distinguished Professor and Chair
Experimental and Systems Pharmacology
Washington State University College of
Pharmacology
Spokane, Washington
Genetic Disorders of Neurotransmitters
Mark Gibson, MD
Professor (Clinical) Emeritus
Department of Obstetrics and Gynecology
Chief, Division of Reproductive Endocrinology
University of Utah School of Medicine
Salt Lake City, Utah
Polycystic Ovary Syndrome and Hirsutism
Francis Gigliotti, MD
Professor of Pediatrics and Microbiology and
Immunology
Lindsey Distinguished Professor for Pediatric
Research
University of Rochester School of Medicine and
Dentistry
Division of Pediatric Infectious Diseases
University of Rochester Medical Center
Rochester, New York
Pneumocystis jiroveci (Pneumocystis carinii)
 Contributors xv

Walter S. Gilliam, MSEd, PhD Leslie B. Gordon, MD, PhD Larry A. Greenbaum, MD, PhD
Associate Professor Associate Professor of Pediatrics Research Marcus Professor of Pediatrics
Department of Psychology Warren Alpert Medical School of Brown University Director, Division of Pediatric Nephrology
Child Study Center Providence, Rhode Island; Emory University School of Medicine
Director, The Edward Zigler Center in Child Department of Anesthesia Children’s Healthcare of Atlanta
Development and Social Policy Boston Children’s Hospital Atlanta, Georgia
Yale School of Medicine Harvard Medical School Rickets and Hypervitaminosis D
New Haven, Connecticut Boston, Massachusetts; Vitamin E Deficiency
Childcare: How Pediatricians Can Support Children Medical Director, The Progeria Research Vitamin K Deficiency
and Families Foundation Micronutrient Mineral Deficiencies
Peabody, Massachusetts Electrolyte and Acid-Base Disorders
Salil Ginde, MD, MPH Hutchinson-Gilford Progeria Syndrome Maintenance and Replacement Therapy
Assistant Professor of Pediatrics Deficit Therapy
Division of Pediatric Cardiology Marc H. Gorelick, MD, MSCE Fluid and Electrolyte Treatment of Specific Disorders
Medical College of Wisconsin Professor of Pediatrics
Milwaukee, Wisconsin Medical College of Wisconsin Anne G. Griffiths, MD
Congenital Heart Disease in Adults Children’s Hospital of Wisconsin Instructor in Pediatrics
Milwaukee, Wisconsin Northwestern University Feinberg School of
Charles M. Ginsburg, MD Evaluation of the Sick Child in the Office and Clinic Medicine
Senior Associate Dean for Academic Hospitalist, Neonatal Intensive Care Unit
Administration Jane M. Gould, MD, FAAP Ann & Robert H. Lurie Children’s Hospital of
Professor of Pediatrics Associate Professor of Pediatrics Chicago
Marilyn R. Corrigan Distinguished Chair in Drexel University College of Medicine Chicago, Illinois
Pediatric Research Attending Physician, Infectious Diseases Chronic or Recurrent Respiratory Symptoms
University of Texas Southwestern Medical Center St. Christopher’s Hospital for Children
Houston, Texas Philadelphia, Pennsylvania Allison Grimes, MD
Animal and Human Bites Cryptococcus neoformans Fellow in Pediatric Hematology/Oncology
Histoplasmosis (Histoplasma capsulatum) University of Texas Health Sciences Center
John A. Girotto, MD, MMA, FAAP, Paracoccidioides brasiliensis San Antonio, Texas
FACS Zygomycosis (Mucormycosis) Abnormal Hemoglobins Causing Cyanosis
Associate Professor of Pediatrics, Neurosurgery, Hereditary Methemoglobinemia
and Plastic and Reconstructive Surgery Olivier Goulet, MD Hereditary Methemoglobinemia with Deficiency of
Director, Cleft and Craniofacial Anomalies Center Professor of Pediatrics NADH Cytochrome B5 Reductase
Golisano Children’s Hospital at Strong University of Paris V—René Descartes
University of Rochester Medical Center Head, Division of Pediatric Gastroenterology- Natalia M. Grindler, MD
Rochester, New York Hepatology and Nutrition Resident Physician
Deformational Plagiocephaly Hôpital Necker-Enfants Malades/AP-HP Department of Obstetrics and Gynecology
Paris, France Washington University School of Medicine in St.
Lisa Giulino-Roth, MD Other Malabsorptive Syndromes Louis
Assistant Professor of Pediatrics St. Louis, Missouri
Division of Pediatric Hematology/Oncology Deanna M. Green, MD, MHS Vulvovaginal and Müllerian Anomalies
Weill Cornell Medical College Assistant Professor of Pediatrics
New York, New York Division of Pediatric Pulmonary and Sleep Kenneth L. Grizzle, PhD
Lymphoma Medicine Associate Professor
Duke University School of Medicine Child Development Center—Brookfield
Frances Page Glascoe, PhD Durham, North Carolina Medical College of Wisconsin
Professor Cystic Fibrosis Brookfield, Wisconsin
Department of Pediatrics Childhood-Onset Fluency Disorder: Dysfluency
Vanderbilt University School of Medicine Michael Green, MD, MPH (Stuttering, Stammering)
Nashville, Tennessee Professor of Pediatrics and Surgery
Developmental-Behavioral Screening and University of Pittsburgh School of Medicine Veronique Groleau, MD
Surveillance Division of Pediatric Infectious Diseases Fellow
Children’s Hospital of Pittsburgh of UPMC Division of Gastroenterology, Hepatology, and
Denise M. Goodman, MD, MS Pittsburgh, Pennsylvania Nutrition
Professor Infections in Immunocompromised Persons Children’s Hospital of Philadelphia
Department of Pediatrics Philadelphia, Pennsylvania
Northwestern University Feinberg School of Thomas P. Green, MD Nutritional Requirements
Medicine Founders’ Board Centennial Professor and Chair Feeding Healthy Infants, Children, and Adolescents
Ann & Robert H. Lurie Children’s Hospital of Department of Pediatrics
Chicago Northwestern University Feinberg School of Andrew B. Grossman, MD
Chicago, Illinois Medicine Assistant Professor of Clinical Pediatrics
Wheezing, Bronchiolitis, and Bronchitis Physician-in-Chief University of Pennsylvania Perelman School of
Ann & Robert H. Lurie Children’s Hospital of Medicine
Alison Gopnik, PhD Chicago Co-Director, Center for Pediatric Inflammatory
Professor of Psychology and Affiliate Professor of Chicago, Illinois Bowel Disease
Philosophy Diagnostic Approach to Respiratory Disease The Children’s Hospital of Philadelphia
University of California at Berkeley Chronic or Recurrent Respiratory Symptoms Philadelphia, Pennsylvania
Berkeley, California Pulmonary Edema Inflammatory Bowel Disease
Cognitive Development: Domains and Theories
xvi Contributors

David C. Grossman, MD, MPH Scott B. Halstead, MD Lindsay A. Hatzenbuehler, MD, MPH
Senior Investigator Group Health Research Professor of Pediatrics and Medical Genetics Pediatric Infectious Diseases Fellow
Institute University of British Columbia Faculty of Medicine Baylor College of Medicine
Professor of Health Services British Columbia’s Children’s Hospital Texas Children’s Hospital
University of Washington School of Public Health Vancouver, British Columbia, Canada Houston, Texas
Adjunct Professor of Pediatrics Arboviral Infections in North America Tuberculosis (Mycobacterium tuberculosis)
University of Washington School of Medicine Arboviral Infections Outside North America
Seattle, Washington Dengue Fever and Dengue Hemorrhagic Fever Fern R. Hauck, MD, MS
Injury Control Yellow Fever Spencer P. Bass MD Twenty-First Century
Ebola and Other Viral Hemorrhagic Fevers Professor of Family Medicine
Alfredo Guarino, MD Hantavirus Pulmonary Syndrome Departments of Family Medicine and Public
Professor Health Sciences
Department of Pediatrics Margaret R. Hammerschlag, MD Director, International Family Medicine Clinic
University of Naples Federico II Professor of Pediatrics and Medicine University of Virginia School of Medicine
Napoli, Italy Director, Division of Pediatric Infectious Diseases Charlottesville, Virginia
Chronic Diarrhea SUNY Down State Medical Center Sudden Infant Death Syndrome
Brooklyn, New York
Reut Gurion, DO Chlamydia (Chlamydophila) pneumoniae Fiona P. Havers, MD, MHS
Pediatric Rheumatology Fellow Chlamydia trachomatis Epidemic Intelligence Service Office
Division of Rheumatology Psittacosis (Chlamydia psittaci) Epidemiology and Prevention Branch, Influenza
University Hospitals Case Medical Center Division
Rainbow Babies & Children’s Hospital Aaron Hamvas, MD National Center for Immunization and Respiratory
Cleveland, Ohio Raymond and Hazel Speck Barry Professor of Diseases
Miscellaneous Conditions Associated with Arthritis Neonatology Centers for Disease Control and Prevention
Head, Division of Neonatology Atlanta, Georgia
Lisa R. Hackney, MD Ann & Robert H. Lurie Children’s Hospital of Influenza Viruses
Assistant Professor of Pediatrics Chicago
Division of Pediatric Hematology/Oncology Northwestern University Feinberg School of Jacqueline T. Hecht, PhD
Cleveland Clinic Foundation Medicine Professor and Division Head
Cleveland, Ohio Chicago, Illinois Leah L. Lewis Distinguished Chair
Hereditary Stomatocytosis Diffuse Lung Diseases in Childhood Pediatric Research Center
Glucose-6-Phosphate Dehydrogenase Deficiency and Vice-Chair for Research
Related Deficiencies Abeer J. Hani, MD Department of Pediatrics
Resident Physician UT Health Medical School of Houston
Gabriel G. Haddad, MD Division of Pediatric Neurology Associate Dean for Research
Distinguished Professor and Chair Duke University Medical Center UT Health School of Dentistry
Department of Pediatrics Durham, North Carolina Houston, Texas
University of California, San Diego Seizures in Childhood General Considerations (Bone and Joint Disorders)
Physician-in-Chief Disorders Involving Cartilage Matrix Proteins
Chief Scientific Officer James C. Harris, MD Disorders Involving Transmembrane Receptors
Rady Children’s Hospital Professor of Pediatrics, Psychiatry and Behavioral Disorders Involving Ion Transporters
San Diego, California Sciences, Mental Health, and History of Disorders Involving Transcription Factors
Diagnostic Approach to Respiratory Disease Medicine Disorders Involving Defective Bone Resorption
Division of Child and Adolescent Psychiatry Disorders for Which Defects Are Poorly Understood
Joseph Haddad Jr., MD Director, Developmental Neuropsychiatry or Unknown
Howard W. Smith Professor and Interim Chair Johns Hopkins University School of Medicine
Lawrence Savetsky Professor Baltimore, Maryland Sabrina M. Heidemann, MD
Department of Otolaryngology—Head and Neck Disorders of Purine and Pyrimidine Metabolism Professor
Surgery Department of Pediatrics
Columbia University College of Physicians and Mary E. Hartman, MD, MPH Wayne State University School of Medicine
Surgeons Assistant Professor of Pediatrics Director, Intensive Care Unit
Director, Pediatric Otolaryngology—Head and Washington University in St. Louis Co-Director of Transport
Neck Surgery Pediatric Critical Care Medicine Children’s Hospital of Michigan
New York-Presbyterian Morgan Stanley Children’s St. Louis Children’s Hospital Detroit, Michigan
Hospital St. Louis, Missouri Respiratory Pathophysiology and Regulation
New York, New York Pediatric Emergencies and Resuscitation
Congenital Disorders of the Nose J. Owen Hendley, MD
Acquired Disorders of the Nose David B. Haslam, MD Professor
Nasal Polyps Associate Professor of Pediatrics Department of Pediatrics
General Considerations and Evaluation (Ear) University of Cincinnati College of Medicine University of Virginia School of Medicine
Hearing Loss Director, Antimicrobial Stewardship Program Charlottesville, Virginia
Congenital Malformations Clinical Director, Division of Infectious Diseases Sinusitis
External Otitis (Otitis Externa) Cincinnati Children’s Hospital Medical Center Retropharyngeal Abscess, Lateral Pharyngeal
The Inner Ear and Diseases of the Bony Labyrinth Cincinnati, Ohio (Parapharyngeal) Abscess, and Peritonsillar
Traumatic Injuries of the Ear and Temporal Bone Non–Group A or B Streptococci Cellulitis/Abscess
Tumors of the Ear and Temporal Bone Enterococcus
Frederick M. Henretig, MD
Joseph F. Hagan Jr., MD H. Hesham Abdel-Kader Hassan, MD Division of Emergency Medicine
Clinical Professor Professor of Pediatrics Children’s Hospital of Philadelphia
Department of Pediatrics Chief, Division of Pediatric Gastroenterology and Professor Emeritus of Pediatrics
University of Vermont College of Medicine Nutrition Perelman School of Medicine
Hagan, Rinehart, and Connolly Pediatricians, The University of Arizona College of Medicine University of Pennsylvania
PLLC Tucson, Arizona Philadelphia, Pennsylvania
Burlington, Vermont Cholestasis Biologic and Chemical Terrorism
Maximizing Children’s Health: Screening,
Anticipatory Guidance, and Counseling
 Contributors xvii

Gloria P. Heresi, MD Jeffrey D. Hord, MD Stephen A. Huang, MD

Professor of Pediatrics Director, Showers Family Center for Childhood Assistant Professor of Pediatrics
Director, Division of Pediatric Infectious Diseases Cancer and Blood Disorders Harvard Medical School
University of Texas Health Sciences Center Associate Chair of Pediatrics for Subspecialty Director, Thyroid Program
Houston, Texas Practices Division of Endocrinology
Campylobacter Akron Children’s Hospital Boston Children’s Hospital
Yersinia Akron, Ohio Boston, Massachusetts
Aeromonas and Plesiomonas The Acquired Pancytopenias Thyroid Development and Physiology
Defects of Thyroxine-Binding Globulin
Andrew D. Hershey, MD, PhD, FAHS B. David Horn, MD Hypothyroidism
Professor of Pediatrics and Neurology Assistant Professor Thyroiditis
University of Cincinnati College of Medicine Department of Orthopaedic Surgery Goiter
Endowed Chair, Division of Neurology University of Pennsylvania Perelman School of Hyperthyroidism
Cincinnati Children’s Hospital Medical Center Medicine Carcinoma of the Thyroid
Cincinnati, Ohio Attending Orthopaedic Surgeon
Headaches Children’s Hospital of Philadelphia Heather G. Huddleston, MD
Philadelphia, Pennsylvania Assistant Professor
Cynthia E. Herzog, MD The Hip Department of Obstetrics, Gynecology, and
Professor of Pediatrics Reproductive Sciences
University of Texas MD Anderson Cancer Center Helen M. Horstmann, MD University of California, San Francisco School of
Houston, Texas Associate Professor Medicine
Retinoblastoma Department of Orthopaedic Surgery San Francisco, California
Gonadal and Germ Cell Neoplasms University of Pennsylvania Perelman School of Polycystic Ovary Syndrome and Hirsutism
Neoplasms of the Liver Medicine
Benign Vascular Tumors Attending Physician Vicki Huff, PhD
Melanoma Children’s Hospital of Philadelphia Professor
Nasopharyngeal Carcinoma Philadelphia, Pennsylvania Department of Molecular Genetics/Cancer
Adenocarcinoma of the Colon and Rectum Arthrogryposis Genetics
Desmoplastic Small Round Cell Tumor University of Texas MD Anderson Cancer Center
William A. Horton, MD Houston, Texas
Jessica Hochberg, MD Professor Neoplasms of the Kidney
Assistant Professor of Pediatrics Department of Molecular Medical Genetics
Division of Pediatric Hematology, Oncology, and Oregon Health & Science University Denise Hug, MD
Stem Cell Transplant Director of Research Associate Professor
New York Medical College Shriners Hospitals for Children Department of Ophthalmology
Maria Fareri Children’s Hospital at Westchester Portland, Oregon University of Missouri—Kansas City School of
Medical Center General Considerations (Bone and Joint Disorders) Medicine
Valhalla, New York Disorders Involving Cartilage Matrix Proteins Children’s Mercy Hospital
Lymphoma Disorders Involving Transmembrane Receptors Kansas City, Missouri
Disorders Involving Ion Transporters Growth and Development (Eye)
Holly R. Hoefgen, MD Disorders Involving Transcription Factors Examination of the Eye
Fellow, Department of Obstetrics and Gynecology Disorders Involving Defective Bone Resorption Abnormalities of Refraction and Accommodation
Washington University School of Medicine in St. Disorders for Which Defects Are Poorly Understood Disorders of Vision
Louis or Unknown Abnormalities of Pupil and Iris
St. Louis, Missouri Disorders of Eye Movement and Alignment
Vulvovaginitis Peter J. Hotez, MD, PhD, FASTMH, Abnormalities of the Lids
FAAP Disorders of the Lacrimal System
Lauren D. Holinger, MD, FAAP, FACS Founding Dean, National School of Tropical Disorders of the Conjunctiva
Paul H. Holinger MD Professor and Interim Head, Medicine Abnormalities of the Cornea
Division of Otolaryngology Professor of Pediatrics and Molecular Virology and Abnormalities of the Lens
Department of Pediatrics Microbiology Disorders of the Uveal Tract
Northwestern University Feinberg School of Baylor College of Medicine Disorders of the Retina and Vitreous
Medicine Endowed Chair in Tropical Pediatrics Abnormalities of the Optic Nerve
Ann & Robert H. Lurie Children’s Hospital of Texas Children’s Hospital Childhood Glaucoma
Chicago Houston, Texas Orbital Abnormalities
Chicago, Illinois Hookworms (Necator americanus and Ancylostoma Orbital Infections
Congenital Anomalies of the Larynx, Trachea, and spp.) Injuries to the Eye
Bronchi
Foreign Bodies in the Airway Evelyn Hsu, MD Dennis P.M. Hughes, MD, PhD
Laryngotracheal Stenosis and Subglottic Stenosis Assistant Professor of Pediatrics Associate Professor of Pediatrics
Neoplasms of the Larynx, Trachea, and Bronchi Seattle Children’s Hospital University of Texas MD Anderson Cancer Center
Seattle, Washington Houston, Texas
Cynthia Holland-Hall, MD, MPH Liver Transplantation Melanoma
Associate Clinical Professor of Clinical Pediatrics
The Ohio State University College of Medicine Winston W. Huh, MD
Section of Adolescent Medicine Assistant Professor of Pediatrics
Nationwide Children’s Hospital University of Texas MD Anderson Cancer Center
Columbus, Ohio Houston, Texas
Adolescent Physical and Social Development Gonadal and Germ Cell Neoplasms
Transitioning to Adult Care Adenocarcinoma of the Colon and Rectum
The Breast
xviii Contributors

Stephen R. Humphrey, MD Tara Jatlaoui, MD, MPH Bridgette L. Jones, MD

Resident Physician Research Assistant Professor Associate Professor of Pediatrics
Department of Dermatology Department of Obstetrics and Gynecology Division of Allergy, Asthma, and Immunology
Medical College of Wisconsin The University of North Carolina at Chapel Hill University of Missouri—Kansas City School of
Children’s Hospital of Wisconsin Guest Researcher, Division of Reproductive Health Medicine
Milwaukee, Wisconsin Centers for Disease Control and Prevention Section of Clinical Pharmacology and Medical
Principles of Therapy (Skin) Atlanta, Georgia Toxicology
Contraception Children’s Mercy Hospitals and Clinics
David A. Hunstad, MD Kansas City, Missouri
Associate Professor of Pediatrics and Molecular M. Kyle Jensen, MD Principles of Drug Therapy
Microbiology Assistant Professor of Pediatrics
Washington University School of Medicine in St. University of Utah School of Medicine James F. Jones, MD
Louis Division of Pediatric Gastroenterology Research Medical Officer
St. Louis, Missouri Primary Children’s Hospital Viral Exanthems and Herpesvirus Branch
Animal and Human Bites Salt Lake City, Utah Division of Viral and Rickettsial Diseases
Viral Hepatitis National Center for Infectious Diseases
Carl E. Hunt, MD Centers for Disease Control and Prevention
Research Professor of Pediatrics Hal B. Jenson, MD, MBA Atlanta, Georgia
Uniformed Services University of the Health Founding Dean Chronic Fatigue Syndrome
Sciences Professor, Department of Pediatric and Adolescent
Division of Neonatology Medicine Marsha Joselow, MSW, LICSW
Walter Reed National Military Medical Center Western Michigan University Department of Psychosocial Oncology and
Bethesda, Maryland; Homer Stryker M.D. School of Medicine Palliative Care
Adjunct Professor of Pediatrics Kalamazoo, Michigan Boston Children’s Hospital
George Washington University School of Medicine Chronic Fatigue Syndrome Dana-Farber Cancer Institute
Washington, DC Epstein-Barr Virus Boston, Massachusetts
Sudden Infant Death Syndrome Human T-Lymphotropic Viruses (1 and 2) Pediatric Palliative Care

Anna K. Hunter, MD Chandy C. John, MD, MS Nicholas Jospe, MD

Assistant Clinical Professor of Pediatrics Ryan White Professor of Pediatrics Professor of Pediatrics
University of California, San Francisco Professor of Pediatrics, Microbiology and Division of Pediatric Endocrinology
UCSF Fresno Center for Medical Education and Immunology Golisano Children’s Hospital
Research Director, Ryan White Center for Pediatric University of Rochester Medical Center
Fresno, California; Infectious Diseases and Global Health Rochester, New York
Pediatric Gastroenterologist Indiana University School of Medicine Diabetes Mellitus
Children’s Hospital Central California Riley Hospital for Children at Indiana University
Madera, California Health Joel C. Joyce, MD
Pyloric Stenosis and Other Congenital Anomalies of Indianapolis, Indiana Pediatric Dermatology
the Stomach Health Advice for Children Traveling Internationally NorthShore University HealthSystem
Giardiasis and Balantidiasis Skokie, Illinois;
Stacey S. Huppert, PhD Malaria (Plasmodium) Clinician Educator
Associate Professor of Pediatrics University of Chicago Pritzker School of Medicine
University of Cincinnati College of Medicine Collin C. John, MD, MPH, FAAP Chicago, Illinois
Division of Gastroenterology, Hepatology, and Assistant Professor of Internal Medicine and Vesiculobullous Disorders
Nutrition Pediatrics Nutritional Dermatoses
Division of Developmental Biology Medical Director, West Virginia Birth Score
Cincinnati Children’s Hospital Medical Center Program Anna M. Juern, MD
Cincinnati, Ohio West Virginia University School of Medicine Division of Pediatric Dermatology
Morphogenesis of the Liver and Biliary System Morgantown, West Virginia Medical College of Wisconsin
Disorders of Lipoprotein Metabolism and Transport Milwaukee, Wisconsin
Patricia I. Ibeziako, MD Hyperpigmented Lesions
Assistant Professor of Psychiatry Michael V. Johnston, MD Cutaneous Bacterial Infections
Harvard Medical School Professor of Neurology, Pediatrics, and Physical Cutaneous Fungal Infections
Director, Psychiatry Consultation Service Medicine and Rehabilitation Cutaneous Viral Infections
Boston Children’s Hospital Johns Hopkins University School of Medicine Arthropod Bites and Infestations
Boston, Massachusetts Kennedy Krieger Institute
Somatic Symptom and Related Disorders Baltimore, Maryland Marielle A. Kabbouche, MD
Congenital Anomalies of the Central Nervous System Associate Professor of Pediatrics and Neurology
Samar H. Ibrahim, MBChB Encephalopathies University of Cincinnati College of Medicine
Assistant Professor of Pediatrics Division of Neurology
Division of Pediatric Gastroenterology and Richard B. Johnston Jr., MD Cincinnati Children’s Hospital Medical Center
Hepatology Professor of Pediatrics Cincinnati, Ohio
Mayo Clinic Associate Dean for Research Development Headaches
Rochester, Minnesota University of Colorado School of Medicine
Mitochondrial Hepatopathies Aurora, Colorado; Linda Kaljee, PhD, MAA
National Jewish Health Associate Professor
Richard F. Jacobs, MD, FAAP Denver, Colorado Department of Pediatrics
Robert H. Fiser Jr. MD Endowed Chair in Monocytes, Macrophages, and Dendritic Cells Prevention Research Center
Pediatrics The Complement System Wayne State University School of Medicine
Professor and Chair, Department of Pediatrics Disorders of the Complement System Detroit, Michigan
University of Arkansas for Medical Sciences Cultural Issues in Pediatric Care
Pediatrician-in-Chief
Arkansas Children’s Hospital
Little Rock, Arkansas
Actinomyces
Nocardia
Tularemia (Francisella tularensis)
Brucella
 Contributors xix

Deepak Kamat, MD, PhD, FAAP Virginia A. Keane, MD Judith R. Kelsen, MD

Professor and Vice-Chair of Education Associate Professor Assistant Professor of Pediatrics
Department of Pediatrics Department of Pediatrics University of Pennsylvania Perelman School of
Wayne State University School of Medicine University of Maryland School of Medicine Medicine
Designated Institutional Official Baltimore, Maryland Attending Physician
Children’s Hospital of Michigan Assessment of Growth Division of Gastroenterology, Hepatology, and
Detroit, Michigan Nutrition
Fever Gregory L. Kearns, PharmD, PhD The Children’s Hospital of Philadelphia
Fever Without a Focus Marion Merrell Dow / Missouri Chair of Medical Philadelphia, Pennsylvania
Research Foreign Bodies and Bezoars
Alvina R. Kansra, MD Professor of Pediatrics and Pharmacology
Assistant Professor of Pediatrics University of Missouri—Kansas City School of Kathi J. Kemper, MD, MPH
Medical College of Wisconsin Medicine Director, OSU Center for Integrative Health and
Division of Endocrinology Chief Scientific Officer and Chairman, Research Wellness
Children’s Hospital of Wisconsin Development and Clinical Investigation Professor of Pediatrics, Nursing, and Health and
Milwaukee, Wisconsin Associate Chair, Department of Pediatrics Rehabilitation Sciences
Hypofunction of the Ovaries Director, Pediatric Trial Network Ohio State University Wexner Medical Center
Pseudoprecocity Resulting from Lesions of the Ovary Children’s Mercy Hospitals and Clinics Nationwide Children’s Hospital
Kansas City, Missouri; Columbus, Ohio
Sheldon L. Kaplan, MD Clinical Professor of Pediatrics Complementary Therapies and Integrative Medicine
Professor and Vice-Chair for Clinical Affairs University of Kansas School of Medicine
Department of Pediatrics Kansas City, Kansas Melissa Kennedy, MD
Baylor College of Medicine Principles of Drug Therapy Attending Physician
Head, Department of Pediatric Medicine Division of Gastroenterology, Hepatology, and
Chief, Section of Infectious Disease Sarah E. Keesecker, MD Nutrition
Texas Children’s Hospital Postdoctoral Residency Fellow The Children’s Hospital of Philadelphia
Houston, Texas Department of Otolaryngology—Head and Neck Philadelphia, Pennsylvania
Osteomyelitis Surgery Malrotation
Septic Arthritis Columbia University College of Physicians and Meckel Diverticulum and Other Remnants of the
Surgeons Omphalomesenteric Duct
Aaron M. Karlin, MD New York, New York Intussusception
Clinical Associate Professor Congenital Disorders of the Nose Malformations
Department of Physical Medicine and Acquired Disorders of the Nose Ascites
Rehabilitation Nasal Polyps
Louisiana State University School of Medicine General Considerations and Evaluation (Ear) Eitan Kerem, MD
Section Head, Pediatric Rehabilitation Hearing Loss Professor and Chair
Ochsner Clinic Medical Center Congenital Malformations Department of Pediatrics
Ochsner Children’s Health Center External Otitis (Otitis Externa) Hadassah University Medical Center
New Orleans, Louisiana The Inner Ear and Diseases of the Bony Labyrinth Jerusalem, Israel
Management of Musculoskeletal Injury Traumatic Injuries of the Ear and Temporal Bone Effects of War on Children
Specific Sports and Associated Injuries Tumors of the Ear and Temporal Bone
Joseph E. Kerschner, MD, FACS,
Daniel L. Kastner, MD, PhD Desmond P. Kelly, MD FAAP
Scientific Director Professor of Clinical Pediatrics Professor of Pediatrics
National Human Genome Research Institute Vice-Chair for Academics, Department of Dean and Executive Vice-President
Distinguished Investigator Pediatrics Medical College of Wisconsin
Medical Genetics Branch University of South Carolina School of Medicine Milwaukee, Wisconsin
National Institutes of Health Greenville Otitis Media
Bethesda, Maryland Greenville, South Carolina
Hereditary Periodic Fever Syndromes and Other Neurodevelopmental Function and Dysfunction in Seema Khan, MD
Systemic Autoinflammatory Diseases the School-Age Child Associate Professor of Pediatrics
George Washington University School of Medicine
Emily R. Katz, MD Kevin J. Kelly, MD and Health Sciences
Clinical Assistant Professor Professor of Pediatrics Division of Gastroenterology and Nutrition
Department of Psychiatry and Human Behavior Division of Pediatric Allergy, Immunology, and Children’s National Medical Center
Brown University Alpert Medical School Rheumatology Washington, DC
Director, Consultation Liaison Service University of North Carolina School of Medicine Embryology, Anatomy, and Function of the
Hasbro Children’s Hospital Vice-Chair, Clinical Operations Esophagus
Providence, Rhode Island Pediatrician-in-Chief Congenital Anomalies: Esophageal Atresia and
Rumination and Pica North Carolina Children’s Hospital Tracheoesophageal Fistula
Chapel Hill, North Carolina Obstructing and Motility Disorders of the Esophagus
James W. Kazura, MD Immune and Inflammatory Lung Disease Dysmotility
Professor of Medicine in International Health Hiatal Hernia
Division of Geographic Medicine Matthew S. Kelly, MD, MPH Gastroesophageal Reflux Disease
Case Western Reserve University School of Pediatric Global Health Fellow Eosinophilic Esophagitis and Non–Gastroesophageal
Medicine Children’s Hospital of Philadelphia Reflux Disease Esophagitis
Cleveland, Ohio Philadelphia, Pennsylvania; Esophageal Perforation
Ascariasis (Ascaris lumbricoides) Princess Marina Hospital Esophageal Varices
Trichuriasis (Trichuris trichiura) Gaborone, Botswana, Africa Ingestions
Enterobiasis (Enterobius vermicularis) Community-Acquired Pneumonia
Strongyloidiasis (Strongyloides stercoralis) Jennifer S. Kim, MD
Lymphatic Filariasis (Brugia malayi, Brugia timori, Assistant Professor of Pediatrics
and Wuchereria bancrofti) Jaffe Food Allergy Institute
Other Tissue Nematodes Icahn School of Medicine at Mount Sinai
Toxocariasis (Visceral and Ocular Larva Migrans) New York, New York
Trichinosis (Trichinella spiralis) Diagnosis of Allergic Disease
Principles of Treatment of Allergic Disease
xx Contributors

Charles H. King, MD Robert M. Kliegman, MD Elliot J. Krane, MD, FAAP

Professor of International Health Professor and Chairman Emeritus Professor of Pediatrics, and Anesthesiology,
Center for Global Health and Diseases Department of Pediatrics Perioperative, and Pain Medicine
Case Western Reserve University School of Medical College of Wisconsin Stanford University School of Medicine
Medicine Children’s Hospital of Wisconsin Chief, Pediatric Pain Management
Cleveland, Ohio Milwaukee, Wisconsin Stanford Children’s Health
Schistosomiasis (Schistosoma) Refeeding Syndrome Lucile Packard Children’s Hospital at Stanford
Flukes (Liver, Lung, and Intestinal) Liver Abscess Stanford, California
Generalized Arterial Calcification of Infancy/ Pediatric Pain Management
Stephen L. Kinsman, MD Idiopathic Infantile Arterial Calcification
Associate Professor of Pediatrics Arterial Calcifications Caused by Deficiency of Peter J. Krause, MD
Division of Pediatric Neurology CD73 Senior Research Scientist
Medical University of South Carolina Female Genital Mutilation/Cutting Department of Epidemiology and Microbial
Charleston, South Carolina Reflex Seizures (Stimulus Precipitated Seizures) Diseases
Congenital Anomalies of the Central Nervous System Nodding Syndrome Yale School of Public Health
Department of Medicine and Department of
Adam Kirton, MD, MSc, FRCPC William C. Koch, MD, FAAP, FIDSA Pediatrics
Associate Professor of Pediatrics and Clinical Associate Professor of Pediatrics Yale School of Medicine
Neurosciences Medical College of Virginia / Virginia New Haven, Connecticut
University of Calgary Faculty of Medicine Commonwealth University Babesiosis (Babesia)
Director, Calgary Pediatric Stroke Program Richmond, Virginia
Alberta Children’s Hospital Research Institute Parvoviruses Richard E. Kreipe, MD, FACCP,
Calgary, Alberta, Canada FSAHM, FAED
Pediatric Stroke Patrick M. Kochanek, MD, MCCM Dr. Elizabeth R. McArnarney Professor in
Ake N. Grenvik Professor of Critical Care Pediatrics funded by Roger and Carolyn
Priya S. Kishnani, MD, MBBS Medicine Friedlander
C.L. and Sue Chen Professor of Pediatrics Vice-Chairman, Department of Critical Care Division of Adolescent Medicine
Chief, Division of Medical Genetics Medicine University of Rochester School of Medicine
Duke University Medical Center Professor of Anesthesiology, Pediatrics, Golisano Children’s Hospital
Durham, North Carolina Bioengineering, and Clinical and Translational Medical Director, Western New York
Defects in Metabolism of Carbohydrates Science Comprehensive Care Center for Eating
Director, Safar Center for Resuscitation Research Disorders
Robert L. Kitts, MD University of Pittsburgh School of Medicine Rochester, New York
Assistant Professor of Psychiatry Pittsburgh, Pennsylvania Eating Disorders
Harvard Medical School Neurologic Emergencies and Stabilization
Director, Child and Adolescent Psychiatry Steven E. Krug, MD
Fellowship Eric Kodish, MD Professor of Pediatrics
Boston Children’s Hospital Professor and Chairman Division of Pediatric Emergency Medicine
Boston, Massachusetts Department of Bioethics Northwestern University Feinberg School of
Rumination and Pica The Cleveland Clinic Foundation Medicine
Cleveland, Ohio Ann & Robert H. Lurie Children’s Hospital of
Martin B. Kleiman, MD Ethics in Pediatric Care Chicago
Ryan White Professor of Pediatrics Chicago, Illinois
Indiana University School of Medicine Stephan A. Kohlhoff, MD Emergency Medical Services for Children
Riley Children’s Hospital Assistant Professor of Pediatrics and Medicine
Indianapolis, Indiana Associate Director, Pediatric Infectious Diseases John F. Kuttesch Jr., MD, PhD
Coccidioidomycosis (Coccidioides species) SUNY Downstate Medical Center Chief, Division of Pediatric Hematology/Oncology
Brooklyn, New York Department of Pediatrics
Bruce L. Klein, MD Chlamydia (Chlamydophila) pneumoniae University of New Mexico School of Medicine
Visiting Associate Professor of Pediatrics Psittacosis (Chlamydia psittaci) Albuquerque, New Mexico
Johns Hopkins University School of Medicine Brain Tumors in Childhood
Associate Director, Pediatric Emergency Medicine Mark A. Kostic, MD
Director, Pediatric Transport Associate Professor of Pediatrics and Emergency Jennifer M. Kwon, MD, MPH
Johns Hopkins Children’s Center Medicine Associate Profess or of Pediatrics and Neurology
Baltimore, Maryland Division of Pediatric Emergency Medicine University of Rochester School of Medicine
Interfacility Transport of the Seriously Ill or Injured Medical College of Wisconsin Associate Director, Clinic for Inherited Metabolic
Pediatric Patient Associate Medical Director Diseases
Acute Care of the Victim of Multiple Trauma Wisconsin Poison Center Golisano Children’s Hospital
Milwaukee, Wisconsin Rochester, New York
Bruce S. Klein, MD Poisoning Neurodegenerative Disorders of Childhood
Professor of Pediatrics and Medical Microbiology
University of Wisconsin School of Medicine Linda E. Krach, MD Catherine S. Lachenauer, MD
Madison, Wisconsin Adjunct Professor Assistant Professor of Pediatrics
Blastomycosis (Blastomyces dermatitidis) Department of Physical Medicine and Harvard Medical School
Rehabilitation Division of Infectious Diseases
Michael D. Klein, MD, FACS, FAAP University of Minnesota School of Medicine Boston Children’s Hospital
Arvin I. Philippart MD Endowed Chair of President, Courage Kenny Rehabilitation Institute Boston, Massachusetts
Pediatric Surgical Research (part of Allina Health) Group B Streptococcus
Professor of Surgery Minneapolis, Minnesota
Wayne State University School of Medicine Severe Traumatic Brain Injury
Children’s Hospital of Michigan
Detroit, Michigan
Surgical Conditions of the Anus and Rectum
 Contributors xxi

Stephan Ladisch, MD Phillip S. LaRussa, MD Norma B. Lerner, MD, MPH

Professor of Pediatrics and Biochemistry/Molecular Professor of Pediatrics Special Advisor to the Director
Biology Columbia University Medical Center Division of Blood Diseases and Resources
Department of Pediatrics New York, New York National Heart, Lung, and Blood Institute
George Washington University School of Medicine Varicella-Zoster Virus Infections National Institutes of Health
Children’s Research Institute Bethesda, Maryland
Department of Hematology and Oncology J. Todd R. Lawrence, MD, PhD The Anemias
Children’s National Medical Center Assistant Professor Congenital Hypoplastic Anemia (Diamond-Blackfan
Washington, DC Department of Orthopaedic Surgery Anemia)
Histiocytosis Syndromes of Childhood University of Pennsylvania Perelman School of Pearson Syndrome
Medicine Acquired Pure Red Blood Cell Anemia
Stephen H. LaFranchi, MD Attending Orthopaedic Surgeon Anemia of Chronic Disease and Renal Disease
Professor of Pediatrics Children’s Hospital of Philadelphia Congenital Dyserythropoietic Anemias
Division of Pediatric Endocrinology Philadelphia, Pennsylvania Physiologic Anemia of Infancy
Oregon Health & Science University The Knee Megaloblastic Anemias
Portland, Oregon
Thyroid Development and Physiology Brendan Lee, MD, PhD Steven O. Lestrud, MD
Defects of Thyroxine-Binding Globulin Robert and Janice McNair Endowed Chair in Assistant Professor of Pediatrics
Hypothyroidism Molecular and Human Genetics Northwestern University Feinberg School of
Thyroiditis Professor, Department of Molecular and Human Medicine
Goiter Genetics Medical Director, Respiratory Care
Hyperthyroidism Baylor College of Medicine Ann & Robert H. Lurie Children’s Hospital of
Carcinoma of the Thyroid Houston, Texas Chicago
Integration of Genetics into Pediatric Practice Chicago, Illinois
Oren J. Lakser, MD The Genetic Approach in Pediatric Medicine Bronchopulmonary Dysplasia
Assistant Professor of Pediatrics The Human Genome
Northwestern University Feinberg School of Patterns of Genetic Transmission Donald Y.M. Leung, MD, PhD
Medicine Cytogenetics Edelstein Family Chair of Pediatric
Associate Clinician Specialist Genetics of Common Disorders Allergy-Immunology
Division of Pulmonary Medicine National Jewish Health
Ann & Robert H. Lurie Children’s Hospital of K. Jane Lee, MD, MA Professor of Pediatrics
Chicago Associate Professor University of Colorado School of Medicine
Chicago, Illinois Department of Pediatrics Denver, Colorado
Bronchiectasis Medical College of Wisconsin Atopic Dermatitis (Atopic Eczema)
Pulmonary Abscess Division of Pediatric Critical Care
Children’s Hospital of Wisconsin Chris A. Liacouras, MD
Marc B. Lande, MD, MPH Milwaukee, Wisconsin Professor of Pediatrics
Professor of Pediatrics Brain Death University of Pennsylvania Perelman School of
Division of Pediatric Nephrology Medicine
University of Rochester Medical Center J. Steven Leeder, PharmD, PhD Co-Director, Center for Pediatric Eosinophilic
School of Medicine and Dentistry Marion Merrell Dow / Missouri Endowed Chair in Disorders
Rochester, New York Pediatric Pharmacology The Children’s Hospital of Philadelphia
Systemic Hypertension Chief, Division of Pediatric Pharmacology and Philadelphia, Pennsylvania
Medical Toxicology Normal Digestive Tract Phenomena
Philip J. Landrigan, MD, MSc, FAAP Children’s Mercy Hospitals and Clinics Major Symptoms and Signs of Digestive Tract
Dean for Global Health Kansas City, Missouri; Disorders
Ethel H. Wise Professor and Chair, Department of Adjunct Professor Normal Development, Structure, and Function
Preventive Medicine Department of Pharmacology, Toxicology, and (Stomach)
Director, Children’s Environmental Health Center Therapeutics Pyloric Stenosis and Other Congenital Anomalies of
Icahn School of Medicine at Mount Sinai Kansas University School of Medicine the Stomach
New York, New York Kansas City, Kansas Intestinal Atresia, Stenosis, and Malrotation
Chemical Pollutants Pediatric Pharmacogenetics, Pharmacogenomics, Intestinal Duplications, Meckel Diverticulum, and
and Pharmacoproteomics Other Remnants of the Omphalomesenteric Duct
Gregory L. Landry, MD Motility Disorders and Hirschsprung Disease
Professor Rebecca K. Lehman, MD Ileus, Adhesions, Intussusception, and Closed-Loop
Department of Pediatrics Assistant Professor of Pediatrics Obstructions
University of Wisconsin—Madison Division of Pediatric Neurology Foreign Bodies and Bezoars
School of Medicine and Public Health Medical University of South Carolina Functional Abdominal Pain (Nonorganic Chronic
Madison, Wisconsin Charleston, South Carolina Abdominal Pain)
Epidemiology and Prevention of Injuries Neurologic Evaluation Malformations
Heat Injuries Chorea, Athetosis, Tremor Ascites
Female Athletes: Menstrual Problems and the Risk Peritonitis
of Osteopenia Michael J. Lentze, MD
Performance-Enhancing Aids Professor of Pediatrics Christopher W. Liebig, MD
Division of Pediatric Gastroenterology Pediatric Sports Medicine Fellow
Wendy G. Lane, MD, MPH, FAAP Medizinische Universität Bonn Akron Children’s Hospital
Assistant Professor Bonn, Germany Akron, Ohio
Departments of Pediatrics and Epidemiology and Evaluation of Children with Suspected Intestinal Sports-Related Traumatic Brain Injury (Concussion)
Preventive Medicine Malabsorption
University of Maryland School of Medicine Enzyme Deficiencies
Baltimore, Maryland
Abused and Neglected Children
xxii Contributors

Timothy P. Lindquist, MD Anna Lena Lopez, MD, MPH Joseph A. Majzoub, MD

Pediatric Ophthalmologist Research Associate Professor Thomas Morgan Rotch Professor of Pediatrics
Children’s Mercy Hospital Institute of Child Health and Human Development Professor of Medicine
Kansas City, Missouri University of the Philippines Manila—National Harvard Medical School
Growth and Development (Eye) Institutes of Health Chief, Division of Endocrinology
Examination of the Eye Clinical Associate Professor, Department of Boston Children’s Hospital
Abnormalities of Refraction and Accommodation Pediatrics Boston, Massachusetts
Disorders of Vision University of the Philippines College of Medicine Diabetes Insipidus
Abnormalities of Pupil and Iris Manila, Philippines Other Abnormalities of Arginine Vasopressin
Disorders of Eye Movement and Alignment Cholera Metabolism and Action
Abnormalities of the Lids
Disorders of the Lacrimal System Steven V. Lossef, MD Asim Maqbool, MD
Disorders of the Conjunctiva Head, Pediatric Interventional Radiology Assistant Professor of Pediatrics
Abnormalities of the Cornea Division of Diagnostic Imaging and Radiology University of Pennsylvania Perelman School of
Abnormalities of the Lens Children’s National Medical Center Medicine
Disorders of the Uveal Tract Washington, DC Division of Gastroenterology, Hepatology, and
Disorders of the Retina and Vitreous Pertussis (Bordetella pertussis and Bordetella Nutrition
Abnormalities of the Optic Nerve parapertussis) Children’s Hospital of Philadelphia
Childhood Glaucoma Pleurisy, Pleural Effusions, and Empyema Philadelphia, Pennsylvania
Orbital Abnormalities Pneumothorax Nutritional Requirements
Orbital Infections Hemothorax
Injuries to the Eye Chlyothorax Ashley M. Maranich, MD
Pediatric Infectious Disease
Andrew H. Liu, MD Jennifer A. Lowry, MD Director, Transitional Year Program
Professor Associate Professor of Pediatrics San Antonio Military Medical Center
Department of Pediatrics University of Missouri—Kansas City School of Fort Sam Houston, Texas
National Jewish Health Medicine Malassezia
University of Colorado School of Medicine Section Chief, Medical Toxicology
Denver, Colorado Division of Clinical Pharmacology and Therapeutic Mona Marin, MD
Childhood Asthma Innovations Medical Epidemiologist
Medical Director, Center for Environmental Health Epidemiology Branch, Division of Viral Diseases
Stanley F. Lo, PhD Children’s Mercy Hospitals and Clinics National Center for Immunization and Respiratory
Associate Professor of Pathology Kansas City, Missouri Diseases
Medical College of Wisconsin Principles of Drug Therapy Centers for Disease Control and Prevention
Co-Director, Clinical Laboratories Atlanta, Georgia
Co-Director, Biochemical Genetics Laboratory Nora T. MacZura, MD Varicella-Zoster Virus Infections
Technical Director, Chemistry and Point of Care Division of Gynecologic Oncology
Testing Laboratories Department of Obstetrics and Gynecology Joan C. Marini, MD, PhD
Children’s Hospital of Wisconsin Springfield Clinic Chief, Bone and Extracellular Matrix Branch
Milwaukee, Wisconsin Springfield, Illinois National Institute for Child Health and
Laboratory Testing in Infants and Children Neoplasms and Adolescent Screening for Human Development
Reference Intervals for Laboratory Tests and Papillomavirus National Institutes of Health
Procedures Bethesda, Maryland
Prashant V. Mahajan, MD, MPH, MBA Osteogenesis Imperfecta
Franco Locatelli, MD Professor of Pediatrics and Emergency Medicine
Professor of Pediatrics Carman and Ann Adams Department of Pediatrics Thomas C. Markello, MD, PhD
University of Pavia Wayne State University School of Medicine National Human Genome Research Institute
Pavia, Italy; Division Chief and Research Director National Institutes of Health
Director, Department of Pediatric Hematology and Director, Center for Quality and Innovation Bethesda, Maryland
Oncology Pediatric Emergency Medicine Genetic Approaches to Rare and Undiagnosed
IRCCS Ospedale Pediatrico Bambino Gesù Children’s Hospital of Michigan Diseases
Rome, Italy Detroit, Michigan
Principles and Clinical Indications of Hematopoietic Heavy Metal Intoxication Morri Markowitz, MD
Stem Cell Transplantation Professor of Pediatrics and Medicine
Hematopoietic Stem Cell Transplantation from Akhil Maheshwari, MD Albert Einstein College of Medicine
Alternative Sources and Donors Associate Professor of Pediatrics and Clinical Director, Pediatric Environmental Sciences
Graft-Versus-Host Disease, Rejection, and Pharmacology The Children’s Hospital at Montefiore
Venoocclusive Disease University of Illinois, Chicago Bronx, New York
Infectious Complications of Hematopoietic Stem Cell Chief, Division of Neonatology Lead Poisoning
Transplantation Director, Center for Neonatal and Pediatric
Late Effects of Hematopoietic Stem Cell Gastrointestinal Disease Kevin P. Marks, MD
Transplantation Medical Director, Neonatal Intensive Care Unit Clinical Assistant Professor
and Intermediate Care Nursery Department of Pediatrics
John H. Lockhart, MD Children’s Hospital of University of Illinois Oregon Health & Science University School of
Clinical Assistant Professor Chicago, Illinois Medicine
Departments of Orthopedics and Sports Medicine Diaphragmatic Hernia General Pediatrician
Seattle Children’s Hospital Foramen of Morgagni Hernia PeaceHealth Medical Group
Seattle, Washington Paraesophageal Hernia Portland, Oregon
Cervical Spinal Injuries Eventration Developmental-Behavioral Screening and
Digestive System Disorders Surveillance
Sarah S. Long, MD Blood Disorders
Professor of Pediatrics
Drexel University College of Medicine
Chief, Section of Infectious Diseases
St. Christopher’s Hospital for Children
Philadelphia, Pennsylvania
Pertussis (Bordetella pertussis and Bordetella
parapertussis)
 Contributors xxiii

Stacene R. Maroushek, MD, PhD, Dennis J. Matthews, MD Mary A. McMahon, MD

MPH Professor and Chair Assistant Professor
Assistant Professor of Pediatrics Department of Physical Medicine and Department of Pediatrics
Division of Pediatric Infectious Diseases and Rehabilitation University of Cincinnati College of Medicine
Immunology University of Colorado School of Medicine Director, Division of Physical Medicine and
University of Minnesota Medical School Medical Director Rehabilitation
Pediatric Infectious Diseases and General Children’s Hospital Rehabilitation Center Director, Physical Medicine and Rehabilitation
Pediatrics PPAARDI-in-Chief Residency Program
Hennepin County Medical Center Children’s Hospital Colorado Cincinnati Children’s Hospital Medical Center
Minneapolis, Minnesota Denver, Colorado Cincinnati, Ohio
Medical Evaluation of Immigrant (Foreign-Born) Principles of Rehabilitation Medicine Spinal Cord Injury and Spinal Cord Autonomic
Children for Infectious Diseases Crisis Management
Principles of Antimycobacterial Therapy Robert L. Mazor, MD
Clinical Associate Professor Asuncion Mejias, MD, PhD, MSCS
Kari L. Martin, MD Department of Pediatrics Assistant Professor of Pediatrics
Assistant Professor of Dermatology and Child University of Washington School of Medicine Section of Infectious Diseases and Immunology
Health Division of Critical Care and Cardiac Surgery The Ohio State University College of Medicine
Associate Residency Program Director Department Clinical Director, CICU The Research Institute at Nationwide Children’s
of Dermatology Seattle Children’s Hospital and Regional Medical Hospital
University of Missouri School of Medicine Center Columbus, Ohio
Columbia, Missouri Seattle, Washington Hansen Disease (Mycobacterium leprae)
Diseases of the Neonate Pulmonary Edema Mycoplasma pneumoniae
Cutaneous Defects Genital Mycoplasmas (Mycoplasma hominis,
Ectodermal Dysplasias Megan E. McCabe, MD Mycoplasma genitalium, and Ureaplasma
Vascular Disorders Assistant Professor urealyticum)
Cutaneous Nevi Department of Pediatrics
Disorders of Keratinization Yale School of Medicine Peter C. Melby, MD
Disorders of the Sweat Glands New Haven, Connecticut Professor of Internal Medicine (Infectious
Disorders of Hair Loss, Separation, and Bereavement Diseases), Microbiology and Immunology, and
Disorders of the Nails Pathology
Tumors of the Skin Susanna A. McColley, MD Director, Center for Tropical Diseases
Professor of Pediatrics University of Texas Medical Branch at Galveston
Wilbert H. Mason Jr., MD, MPH Northwestern University Feinberg School of Galveston, Texas
Professor Emeritus of Clinical Pediatrics Medicine Leishmaniasis (Leishmania)
University of Southern California Keck School of Director, Clinical and Translational Research
Medicine Stanley Manne Children’s Research Institute Alexandra N. Menchise, MD
Chief, Pediatric Infectious Diseases Ann & Robert H. Lurie Children’s Hospital of Pediatric Gastroenterology Fellow
Children’s Hospital of Los Angeles Chicago Cincinnati Children’s Hospital Medical Center
Los Angeles, California Chicago, Illinois Cincinnati, Ohio
Measles Pulmonary Tumors Metabolic Diseases of the Liver
Rubella Extrapulmonary Diseases with Pulmonary
Mumps Manifestations Diane F. Merritt, MD
Professor
Christopher Mastropietro, MD Margaret M. McGovern, MD, PhD Department of Obstetrics and Gynecology
Assistant Professor Professor and Chair Director, Pediatric and Adolescent Gynecology
Department of Pediatrics Department of Pediatrics Washington University School of Medicine in St.
Wayne State University School of Medicine Stony Brook University School of Medicine Louis
Associate Fellowship Director Physician-in-Chief, Stony Brook Long Island St. Louis, Missouri
Division of Critical Care Children’s Hospital History and Physical Examination (Gynecology)
Children’s Hospital of Michigan Stony Brook, New York Vulvovaginitis
Detroit, Michigan Lipidoses (Lysosomal Storage Disorders) Bleeding
Mechanical Ventilation Mucolipidoses Breast Concerns
Disorders of Glycoprotein Degradation and Neoplasms and Adolescent Screening for Human
Kimberlee M. Matalon, PhD Structure Papillomavirus
Associate Professor
Department of Health and Human Performance Heather S. McLean, MD Ethan A. Mezoff, MD
University of Houston Associate Professor of Pediatrics Pediatric Gastroenterology Fellow
Houston, Texas Duke University School of Medicine Cincinnati Children’s Hospital Medical Center
Aspartic Acid (Canavan Disease) Medical Director Cincinnati, Ohio
Pediatric Hospital Medicine Clostridium difficile Infection
Reuben K. Matalon, MD, PhD Duke Children’s Hospital
Professor Durham, North Carolina Marian G. Michaels, MD, MPH
Department of Pediatrics and Genetics Failure to Thrive Professor of Pediatrics and Surgery
University of Texas Medical Branch University of Pittsburgh School of Medicine
University of Texas Children’s Hospital Rima McLeod, MD Division of Pediatric Infectious Diseases
Galveston, Texas Jules and Doris Stein Research to Prevent Children’s Hospital of Pittsburgh of UPMC
Aspartic Acid (Canavan Disease) Blindness Professor of Ophthalmology Pittsburgh, Pennsylvania
Departments of Ophthalmology and Visual Infections in Immunocompromised Persons
Roshni Mathew, MD Sciences and Pediatrics
Clinical Instructor in Pediatrics Medical Director, Toxoplasmosis Center Mohamad A. Mikati, MD
Division of Pediatric Infectious Diseases University of Chicago School of Medicine Wilburt C. Davison Professor of Pediatrics and
Stanford University School of Medicine Chicago, Illinois Professor of Neurobiology
Stanford, California Toxoplasmosis (Toxoplasma gondii) Chief, Division of Pediatric Neurology
Central Nervous System Infections Duke University Medical Center
Brain Abscess Durham, North Carolina
Seizures in Childhood
Conditions That Mimic Seizures
xxiv Contributors

Henry Milgrom, MD Beth Moughan, MD Jayne M. Ness, MD, PhD

Professor of Pediatrics Professor of Clinical Pediatrics Associate Professor of Pediatrics
National Jewish Health Assistant Dean, Affiliate Faculty Development Division of Pediatric Neurology
University of Colorado School of Medicine Associate Chair, Clinical Affairs University of Alabama, Birmingham
Denver, Colorado Section Chief, Ambulatory Pediatrics Birmingham, Alabama
Allergic Rhinitis Temple University School of Medicine Demyelinating Disorders of the Central Nervous
Philadelphia, Pennsylvania System
E. Kathryn Miller, MD, MPH Sporotrichosis (Sporothrix schenckii)
Assistant Professor Kathleen A. Neville, MD, MS
Departments of Pediatrics and Allergy and James R. Murphy, PhD Associate Professor of Pediatrics
Immunology Professor of Pediatrics University of Missouri—Kansas City School of
Vanderbilt University School of Medicine Director, Pediatric Infectious Disease Research Medicine
Nashville, Tennessee University of Texas Health Science Center Director, Experimental Therapeutics in Pediatric
The Common Cold Houston, Texas Cancer
Rhinoviruses Campylobacter Department of Pediatric Hematology/Oncology
Yersinia Children’s Mercy Hospitals and Clinics
Jonathan W. Mink, MD, PhD Kansas City, Missouri
Frederick A. Horner MD Endowed Professor in Kevin P. Murphy, MD Pediatric Pharmacogenetics, Pharmacogenomics,
Pediatric Neurology Medical Director Pediatric Rehabilitation and Pharmacoproteomics
Professor of Neurology, Neurobiology and Sanford Health Systems
Anatomy, Brain and Cognitive Sciences, and Bismarck, North Dakota; Mary A. Nevin, MD
Pediatrics Medical Director, Gillette Children’s Specialty Associate Professor of Pediatrics
Chief, Division of Child Neurology Healthcare Northwestern University Feinberg School of
Vice-Chair, Department of Neurology Duluth Clinic Medicine
University of Rochester Medical Center Duluth, Minnesota Department of Pulmonary and Critical Care
Rochester, New York Management of Musculoskeletal Injury Medicine
Movement Disorders Specific Sports and Associated Injuries Ann & Robert H. Lurie Children’s Hospital of
Chicago
R. Justin Mistovich, MD Timothy F. Murphy, MD Chicago, Illinois
Clinical Fellow Distinguished Professor Pulmonary Hemosiderosis
Division of Pediatric Orthopaedic Surgery Director, UB Clinical and Translational Research Pulmonary Embolism, Infarction, and Hemorrhage
University of Pennsylvania Perelman School of Center
Medicine University at Buffalo, State University of New York Jane W. Newburger, MD
Children’s Hospital of Philadelphia School of Medicine and Biomedical Sciences Commonwealth Professor of Pediatrics
Philadelphia, Pennsylvania Buffalo, New York Harvard Medical School
The Spine Moraxella catarrhalis Associate Cardiologist-in-Chief, Research and
Education
Grant A. Mitchell, MD Thomas S. Murray, MD, PhD Director, Cardiac Neurodevelopmental Program
Professor of Pediatrics Associate Professor of Medical Sciences Director, Kawasaki Program
Division of Medical Genetics Quinnipiac University Frank H Netter MD School Children’s Hospital Boston
University of Montreal Faculty of Medicine of Medicine Boston, Massachusetts
Service de Genetique Medicale Hamden, Connecticut Kawasaki Disease
Hospital Ste-Justine Listeria monocytogenes
Montreal, Quebec, Canada Pseudomonas, Burkholderia, and Peter E. Newburger, MD
Tyrosine Stenotrophomonas Ali and John Pierce Professor of Pediatric
Hematology/Oncology
Esi Morgan-DeWitt, MD, MSCE René P. Myers, MD Vice-Chair for Research
Associate Professor of Pediatrics Chief Resident Department of Pediatrics
University of Cincinnati College of Medicine Department of Plastic Surgery University of Massachusetts Medical School
Division of Rheumatology University of Rochester Medical Center Worcester, Massachusetts
James M. Anderson Center for Health Systems Rochester, New York Leukopenia
Excellence Deformational Plagiocephaly Leukocytosis
Cincinnati Children’s Hospital Medical Center
Cincinnati, Ohio Mindo J. Natale, PsyD Linda S. Nield, MD
Treatment of Rheumatic Diseases Assistant Professor of Psychology Professor of Pediatrics
Sarcoidosis University of South Carolina School of Medicine Director, Pediatrics Residency Program
Senior Staff Psychologist West Virginia University School of Medicine
Anna-Barbara Moscicki, MD GHS Children’s Hospital Morgantown, West Virginia
Professor of Pediatrics Greenville, South Carolina Fever
University of California, San Francisco Neurodevelopmental Function and Dysfunction in Fever Without a Focus
Senior Director, Pediatric Glaser Clinic the School-Age Child
San Francisco, California Susan Niermeyer, MD, MPH, FAAP
Human Papillomaviruses William A. Neal, MD Professor of Pediatrics
Professor of Pediatrics Section of Neonatology
Lovern R. Moseley, PhD Division of Pediatric Cardiology University of Colorado School of Medicine
Department of Psychiatry West Virginia University School of Medicine Aurora, Colorado
Boston Medical Center Morgantown, West Virginia Altitude-Associated Illness in Children (Acute
Boston, Massachusetts Disorders of Lipoprotein Metabolism and Transport Mountain Sickness)
Mood Disorders
Disruptive, Impulse-Control, and Conduct Disorders Maureen R. Nelson, MD
Pediatric Subspecialty Services
Dell’s Children’s Medical Center of Central Texas
Austin, Texas
Birth Brachial Plexus Palsy

Zehava L. Noah, MD Jean-Marie Okwo-Bele, MD, MPH
Associate Professor of Pediatrics Director
Northwestern University Feinberg School of Immunization, Vaccines, and Biologicals
Medicine Department
Division of Pediatric Critical Care Medicine World Health Organization
Ann & Robert H. Lurie Children’s Hospital of Geneva, Switzerland
Chicago International Immunization Practices
Chicago, Illinois
Chronic Severe Respiratory Insufficiency Keith T. Oldham, MD
Professor and Chief
Lawrence M. Nogee, MD Division of Pediatric Surgery
Professor of Pediatrics Medical College of Wisconsin
Department of Pediatrics Children’s Hospital of Wisconsin
Division of Neonatology and Perinatology Milwaukee, Wisconsin
Johns Hopkins University School of Medicine Acute Appendicitis
Baltimore, Maryland Inguinal Hernias
Diffuse Lung Diseases in Childhood Epigastric Hernia
Robert L. Norris, MD, FACEP, FAAEM Joyce L. Oleszek, MD
Professor of Surgery Associate Professor
Chief, Division of Emergency Medicine Department of Physical Medicine and
Stanford University Medical Center Rehabilitation
Stanford, California University of Colorado School of Medicine
Envenomations Attending Physician
Children’s Hospital Colorado
Anna Nowak-Wȩgrzyn, MD Denver, Colorado
Associate Professor of Pediatrics Spasticity
Jaffe Food Allergy Institute
Icahn School of Medicine at Mount Sinai Scott E. Olitsky, MD
New York, New York Professor of Ophthalmology
Serum Sickness University of Kansas School of Medicine
Food Allergy and Adverse Reactions to Foods University of Missouri—Kansas City School of
Medicine
Stephen K. Obaro, MD, PhD, FRCPCH Section Chief, Ophthalmology
Professor of Pediatrics Children’s Mercy Hospitals and Clinics
Division of Infectious Diseases Kansas City, Missouri
University of Nebraska Medical Center Growth and Development (Eye)
Omaha, Nebraska Examination of the Eye
Nonvenereal Treponemal Infections Abnormalities of Refraction and Accommodation
Relapsing Fever (Borrelia) Disorders of Vision
Abnormalities of Pupil and Iris
Makram M. Obeid, MD Disorders of Eye Movement and Alignment
Clinical Fellow in Neurology Abnormalities of the Lids
Boston Children’s Hospital Disorders of the Lacrimal System
Boston, Massachusetts Disorders of the Conjunctiva
Conditions That Mimic Seizures Abnormalities of the Cornea
Abnormalities of the Lens
Hope L. O’Brien, MD Disorders of the Uveal Tract
Assistant Professor of Pediatrics and Neurology Disorders of the Retina and Vitreous
University of Cincinnati College of Medicine Abnormalities of the Optic Nerve
Director, Young Adult Headache Program Childhood Glaucoma
Division of Neurology Orbital Abnormalities
Cincinnati Children’s Hospital Medical Center Orbital Infections
Cincinnati, Ohio Injuries to the Eye
Headaches
John M. Olsson, MD, CPE
Theresa J. Ochoa, MD Professor of Pediatrics
Associate Professor of Epidemiology and Pediatrics Division Chief, General Pediatrics
The University of Texas Health Science Center at Brody School of Medicine
Houston East Carolina University
Houston, Texas; Greenville, North Carolina
Universidad Peruana Cayetano Heredia The Newborn
Lima, Peru
Shigella Amanda K. Ombrello, MD
Escherichia coli Staff Clinician
National Human Genome Research Institute
Robin K. Ohls, MD National Institutes of Health
Professor of Pediatrics Bethesda, Maryland
University of New Mexico School of Medicine Hereditary Periodic Fever Syndromes and Other
Albuquerque, New Mexico Systemic Autoinflammatory Diseases
Development of the Hematopoietic System Amyloidosis
Contributors xxv
Susan R. Orenstein, MD
Professor Emerita
University of Pittsburgh School of Medicine
Division of Pediatric Gastroenterology
Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Embryology, Anatomy, and Function of the
Esophagus
Congenital Anomalies: Esophageal Atresia and
Tracheoesophageal Fistula
Obstructing and Motility Disorders of the Esophagus
Dysmotility
Hiatal Hernia
Gastroesophageal Reflux Disease
Eosinophilic Esophagitis and Non–Gastroesophageal
Reflux Disease Esophagitis
Esophageal Perforation
Esophageal Varices
Ingestions
Walter A. Orenstein, MD, DSc (Hon)
Professor of Medicine and Pediatrics
Associate Director, Emory Vaccine Center
Emory University
Atlanta, Georgia
Immunization Practices
Marisa Osorio, DO
Acting Assistant Professor
Department of Rehabilitation Medicine
University of Washington School of Medicine
Seattle Children’s Hospital
Seattle, Washington
Ambulation Assistance
Patrick O’Toole, MD
Clinical Fellow
Division of Pediatric Orthopaedic Surgery
University of Pennsylvania Perelman School of
Medicine
Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania
The Neck
Judith A. Owens, MD, MPH
Associate Professor
Harvard Medical School
Director of Sleep Medicine
Boston Children’s Hospital
Boston, Massachusetts
Sleep Medicine
Seza Özen, MD
Professor of Paediatrics
Division of Paediatric Rheumatology
Hacettepe University
Ankara, Turkey
Behçet Disease
Charles H. Packman, MD
Professor of Medicine
University of North Carolina School of Medicine
Levine Cancer Institute, Hematologic Oncology
and Blood Disorders
Charlotte, North Carolina
Hemolytic Anemias Resulting from Extracellular
Factors—Immune Hemolytic Anemias
xxvi Contributors

Priya Pais, MBBS, MS Timothy R. Peters, MD Craig C. Porter, MD

Assistant Professor of Pediatrics
Division of Nephrology
Medical College of Wisconsin
Wauwatosa, Wisconsin
Lower Urinary Tract Causes of Hematuria
Introduction to the Child with Proteinuria
Fixed Proteinuria
Nephrotic Syndrome
Cortical Necrosis
Tonya M. Palermo, PhD
Professor
Department of Anesthesiology
University of Washington School of Medicine
Seattle Children’s Hospital Research Institute
Seattle, Washington
Pediatric Pain Management
Cynthia G. Pan, MD
Professor of Pediatrics
Section Head, Pediatric Nephrology
Medical College of Wisconsin
Medical Director, Pediatric Dialysis and Transplant
Services
Children’s Hospital of Wisconsin
Milwaukee, Wisconsin
Introduction to Glomerular Diseases
Clinical Evaluation of the Child with Hematuria
Isolated Glomerular Diseases with Recurrent Gross
Hematuria
Glomerulonephritis Associated with Infections
Glomerulonephritis Associated with Systemic Lupus
Erythematosus
Diane E. Pappas, MD, JD
Professor
Department of Pediatrics
University of Virginia School of Medicine
Charlottesville, Virginia
Sinusitis
Retropharyngeal Abscess, Lateral Pharyngeal
(Parapharyngeal) Abscess, and Peritonsillar
Cellulitis/Abscess
Elizabeth P. Parks, MD, MSCE
Assistant Professor of Pediatrics
Division of Gastroenterology, Hepatology, and
Nutrition
University of Pennsylvania Perelman School of
Medicine
Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania
Nutritional Requirements
Feeding Healthy Infants, Children, and Adolescents
John S. Parks, MD, PhD
Professor of Pediatrics
Division of Pediatric Endocrinology
Emory University School of Medicine
Atlanta, Georgia
Hormones of the Hypothalamus and Pituitary
Hypopituitarism
Maria Jevitz Patterson, MD, PhD
Professor Emeritus of Microbiology and Molecular
Genetics
Michigan State University College of Human
Medicine
East Lansing, Michigan
Syphilis (Treponema pallidum)
Associate Professor of Pediatrics Professor and Vice-Chair for Faculty
Section of Pediatric Infectious Diseases Department of Pediatrics
Wake Forest University School of Medicine Division of Nephrology
Winston-Salem, North Carolina Medical College of Wisconsin
Streptococcus pneumoniae (Pneumococcus) Milwaukee, Wisconsin
Upper Urinary Tract Causes of Hematuria
Larry K. Pickering, MD Hematologic Diseases Causing Hematuria
Senior Advisor to the Director Anatomic Abnormalities Associated with Hematuria
National Center for Immunization and Respiratory Transient Proteinuria
Diseases Orthostatic (Postural) Proteinuria
Executive Secretary Tubulointerstitial Nephritis
Advisory Committee for Immunization Practices Toxic Nephropathy
Centers for Disease Control and Prevention
Adjunct Professor of Pediatrics Diego Preciado, MD, PhD
Emory University School of Medicine Joseph E. Robert Jr. Professor of Otolaryngology
Atlanta, Georgia Children’s National Medical Center
Immunization Practices Associate Professor of Pediatrics and Surgery
George Washington University School of Medicine
Misha L. Pless, MD Washington, DC
Associate Professor of Neurology Otitis Media
Harvard Medical School
Chief, Division of Neuro-ophthalmology David T. Price, MD
Chief, Division of General Neurology Clinical Professor
Director, Neurology Urgent Access Center Department of Pediatrics
Massachusetts General Hospital East Carolina University
Boston, Massachusetts Greenville, North Carolina
Idiopathic Intracranial Hypertension/Pseudotumor Failure to Thrive
Cerebri
Charles G. Prober, MD
Laura S. Plummer, MD Professor of Pediatrics, Microbiology, and
Assistant Professor Immunology
Department of Ophthalmology Senior Associate Dean, Medical Education
University of Missouri—Kansas City School of Stanford University School of Medicine
Medicine Stanford, California
Children’s Mercy Hospital Central Nervous System Infections
Kansas City, Missouri Brain Abscess
Growth and Development (Eye)
Examination of the Eye David W. Pruitt, MD
Abnormalities of Refraction and Accommodation Assistant Professor
Disorders of Vision Department of Pediatrics
Abnormalities of Pupil and Iris University of Cincinnati College of Medicine
Disorders of Eye Movement and Alignment Medical Director, Inpatient Pediatric Rehabilitation
Abnormalities of the Lids Unit
Disorders of the Lacrimal System Director, Pediatric Rehabilitation Medicine
Disorders of the Conjunctiva Fellowship
Abnormalities of the Cornea Cincinnati Children’s Hospital Medical Center
Abnormalities of the Lens Cincinnati, Ohio
Disorders of the Uveal Tract Spinal Cord Injury and Spinal Cord Autonomic
Disorders of the Retina and Vitreous Crisis Management
Abnormalities of the Optic Nerve
Childhood Glaucoma Linda Quan, MD
Orbital Abnormalities Professor
Orbital Infections Department of Pediatrics
Injuries to the Eye University of Washington School of Medicine
Attending Physician
Andrew J. Pollard, MBBS, BSc, Division of Emergency Medicine
FRCP(UK), FRCPCH, PhD Seattle Children’s Hospital
Professor of Paediatric Infection and Immunity Seattle, Washington
Department of Paediatrics Drowning and Submersion Injury
Director of the Oxford Vaccine Group
University of Oxford Elisabeth H. Quint, MD
Honorary Consultant Paediatrician Professor of Obstetrics and Gynecology
Children’s Hospital Director, Fellowship in Pediatric and Adolescent
Oxford, United Kingdom Gynecology
Neisseria meningitidis (Meningococcus) Van Voightlander Women’s Hospital
University of Michigan Medical School
Ann Arbor, Michigan
Gynecologic Care for Girls with Special Needs

C. Egla Rabinovich, MD, MPH Harold L. Rekate, MD, FACS, FAAP
Associate Professor of Pediatrics Professor of Neurosurgery
Duke University School of Medicine Hofstra Northshore School of Medicine
Co-Chief, Division of Pediatric Rheumatology Director, The Chiari Institute
Duke University Health System Harvey Cushing Neurosciences Institute
Durham, North Carolina Great Neck, New York
Evaluation of Suspected Rheumatic Disease Spinal Cord Disorders
Treatment of Rheumatic Diseases
Juvenile Idiopathic Arthritis Megan E. Reller, MD, PhD, MPH
Scleroderma and Raynaud Phenomenon Assistant Professor of Pathology, Medicine, and
Sjögren Syndrome International Health
Miscellaneous Conditions Associated with Arthritis Johns Hopkins University School of Medicine
Baltimore, Maryland
Leslie J. Raffini, MD Spotted Fever Group Rickettsioses
Associate Professor of Pediatrics Scrub Typhus (Orientia tsutsugamushi)
University of Pennsylvania Perelman School of Typhus Group Rickettsioses
Medicine Ehrlichioses and Anaplasmosis
Division of Hematology Q Fever (Coxiella burnetii)
Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania Jorges D. Reyes, MD
Hemostasis Assistant Professor of Surgery
Hereditary Predisposition to Thrombosis Division of Transplantation
Thrombotic Disorders in Children University of Washington School of Medicine
Disseminated Intravascular Coagulation Chief, Division of Transplant Surgery
Seattle Children’s Hospital
Octavio Ramilo, MD Seattle, Washington
Henry G. Cramblett Chair in Medicine Intestinal Transplantation in Children with
Professor of Pediatrics Intestinal Failure
The Ohio State University College of Medicine Liver Transplantation
Chief, Section of Infectious Diseases and
Immunology Geoffrey A. Rezvani, MD
Nationwide Children’s Hospital Assistant Professor
Columbus, Ohio Department of Pediatrics
Mycoplasma pneumoniae Drexel University College of Medicine
Section of Endocrinology, Diabetes, and
Denia Ramirez-Montealegre, MD Metabolism
Assistant Professor of Neurology St. Christopher’s Hospital for Children
University of Virginia School of Medicine Philadelphia, Pennsylvania;
Division of Pediatric Neurology Novo Nordisk, Inc.
UVA Children’s Hospital Princeton, New Jersey
Charlottesville, Virginia An Approach to Inborn Errors of Metabolism
Ataxias
Iraj Rezvani, MD
Asma Rashid, MD, MPH Professor of Pediatrics (Emeritus)
Department of Psychiatry Temple University School of Medicine
Boston Medical Center Adjunct Professor
Boston, Massachusetts Department of Pediatrics
Disruptive, Impulse-Control, and Conduct Disorders Drexel University College of Medicine
Section of Endocrinology, Diabetes, and
Giuseppe J. Raviola, MD Metabolism
Assistant Professor of Psychiatry and Global St. Christopher’s Hospital for Children
Health and Social Medicine Philadelphia, Pennsylvania
Harvard Medical School An Approach to Inborn Errors of Metabolism
Director, Psychiatry Quality Program Defects in Metabolism of Amino Acids
Boston Children’s Hospital
Boston, Massachusetts A. Kim Ritchey, MD
Autism Spectrum Disorder Professor of Pediatrics
Childhood Psychoses Vice-Chair for Clinical Affairs
Department of Pediatrics
Gerald V. Raymond, MD University of Pittsburgh School of Medicine
Professor of Neurology Division of Hematology/Oncology
University of Minnesota School of Medicine Children’s Hospital of Pittsburgh of UPMC
Chief of Pediatric Neurology Pittsburgh, Pennsylvania
University of Minnesota Medical Center, Fairview Principles of Diagnosis (Cancer)
Minneapolis, Minnesota Principles of Treatment
Disorders of Very Long Chain Fatty Acids The Leukemias
Ann M. Reed, MD Frederick P. Rivara, MD, MPH
Professor of Pediatrics Seattle Children’s Guild Endowed Chair in
Chair, Department of Pediatrics Pediatrics
Physician-in-Chief, Duke Children’s Professor and Vice-Chair, Department of Pediatrics
Duke University University of Washington School of Medicine
Durham, North Carolina Seattle, Washington
Juvenile Dermatomyositis Injury Control
Contributors xxvii
Elizabeth V. Robilotti, MD, MPH
Associate Director, Infection Control
Memorial Hospital Division of Infectious Diseases
Memorial Sloan Kettering Cancer Center
New York, New York
Legionella
Angela Byun Robinson, MD, MPH
Assistant Professor
Department of Pediatrics
Case Western Reserve University School of
Medicine
Program Director, Pediatric Rheumatology
University Hospitals Case Medical Center
Cleveland, Ohio
Juvenile Dermatomyositis
Miscellaneous Conditions Associated with Arthritis
Genie E. Roosevelt, MD, MPH
Associate Professor of Pediatrics
Department of Emergency Medicine
University of Colorado School of Medicine
Denver Health Medical Center
Denver, Colorado
Acute Inflammatory Upper Airway Obstruction
(Croup, Epiglottitis, Laryngitis, and Bacterial
Tracheitis)
David R. Rosenberg, MD
Professor and Chair, Department of Psychiatry
Miriam L. Hamburger Endowed Chair of Child
Psychiatry
Psychiatrist-in-Chief
Wayne State University and the Detroit Medical
Center
Detroit, Michigan
Anxiety Disorders
David S. Rosenblatt, MD
Holder, Dodd Q. Chu and Family Chair in Medical
Genetics
Professor, Departments of Human Genetics,
Medicine, Pediatrics, and Biology
Faculties of Medicine and Science
McGill University
Montreal, Quebec, Canada
Methionine
Valine, Leucine, Isoleucine, and Related Organic
Acidemias
Cindy Ganis Roskind, MD
Assistant Clinical Professor
Division of Pediatric Emergency Medicine
Columbia University College of Physicians and
Surgeons
New York, New York
Acute Care of the Victim of Multiple Trauma
A. Catharine Ross, PhD
Professor and Dorothy Foehr Huck Chair
Department of Nutritional Sciences
The Pennsylvania State University
University Park, Pennsylvania
Vitamin A Deficiencies and Excess
Mary M. Rotar, RN, BSN, CIC
Infection Prevention and Control Coordinator
Children’s Hospital of Wisconsin
Milwaukee, Wisconsin
Infection Prevention and Control
xxviii Contributors
Ranna A. Rozenfeld, MD Robert A. Salata, MD
Associate Professor of Pediatrics and Medical Professor and Executive Vice-Chair, Department of
Education Medicine
Northwestern University Feinberg School of Case Western Reserve University School of
Medicine Medicine
Division of Pediatric Critical Care Medicine Chief, Division of Infectious Diseases and HIV
Ann & Robert H. Lurie Children’s Hospital of Medicine
Chicago University Hospitals Case Medical Center
Chicago, Illinois Cleveland, Ohio
Atelectasis Amebiasis
Trichomoniasis (Trichomonas vaginalis)
Colleen A. Ryan, MD African Trypanosomiasis (Sleeping Sickness;
Instructor in Psychiatry Trypanosoma brucei complex)
Harvard Medical School American Trypanosomiasis (Chagas Disease;
Medical Director, Psychiatry Inpatient Service Trypanosoma cruzi)
Boston Children’s Hospital
Boston, Massachusetts Denise A. Salerno, MD, FAAP
Motor Disorders and Habits Professor of Clinical Pediatrics
Temple University School of Medicine
H.P.S. Sachdev, MD, FIAP, FAMS, Philadelphia, Pennsylvania
FRCPCH Nonbacterial Food Poisoning
Senior Consultant
Departments of Pediatrics and Clinical Edsel Maurice T. Salvana, MD
Epidemiology Clinical Associate Professor of Medicine
Sitaram Bhartia Institute of Science and Research University of the Philippines College of Medicine
New Delhi, India Director, Institute of Molecular Biology and
Vitamin B Complex Deficiencies and Excess Biotechnology
Vitamin C (Ascorbic Acid) National Institutes of Health
Manila, The Philippines;
Ramesh C. Sachdeva, MD, PhD, FAAP, Adjunct Professor of Global Health
FCCM University of Pittsburgh School of Medicine
Professor of Pediatrics (Critical Care) Pittsburgh, Pennsylvania
Medical College of Wisconsin Amebiasis
Milwaukee, Wisconsin; Trichomoniasis (Trichomonas vaginalis)
Associate Executive Director African Trypanosomiasis (Sleeping Sickness;
Medical Director, Quality Initiatives Trypanosoma brucei complex)
Director, Department of Subspecialty Pediatrics American Trypanosomiasis (Chagas Disease;
American Academy of Pediatrics Trypanosoma cruzi)
Elk Grove Village, Illinois
Quality and Safety in Healthcare for Children Hugh A. Sampson, MD
Kurt Hirschhorn Professor of Pediatrics
Manish Sadarangani, BM BCh, DPhil, Jaffe Food Allergy Institute
MRCPCH Icahn School of Medicine at Mount Sinai
Clinical Lecturer and Honorary Specialist Registrar New York, New York
Paediatric Infectious Diseases and Immunology Anaphylaxis
Children’s Hospital Food Allergy and Adverse Reactions to Foods
Oxford, United Kingdom
Neisseria meningitidis (Meningococcus) Thomas J. Sandora, MD, MPH
Assistant Professor of Pediatrics
Rebecca E. Sadun, MD, PhD Harvard Medical School
Adult and Pediatric Rheumatology Fellow Medical Director, Infection Prevention and Control
Departments of Medicine and Pediatrics Division of Infectious Diseases
Duke University School of Medicine Boston Children’s Hospital
Durham, North Carolina Boston, Massachusetts
Systemic Lupus Erythematosus Community-Acquired Pneumonia
Mustafa Sahin, MD, PhD Tracy L. Sandritter, PharmD
Associate Professor of Neurology Pharmacy Resident
Harvard Medical School Transplant Pharmacy
F.M. Kirby Neurobiology Center Children’s Mercy Hospitals and Clinics
Boston Children’s Hospital Kansas City, Missouri
Boston, Massachusetts Principles of Drug Therapy
Neurocutaneous Syndromes
Wudbhav N. Sankar, MD
Assistant Professor
Department of Orthopaedic Surgery
University of Pennsylvania Perelman School of
Medicine
Attending Orthopaedic Surgeon
Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania
The Hip
Eric J. Sarkissian, MD
Ben Fox Clinical Fellow
Department of Orthopaedics
Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania
The Knee
Ajit A. Sarnaik, MD
Assistant Professor
Department of Pediatrics
Wayne State University School of Medicine
Associate Director, Pediatric Residency Program
Children’s Hospital of Michigan
Detroit, Michigan
Respiratory Distress and Failure
Ashok P. Sarnaik, MD
Professor and Interim Chair
Department of Pediatrics
Wayne State University School of Medicine
Pediatrician in Chief
Children’s Hospital of Michigan
Detroit, Michigan
Respiratory Distress and Failure
Respiratory Pathophysiology and Regulation
Harvey B. Sarnat, MD, MS, FRCPC
Professor of Pediatrics, Pathology
(Neuropathology), and Clinical Neurosciences
Division of Pediatric Neurology
University of Calgary Faculty of Medicine
Alberta Children’s Hospital
Calgary, Alberta, Canada
Evaluation and Investigation (Neuromuscular
Disorders)
Developmental Disorders of Muscle
Muscular Dystrophies
Endocrine and Toxic Myopathies
Metabolic Myopathies
Disorders of Neuromuscular Transmission and of
Motor Neurons
Hereditary Motor-Sensory Neuropathies
Toxic Neuropathies
Autonomic Neuropathies
Guillain-Barré Syndrome
Bell Palsy
Minnie M. Sarwal, MD, PhD, FRCP,
DCH
Professor, Transplant Nephrology and Pediatrics
California Pacific Medical Center
Director, The BIOMARC Institute for Personalized
Medicine, Sutter Health Care
Director, The Sarwal Lab, CPMC-Research
Institute
San Francisco, California;
Consulting Professor
Stanford University
Palo Alto, California
Renal Transplantation
Laura E. Schanberg, MD
Professor of Pediatrics
Duke University School of Medicine
Co-Chief, Division of Pediatric Rheumatology
Duke University Medical Center
Durham, North Carolina
Systemic Lupus Erythematosus
Musculoskeletal Pain Syndromes
 Contributors xxix

Mark R. Schleiss, MD J. Paul Scott, MD Ala Shaikhkhalil, MD

Professor of Pediatrics Professor of Pediatrics Fellow
American Legion and Auxiliary Heart Foundation Division of Pediatric Hematology/Oncology Division of Gastroenterology, Hepatology, and
Research Chair Medical College of Wisconsin Nutrition
Director, Division of Pediatric Infectious Diseases Blood Center of Southeastern Wisconsin Children’s Hospital of Philadelphia
and Immunology Milwaukee, Wisconsin Philadelphia, Pennsylvania
University of Minnesota School of Medicine Hemostasis Nutritional Requirements
Minneapolis, Minnesota Hereditary Clotting Factor Deficiencies (Bleeding Feeding Healthy Infants, Children, and Adolescents
Principles of Antibacterial Therapy Disorders)
Principles of Antiviral Therapy von Willebrand Disease Raanan Shamir, MD
Principles of Antiparasitic Therapy Hereditary Predisposition to Thrombosis Professor of Pediatrics
Thrombotic Disorders in Children Sackler Faculty of Medicine
Nina F. Schor, MD, PhD Postneonatal Vitamin K Deficiency Tel-Aviv University
William H. Eilinger Professor and Chair Liver Disease Tel-Aviv, Israel;
Department of Pediatrics Acquired Inhibitors of Coagulation Chairman, Institute of Gastroenterology, Nutrition,
Professor, Department of Neurology Disseminated Intravascular Coagulation and Liver Diseases
Pediatrician-in-Chief Platelet and Blood Vessel Disorders Schneider Children’s Medical Center of Israel
Golisano Children’s Hospital Petach Tikvah, Israel
University of Rochester Medical Center Patrick C. Seed, MD, PhD Intestinal Infections and Infestations Associated with
Rochester, New York Associate Professor of Pediatrics Malabsorption
Neurologic Evaluation Division of Pediatric Infectious Diseases Chronic Malnutrition
Assistant Professor of Molecular Genetics and
Bill J. Schroeder, DO Microbiology Andi L. Shane, MD, MPH, MSc
Pediatric Emergency Medicine Duke University Medical Center Associate Professor of Pediatrics
Advocate Christ Medical Center Durham, North Carolina Division of Pediatric Infectious Diseases
Oak Lawn, Illinois The Microbiome and Pediatric Health Emory University School of Medicine
Envenomations Atlanta, Georgia
George B. Segel, MD Infections of the Neonatal Infant
James W. Schroeder Jr., MD, FACS, Professor of Medicine
FAAP Professor Emeritus of Pediatrics Bruce K. Shapiro, MD
Associate Professor University of Rochester Medical Center Professor of Pediatrics
Department of Otolaryngology—Head and Neck Rochester, New York The Arnold J. Capute MD, MPH Chair in
Surgery Definitions and Classification of Hemolytic Anemias Neurodevelopmental Disabilities
Northwestern University Feinberg School of Hereditary Spherocytosis The Johns Hopkins University School of Medicine
Medicine Hereditary Elliptocytosis Vice-President, Training
Ann & Robert H. Lurie Children’s Hospital of Hereditary Stomatocytosis Kennedy Krieger Institute
Chicago Paroxysmal Nocturnal Hemoglobinuria and Baltimore, Maryland
Chicago, Illinois Acanthocytosis Intellectual Disability
Congenital Anomalies of the Larynx, Trachea, and Enzymatic Defects
Bronchi Hemolytic Anemias Resulting from Extracellular Amanda N. Shaw, MD
Foreign Bodies in the Airway Factors—Immune Hemolytic Anemias Pediatric Endocrinology Fellow
Laryngotracheal Stenosis and Subglottic Stenosis Hemolytic Anemias Secondary to Other University of Texas Health Sciences Center
Neoplasms of the Larynx, Trachea, and Bronchi Extracellular Factors Houston, Texas
Campylobacter
Mark A. Schuster, MD, PhD Ernest G. Seidman, MDCM, FRCPC, Aeromonas and Plesiomonas
William Berenberg Professor of Pediatrics FACG
Harvard Medical School Professor of Medicine and Pediatrics Bennett A. Shaywitz, MD
Chief of General Pediatrics and Vice-Chair for Bruce Kaufman Endowed Chair in IBD Charles and Helen Schwab Professor in Dyslexia
Health Policy McGill University Faculty of Medicine and Learning Development
Department of Medicine Director, McGill Centre of IBD Co-Director, Center for Dyslexia and Creativity
Children’s Hospital Boston McGill University Health Center Chief, Child Neurology
Boston, Massachusetts Montreal, Quebec, Canada Yale University School of Medicine
Gay, Lesbian, and Bisexual Adolescents Immunodeficiency Disorders New Haven, Connecticut
Immunoproliferative Small Intestinal Disease Dyslexia
Gordon E. Schutze, MD Malabsorption in Eosinophilic Gastroenteritis
Executive Vice-Chairman Malabsorption in Inflammatory Bowel Disease Sally E. Shaywitz, MD
Professor of Pediatrics Audrey G. Ratner Professor in Learning
Martin I. Lorin MD Chair in Medical Education Janet R. Serwint, MD Development
Vice-President of International Medical Programs Professor Co-Director, Center for Dyslexia and Creativity
Baylor International Pediatric AIDS Initiative Department of Pediatrics Department of Pediatrics
Baylor College of Medicine Johns Hopkins University School of Medicine Yale University School of Medicine
Texas Children’s Hospital Baltimore, Maryland New Haven, Connecticut
Houston, Texas Loss, Separation, and Bereavement Dyslexia
Actinomyces
Nocardia Dheeraj Shah, MD, FIAP, MAMS Philip M. Sherman, MD, FRCP(C),
Tularemia (Francisella tularensis) Professor FAAP
Brucella Department of Pediatrics Professor of Paediatrics, Microbiology, and
University College of Medical Sciences Dentistry
Daryl A. Scott, MD, PhD Guru Teg Bahadur Hospital University of Toronto Faculty of Medicine
Associate Professor New Delhi, India Division of Gastroenterology, Hepatology, and
Department of Molecular and Human Genetics Vitamin B Complex Deficiencies and Excess Nutrition
Baylor College of Medicine Vitamin C (Ascorbic Acid) Senior Scientist, Cell Biology Research Program
Houston, Texas The Hospital for Sick Children
The Genetic Approach in Pediatric Medicine Toronto, Ontario, Canada
The Human Genome Other Malabsorptive Syndromes
Patterns of Genetic Transmission
xxx Contributors

Benjamin L. Shneider, MD Anne Slavotinek, MBBS, PhD David A. Spiegel, MD

Professor of Pediatrics Professor of Clinical Pediatrics Associate Professor
University of Pittsburgh School of Medicine University of California, San Francisco Department of Orthopaedic Surgery
Director, Pediatric Hepatology San Francisco, California University of Pennsylvania Perelman School of
Children’s Hospital of Pittsburgh of UPMC Dysmorphology Medicine
Pittsburgh, Pennsylvania Attending Orthopaedic Surgeon
Autoimmune Hepatitis Thomas L. Slovis, MD Children’s Hospital of Philadelphia
Professor Emeritus of Radiology and Pediatrics Philadelphia, Pennsylvania
Stanford T. Shulman, MD Wayne State University School of Medicine Hypermobile Pes Planus (Flexible Flatfeet)
Virginia H. Rogers Professor of Pediatric Infectious Department of Pediatric Imaging Toe Deformities
Diseases Children’s Hospital of Michigan Shoes
Northwestern University Feinberg School of Detroit, Michigan The Spine
Medicine Biologic Effects of Radiation on Children The Neck
Chief, Division of Infectious Diseases
Ann & Robert H. Lurie Children’s Hospital of P. Brian Smith, MD, MHS, MPH Helen Spoudeas, MD
Chicago Associate Professor of Pediatrics Honorary Senior Lecturer in Paediatric
Chicago, Illinois Division of Neonatology Endocrinology
Group A Streptococcus Duke University School of Medicine University College London
Durham, North Carolina Consultant in Neuro-Endocrine Late Effects of
Scott H. Sicherer, MD Candida Childhood Cancer
Elliot and Roslyn Jaffe Professor of Pediatrics, University College London Hospital
Allergy, and Immunology Mary Beth F. Son, MD Great Ormond Street Hospital
Jaffe Food Allergy Institute Instructor in Pediatrics London, United Kingdom
Icahn School of Medicine at Mount Sinai Department of Pediatrics Diarrhea from Neuroendocrine Tumors
New York, New York Harvard Medical School
Allergy and the Immunologic Basis of Atopic Disease Staff Physician, Division of Immunology Jürgen W. Spranger, MD
Diagnosis of Allergic Disease Boston Children’s Hospital Professor Emeritus of Pediatrics
Principles of Treatment of Allergic Disease Boston, Massachusetts University of Mainz School of Medicine
Allergic Rhinitis Kawasaki Disease Children’s Hospital
Childhood Asthma Mainz, Germany
Atopic Dermatitis (Atopic Eczema) Laura Stout Sosinsky, PhD Mucopolysaccharidoses
Insect Allergy Senior Research Scientist
Ocular Allergies Early Childhood Development James E. Squires, MD
Urticaria (Hives) and Angioedema Child Trends, Inc. Pediatric Gastroenterology Fellow
Anaphylaxis Bethesda, Maryland Cincinnati Children’s Hospital Medical Center
Serum Sickness Childcare: How Pediatricians Can Support Children Cincinnati, Ohio
Food Allergy and Adverse Reactions to Foods and Families Manifestations of Liver Disease
Adverse Reactions to Drugs
Joseph D. Spahn, MD Rajasree Sreedharan, MBBS, DCH,
Richard Sills, MD Professor MRCPCH
Professor of Pediatrics Department of Pediatrics Assistant Professor of Clinical Pediatrics
Director, Pediatric Hematology/Oncology National Jewish Health University of Pennsylvania Perelman School of
Upstate Medical University University of Colorado School of Medicine Medicine
Syracuse, New York Denver, Colorado Division of Gastroenterology and Nutrition
Iron-Deficiency Anemia Childhood Asthma The Children’s Hospital of Philadelphia
Other Microcytic Anemias Philadelphia, Pennsylvania
Rivkie Spalter Tubular Function
Mark D. Simms, MD, MPH Director Renal Tubular Acidosis
Professor of Pediatrics Mequon Jewish Preschool Nephrogenic Diabetes Insipidus
Medical College of Wisconsin Mequon, Wisconsin Bartter and Gitelman Syndromes and Other
Medical Director The Reggio Emilia Educational Approach and Child Inherited Tubular Transport Abnormalities
Child Development Center Development and Learning Renal Failure
Children’s Hospital of Wisconsin
Milwaukee, Wisconsin Mark A. Sperling, MD Raman Sreedharan, MD, DCH,
Language Development and Communication Professor and Chair Emeritus MRCPCH
Disorders Department of Pediatrics Clinical Assistant Professor of Pediatrics
Adoption University of Pittsburgh School of Medicine University of Pennsylvania Perelman School of
Division of Endocrinology, Metabolism, and Medicine
Eric A.F. Simões, MBBS, DCH, MD Diabetes Mellitus EHR Medical Director, Specialty Care
Professor of Pediatrics Children’s Hospital of Pittsburgh The Children’s Hospital of Philadelphia
University of Colorado School of Medicine Pittsburgh, Pennsylvania Philadelphia, Pennsylvania
Professor of Epidemiology Hypoglycemia Major Symptoms and Signs of Digestive Tract
Center for Global Health Disorders
Colorado School of Public Health Robert L. Spicer, MD Functional Abdominal Pain (Nonorganic Chronic
Division of Infectious Diseases Professor of Pediatrics Abdominal Pain)
The Children’s Hospital University of Nebraska Medical Center College of
Aurora, Colorado Medicine Nivedita Srinivas, MD
Polioviruses Clinical Professor of Pediatrics Clinical Instructor in Pediatrics
Creighton University School of Medicine Division of Pediatric Infectious Diseases
Kari A. Simonsen, MD Clinical Service Chief, Cardiology Stanford University School of Medicine
Assistant Professor of Pediatrics Children’s Hospital and Medical Center Stanford, California
Division of Infectious Diseases Omaha, Nebraska Central Nervous System Infections
University of Nebraska Medical Center Diseases of the Myocardium
Omaha, Nebraska Diseases of the Pericardium
Leptospira Tumors of the Heart
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the Society for six months and who were in the employment of the
Society at the date of commencing the fund, if they were sixteen
years of age or upwards and not over fifty years of age in the case of
males or forty-five years of age in the case of females, should be
members of the fund. The proposed scale of contributions to the
scheme was 5 per cent. of the wages or salary received, and
contributors were to be eligible at sixty years of age to retire on
pension if they so desired. At the age of sixty-five for males and fifty
for females they would be eligible to receive annuities ranging from
25 per cent. of their salaries, after ten years’ payment of
contributions, to 85 per cent. of their salaries after having paid
contributions for fifty-one years. To assist in launching the scheme it
was proposed that the Society should make an initial contribution of
£10,000. It was also proposed that the superannuation fund should
be managed by a committee of seven, which committee should
consist of the chairman and three directors for the time being of the
U.C.B.S. and three representatives of the employees, who must have
at least three years’ service with the Society.
When the scheme was brought forward again at the September
meeting of the Society one of the amendments sent in was from St
George Society, and called for the rejection of the scheme in its
entirety. The motion to reject the scheme was seconded by a
representative of the employees, who referred to the “autocratic”
methods of the directors in adopting this scheme and bringing it
forward without consulting the workers. The result was that the
scheme was disapproved. The scheme which was brought forward by
the S.C.W.S. for the superannuation of their employees suffered the
same fate.
 THE INTERNATIONAL CO-OPERATIVE
CONGRESS.
It was as the result of an invitation which came from the Scottish
National Co-operative Conference, held in Kilmarnock in 1910, that
the International Co-operative Congress held in Hamburg in the
autumn of that year decided to come to Glasgow for the 1913
Congress rather than go to Vienna, the claims of which city were
strongly urged by Dr Beno Karpeles, in opposition to the claims of
Glasgow, as set forth by Mr James Deans.
The year 1913 was a big year for Scottish Co-operators, for not only
had they to entertain the International Congress in the autumn, but
Scotland was also the location of the British Congress in the summer,
and pessimists were not wanting who thought that the Co-operators
of Scotland had undertaken a task which was too heavy for them
when they decided to entertain two so great Congresses as the British
and the International in one year. Events proved that the pessimists
were wrong, however. One of the first duties which fell to the lot of
the committee which was appointed to make preparations for the
International Congress was that of finding a suitable house for it, but
they did not require to look far afield. The U.C.B.S. were the owners
of the best hall in the city for the purpose for which it was required.
In St Mungo Hall there was ample accommodation for the Congress
itself, while in the adjoining halls ample space for dining the
delegates could be provided. The Bakery was just across the street,
and cooking and waiting facilities were all that could be desired. So it
was decided that in St Mungo Hall the Congress should be held.
The U.C.B.S. undertook all the work of catering for the delegates at
luncheon each day. They also undertook the provision of the
luncheon which was given by the reception committee on the
Saturday, and they themselves provided the entertainment for one of
the afternoons of Congress. It was universally acknowledged that the
International Congress of 1913 was the best International Co-
operative Congress held, and to this happy result the U.C.B.S.
contributed no small share. The event was one which will not readily
be forgotten by those privileged to take part. Alas, that the
expressions of fraternity so freely uttered then should have been so
soon made of no avail by the outbreak of war.
 THE HOLIDAY CAMP.
It is to Mr John Dewar, for many years president of the
Renfrewshire Co-operative Conference Association, that the idea of a
Co-operative holiday camp owes its origin. For many years Mr Dewar
was an enthusiastic Volunteer, and his experiences under canvas
during the annual training periods of his regiment impressed him
with the value of this form of holiday. Associated with him in his
propaganda for a camping association on Co-operative lines was Mr
James Lucas, at that time president of the Glasgow and Suburbs
Conference Association, and latterly, also, Mr John Paton, of the
Renfrewshire Conference council, who had been converted to the
idea as the result of a visit to Douglas, I.O.M., where he had seen the
huge city under canvas which for a number of years housed
thousands of holiday-making Lancashire lads every summer.
By 1910 these gentlemen had been able to get their organisation so
far advanced that they had selected a site on the Ayrshire Coast for
their first camp, and had made arrangements with the farmer who
rented the land. At the last moment, however, the landowner stepped
in and vetoed the whole proceedings. This put an end to doing
anything further with regard to a camp during that year, but the
search for a suitable site continued and, at length, the little farm of
Roseland, situated on Canada Hill, Rothesay, overlooking the Bay,
was secured. The farm was for sale, but the committee in charge of
the arrangements considered that purchase was too bold an initial
step to take, so they leased the farm for six months; securing an
option to purchase at the end of that period if they wished.
Here, in the summer of 1911, the first Scottish Co-operative
holiday camp was established. It was rather a primitive affair, that
first camp. The cooking was done in the little farmhouse, while the
campers had their meals in a large marquee. The U.C.B.S. directors
took a keen interest in the camp from the very beginning. The
catering was done by them, and the catering staff were housed in the
little farmhouse.
 Primitive though the arrangements were, they appealed to the
campers, who were unanimous in their praise of the beautiful
situation, the pure air, the perfect catering, and the small outlay for
which they secured a perfect holiday. Thus encouraged, the
committee which had promoted the camp proceeded to organise a
Co-operative society to work it, and in this Co-operative society the
U.C.B.S. took out twenty-five shares. The farm was purchased for
£600, and in September the Baking Society increased the number of
their shares to 100.
In 1912 the camp was much better organised than in 1911, but it
was still far from being what its promoters desired to see it. They
were hampered for lack of funds, however, as the Co-operative
societies were showing caution and a lack of faith in the enterprise,
and were not providing the capital necessary to work it properly as
readily as had been expected. The only fault which the committee
found with the site lay in the fact that in dry summers the water
supply was inadequate. The summer of 1912 also showed them that it
was desirable that something more impervious to rain than a
marquee was desirable for the gatherings of campers and, in order
that these two defects might be put right, they applied to the U.C.B.S.
for a loan of £1,000 on the security of the property. This loan was
granted them, and so good use did they make of the power which it
gave them that, before the time came for opening the camp in 1913,
they had put down a huge storage tank for water, capable of storing
20,000 gallons; and had erected a dining hall large enough to dine
several hundred persons.
The camp was a very great success in the third year. Its popularity
was so great that the committee found it quite impossible to provide
accommodation for all who wished to avail themselves of its facilities
for holiday making, and this has been the case in each succeeding
year, notwithstanding the influence of the war. At the end of the
third season, however, the committee of the association came to the
conclusion that, if the camp was to be made the success they believed
it was capable of becoming, some rearrangement of its management
would require to be made, so they invited the Baking Society to take
it over as a going concern and work it themselves.
They explained to the directors of the Baking Society that they
were not taking this step because they disbelieved in its success, but
solely on the ground that they considered that dual control was not
good for discipline and did not make for good management.
The directors of the Baking Society promised to consider the
matter, and the result was they brought forward to the quarterly
meeting, held in March 1914, a recommendation that the camp
should be taken over, and this recommendation was accepted by the
delegates. Since then the camp has been managed by the U.C.B.S.
In 1914 accommodation was provided for 250 persons, and it is
extremely probable that greatly increased accommodation would
have been provided before now had it not been for the intervention
of the war which, by providing another and much more strenuous
form of camping for the past and prospective frequenters of Canada
Hill, prevented for the time being such further developments.
Doubtless, however, with the return of Europe to sanity, such
developments will take place; until, before many years are past,
almost the whole of the Society’s seven-acre estate will be covered in
the summer and autumn months with the picturesque pyramids of
white canvas.
 THE SOCIETY’S PROGRESS.
In all its branches, with the exception of the tearooms, the
progress of the Society during these four years had been remarkable.
In 1913, however, the London Street tearoom was closed, and as soon
as the lease of the Union Halls expired they also were given up. At
the beginning of the period the output had averaged 3,820 sacks per
week, while at its end the average output was 4,648, an increase of
848 sacks per week in four years. The aggregate sales for the year
which ended in July 1914 were £692,600. Truly, the Society had
travelled far from the days when a small two-oven bakehouse
sufficed for all its output. The membership now consisted of 201
societies; which was also a contrast to the eight small struggling
societies which had banded themselves together in the last days of
December 1868 to form the Federation.
The time had now arrived when the Federation was to be put to a
more severe test than ever before since it had attained to years of
maturity. Like a thunderclap the war storm which had been
gathering over Europe during the month of July burst on an
astonished world which had almost come to believe war on such a
gigantic scale impossible, and many were the doubts expressed, even
by sincere wellwishers of the Co-operative movement, as to how it
would weather the storm. The next chapter will tell how one
federation kept the Co-operative flag flying and added to the laurels
it had gained by its devoted and loyal service to the interests of the
common people.
 CHAPTER XVIII.
BAKING UNDER WAR CONDITIONS.

THE EARLY DAYS OF WAR—KEEPING DOWN PRICES: THE

DIRECTORS’ VIEW—HALF-PAY TO SOLDIER EMPLOYEES
—ARMY CONTRACTS—HORSES AND MOTORS
COMMANDEERED—PRICE OF BREAD ADVANCED—
DEATH OF BISCUIT FACTORY MANAGER—MORE ARMY
CONTRACTS—EXTENSIONS AND ALTERATIONS—M‘NEIL
STREET BLOCK COMPLETED—BUSINESS ORGANISATION
—TEABREAD AND PASTRY SHOPS—THE PRICE OF BREAD
—INCREASING OUTPUT—BISCUIT AND TEABREAD
TRADE—THE SOCIETY AND ITS WORKERS—DELIVERY
DIFFICULTIES—DEATH OF MR DUNCAN M‘CULLOCH.

On the fourth day of August 1914, Great Britain entered on a new

era. There are not awanting cynics who declare that Great Britain is
hardly ever out of war, but however that may be, there never has
been in the world’s history a war which seemed in its early days to be
fraught with so dire consequences for civilisation as did that into
which the nations of Europe plunged in those early days of August
1914. For the first few days it seemed as if chaos had suddenly
developed. The people seemed to go mad with panic, and rushed to
purchase goods wherever these could be procured, careless of the
prices which they were called on to pay. To the traders, large and
small, it must have seemed like the beginning of a trading
millennium, and they took immediate advantage of the position in
which they found themselves. Prices doubled, trebled, and
quadrupled; yet the eager rush to buy continued. The poor bought
what they could, but they soon reached the end of their meagre
resources. Not so the rich, however. Amongst them, the panic
seemed to be even greater than amongst the poorer sections of the
community, and they provisioned their houses as if for a siege,
careless as to who must want if only they had plenty in store.

EDUCATIONAL DEPUTATION TO ENGLAND

 EDUCATIONAL DEPUTATION TO ENGLAND

The bakers of Glasgow were also the victims of the profiteering

craze which had suddenly enmeshed the trading public, and at a
meeting which took place on the afternoon of 3rd August, they
proposed that the price of bread should be raised. Mr James Young,
manager of the U.C.B.S., had been present at this meeting and had
opposed the proposal, with the result that it was not carried out. This
action of his was homologated by his board at a special meeting
which was held the same evening, while at another meeting, held
three days later, the committee decided that they would not raise the
price of bread in the meantime. The Baking Society found itself in a
very favourable position at this time. In M‘Neil Street there were
supplies of flour which would keep the bakery going for nine weeks,
while Clydebank had supplies for six, and Belfast for seven weeks.
They were thus in a position to view the situation with more or less
equanimity. The S.C.W.S. were also in a good position so far as
supplies of flour and wheat were concerned, having some nine or ten
weeks’ supplies either on hand or on board ship at the outbreak of
war, and the rapidity with which the German fleet was bottled up
within its own harbours gave security of passage for the time being to
food-carrying vessels. Nevertheless, the general panic of that first
week of war affected the wheat and flour trade as much as it did
many others, and it was not long before flour was selling at a price
which had never been asked for it in the whole course of the
Federation’s history.
These were conditions under which the two great Co-operative
federations were able to show to advantage, and they were conditions
also which proved the wisdom of the Wholesale Society in
establishing its own purchasing agency in Canada; for while outside
millers were asking as much as 65/ a sack for flour in the first week
of the war, the highest price quoted by the Wholesale Society was
37/, and ordinary flour was sold by them at 1/6 per sack advance on
normal price. Thus the two federations were in a position to see to it
between them that on this side of the Atlantic, at least, no undue
advantage was taken of the circumstances created by the war. At the
meeting of the Baking Society’s board, which took place on 1st
September, the committee placed on record their appreciation of the
manner in which the crisis brought about by the war had been met
by the manager, heads of departments, and employees generally, and
desired the manager to convey this expression of the board’s
appreciation to the heads of departments and employees. At the
quarterly meeting of the Society, the directors had a similar
compliment paid to themselves; Mr Shaw, Cambuslang Society,
moving, and Mr Glasse, S.C.W.S., seconding a motion which received
the unanimous endorsement of the delegates, thanking the directors
for the splendid lead which they had given to the purveyors of bread
in the city and far beyond. Mr Shaw drew attention to the importance
and magnificence of what had been done, and thought that the
nation was entitled to recognise what the Co-operative movement
had done, not only now but at all times, in keeping down prices and
in keeping goods pure.
Perhaps the position in which the Federation was placed by the
war and the view of it taken by the directors can be explained most
clearly in the words of Mr Gerrard himself. Addressing the
September quarterly meeting, he stated that the profits for the half-
year which had ended in July had been a little better than usual, but
[3]
“the future was so indefinite that no one could foresee with any
accuracy what would happen. They had been blamed, and were still
being blamed in certain quarters, for not increasing the price of
bread, but they had resolutely refused, thinking it their duty as a
Federation to keep the price of bread and other commodities as low
as possible. Notwithstanding, he understood the price of biscuits had
been increased in some quarters, and this had brought them some
trade that they should have had before. The way in which prices were
rushed up at the commencement of the war had seemed to the board
most unseemly and unpatriotic, and seemed to show that everyone
was trying to make as much as possible out of the war. It was
unfortunate that the price of bread would require to be increased
before the war was over, but until that step was absolutely necessary
they would not increase it, and then only as far as was necessary.
They had received several contracts for bread, and the manner in
which the manager, heads of departments, and the general body of
the employees acted under the stress of these circumstances was
worthy of all praise.”
3. (The Scottish Co-operator, 25th September 1914.)
 HALF-PAY TO SOLDIER EMPLOYEES.
At the outbreak of war, a number of the employees had been
members of the Territorial Forces and had been called up at once,
and the board decided to grant them half-pay. Later, when the call
for more men came, many of the employees joined up, and the
directors decided that those who enlisted should be placed on the
same footing as regarded half-pay as were those who had been called
up at the outbreak of war. At this quarterly meeting the directors
were accused by a representative of the Bonus Investment Society of
not being so generous to their employees who were serving with the
Colours as were some other Co-operative societies, but the chairman
was able to satisfy the delegates that, in those cases where generosity
was most necessary—those of wives with large families—the Baking
Society’s scheme was the one which gave the wife the larger total
income.
This meeting was the one at which the method of giving the
minutes in the form of synopses was first adopted, and one of the
delegates took occasion to compliment the secretary on having
produced synopses of the various minutes which gave the delegates
enough information about the business done to enable them to find
out what was taking place. At this meeting also a grant of £100 was
made to the Belgian Relief Fund, the chairman stating that further
grants could be made if occasion demanded. Other donations made
were:—£500 to the War Relief Fund, £100 to the Lord Mayor of
Belfast’s Fund, and £100 to the fund being raised by the Provost of
Clydebank. It was urged very strongly by several of the delegates that
the administration of the relief fund should be in the hands of the
Government. In the minute of the board meeting of 2nd October, the
fact is noted that during the past quarter the Society’s motors had
covered a distance of 125,015 miles. It had certainly been a busy
quarter.
 ARMY CONTRACTS.
Immediately the war broke out, the United Baking Society were
inundated with Army contracts. In the first few days they had to
make arrangements for supplying camps all over the country, in
addition to those for which they had held the contracts. These new
camps included those at Perth, Inverness, Falkirk, and Dunblane,
and all were supplied at current prices. Yet, notwithstanding the fact
that the Baking Society were doing much work for the Army in that
first week of the war, they were not allowed to escape from some of
the other discomforts which come to the owners of horses and
vehicles in a nation at war. On the 6th of August 18 horses, two
motors, and one lorry were commandeered for military purposes.
Other large bakers suffered in the same way, and on behalf of all of
them a telegram was sent to the Officer in Command, pointing out
the importance of the work which was being done by the baking
firms in the distribution of food, and complaining that serious
hardship to the people would ensue if bakers’ horses were removed.
With this telegram the committee of the Baking Society associated
themselves. To enable them to overtake their work, the Society
decided to purchase several motors which had been offered to them,
while a circular-letter, explaining the position, was sent out to the
societies. That the War Office officials were not ungrateful for the
assistance which had been rendered them in the emergency of
mobilisation was shown by the fact that at the board meeting which
was held on 7th August, letters of congratulation on the manner in
which the service of bread to two camps had been carried out were
read to the committee.
Among the minor results due to the war may be mentioned the
cancelling of a number of social meetings, excursions, marriages,
etc., and the closing down of the holiday camp at the end of August.
At the beginning of October, another attempt was made by the
Glasgow Master Bakers’ Association to have the price of bread raised,
but again the directors of the Baking Society blocked the way. At the
same time, however, the committee came to the decision that, in
view of all the circumstances, they would not raise any objection
should another overture be made. At the beginning of October, the
situation was again reviewed and, in view of the fact that by the
beginning of the year the price of flour would be greatly in advance of
that then being used, it was agreed to resist no longer a slight
advance in the price of bread. For three months the Society had been
the means of keeping the price of bread at the rate at which it was
being sold at the outbreak of war. If we assume that their action
influenced only two hundred thousand households, and that the
average consumption of bread in each household was only one 2–lb.
loaf per day, this action of the Baking Society was responsible for
saving to these householders in three months no less a sum than
£21,250, and probably double that sum, for that only supposes an
advance of one farthing per loaf. The first advance in the price of
bread took place on 16th November. In Belfast the price of bread had
been advanced ¼d. per 2–lb. loaf on 19th October.
 DEATH OF BISCUIT FACTORY MANAGER.
Mr John Gilmour took charge of the Society’s biscuit factory
shortly after it was commenced, and he continued to manage it until
his death, which took place on 9th October 1914. He was highly
respected by both directors and workmen for his devotion to
business and his tact and kindness in dealing with those under him.
He was succeeded by Mr William Ninian, who had the distinction of
being a Bakery-trained man and who was acting as Mr Gilmour’s
assistant at the time of that gentleman’s death.
At the quarterly meeting, the chairman made fitting and
sympathetic reference to the loss which the Society had sustained
through the death of Mr Gilmour. He also referred to the retiral from
active work of one of the Society’s bread bakers, Mr W. Lees, who
had been in the employment of the Society for forty and a half years.
During the quarter an electrically-driven motor had been at work in
Glasgow for the Society. It was proving very satisfactory and the
board, he said, considered that before long these electrically-driven
cars would replace horses on the streets, although petrol-driven cars
would still be used for the long journeys.
At this quarterly meeting, some of the delegates wished to know
why the board had decided that they would no longer resist an
increase in the price of bread seeing that in their minutes they stated
that their contract for flour was still unbroken. The chairman, in
replying, pointed out that flour at the moment was about 10/ higher
in price than before the war, and the board thought it better that the
price should be raised by a halfpenny now than that it should be put
a penny or three halfpence later, when the stock of cheap flour was
completely exhausted. He also stated that eighty-six of the Society’s
employees were then serving in the Army. At this quarterly meeting,
also, the question of granting relief to what were termed “innocent
enemy aliens,” in other words, British women who had married
subjects of nations at war with Britain, and who through the
operation of war were left destitute in this country, was raised
through an appeal on their behalf issued by the International Co-
operative Alliance executive. A proposal was made to grant £25 to
the fund which was being raised, but this was defeated by a two to
one majority. The cake show was held this year as usual, but, as was
to be expected, the sales were not so great as in some former years.
The price had been advanced on the average one penny per pound.
In their report to the delegates to the December quarterly meeting,
the directors stated that they would regard it as an instruction to
make no increase in the prices of their goods so long as they were
able to work without actual loss.
 MORE ARMY CONTRACTS.
In September, an arrangement had been entered into with the
Army Authorities by which the Government supplied the flour and
the Baking Society baked it into bread for the troops. In addition,
several contracts for biscuits for the Army were received. The first
three of these totalled 200 tons. The contracts for the baking of
bread for the Army continued until early in 1916, when an intimation
was received from the Quartermaster of the Scottish Command that
the contract would cease, as the Government were now erecting field
bakeries for themselves. Two months later, however, another
contract was entered into with the Scottish Command on the same
terms as formerly. The contracts carried out by Clydebank and
Belfast Branches have already been referred to.
 EXTENSIONS AND ALTERATIONS.
For the whole of the first year of war and almost the whole of the
second year, the building department of the Society was kept busy
with the extension to the M‘Neil Street premises. The principal
reason for this extension was the necessity for securing more space
for the biscuit factory, and as soon as practicable this extension was
carried through. A new travelling oven was installed early in 1915 at a
cost of £175, and at the same time a new biscuit cutting machine was
got at a cost of £300. A gas-fired travelling oven was also installed
before the end of the year and another one, built in accordance with
alterations suggested by the bakery staff, was installed in October
1916. In the spring of 1915, it was decided to cover over the space
between bakehouses Nos. 11 and 12 for the purpose of providing
dressing rooms for the workers, and at the same time it was decided
to put fans in each flat for ventilation purposes.
M‘NEIL STREET BLOCK COMPLETED.
Parts of the new block at the Adelphi Street and South York Street
corner were occupied as they were completed. Particularly, the
ground floor was occupied as an extension to the biscuit factory, but
it was not until June 1916 that the entire building was ready for the
official opening ceremony. This was of a very modest character, for,
as the chairman stated, the directors did not think the circumstances
of the time lent themselves to the celebration of the opening of their
splendid addition by means of a grand function, and in this he
believed the board had interpreted the wishes of the delegates.
The dressing room for the female workers, which was situated on
the fourth flat, was fitted up in an excellent manner. Each worker
had a locker of her own, made of cast steel, of which she alone held
the key. Fourteen wash-hand basins were fitted up and eight spray
baths. There was also an excellently appointed sickroom, where a girl
who became unwell suddenly could rest, and also a room fitted up
with the appropriate scientific appliances, where accidents could be
treated at once.
 At the quarterly meeting, which took place on the day on which the
new wing of the building was opened, the chairman stated that the
total cost of the land and the buildings on it had been £11,800, while
the total cost of the bakery buildings, including the addition, had
been £131,000; which had been depreciated to the extent of
£52,000.