Nelson Textbook of Pediatrics 20th

Edition Robert M. Kliegman

Visit to download the full and correct content document:
https://ebookmass.com/product/nelson-textbook-of-pediatrics-20th-edition-robert-m-kli
egman/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Nelson Essentials of Pediatrics Karen J. Marcdante Md &

Robert M. Kliegman Md

https://ebookmass.com/product/nelson-essentials-of-pediatrics-
karen-j-marcdante-md-robert-m-kliegman-md/

Nelson Pediatric Symptom-Based Diagnosis 2nd Edition

Robert M. Kliegman

https://ebookmass.com/product/nelson-pediatric-symptom-based-
diagnosis-2nd-edition-robert-m-kliegman/

Nelson Essentials of Pediatrics 8th Edition

https://ebookmass.com/product/nelson-essentials-of-
pediatrics-8th-edition/

Nelson Essentials of Pediatrics 8th Edition Karen

Marcdante

https://ebookmass.com/product/nelson-essentials-of-
pediatrics-8th-edition-karen-marcdante/
Sabiston Textbook of Surgery [Missing Pages ONLY] 20th
Edition Townsend

https://ebookmass.com/product/sabiston-textbook-of-surgery-
missing-pages-only-20th-edition-townsend/

Developmental-Behavioral Pediatrics, 5th Edition Heidi

M. Feldman

https://ebookmass.com/product/developmental-behavioral-
pediatrics-5th-edition-heidi-m-feldman/

(eBook PDF) Marketing 20th Edition by William M. Pride

https://ebookmass.com/product/ebook-pdf-marketing-20th-edition-
by-william-m-pride/

Marketing (MindTap Course List) 20th Edition William M.

Pride

https://ebookmass.com/product/marketing-mindtap-course-list-20th-
edition-william-m-pride/

Nelson Pediatrics Board Review: Certification and

Recertification 1st Edition Terry Dean Jr. Md Phd
(Editor)

https://ebookmass.com/product/nelson-pediatrics-board-review-
certification-and-recertification-1st-edition-terry-dean-jr-md-
phd-editor/
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
system, without permission in writing from the publisher. Details on how to seek permission and further
information about the Publisher’s permissions policies and our arrangements with organizations such as the
Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.
com/permissions.

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

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration,
and contraindications. It is the responsibility of practitioners, relying on their own experience and
knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
any liability for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.

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
Another random document with
no related content on Scribd:
taitamattomasti, että joutui selin lehmänraatoon. Karhu taas nousi
raadon vieressä olevaan puuhun, arvellen sieltä kaikki hyvin
näkevänsä, mutta silti olevansa luokse pääsemättömissä. Puun
oksat kuitenkin estivät häntä joka suunnalle näkemästä.
Pamppailevin sydämin siinä sitten odotetaan pelätyn ja kunnioitetun
vieraan tuloa.

Tällä välin olivat kettu ja kissa lähteneet tulemaan pitopaikalle,

kettu edellä ja kissa jäljessä. Siinä raadon vieressä oli suota, jonka
yli heidän matkansa piti, ja yli tultuaan kissa päristeli vettä
käpälistään, se kun ei siedä niiden kastuvan. Senpä kuuli karhu ja
sopotti hiljaa sudelle: »Jo tulee! On se aika vänni, kun tulta iskee
tullessaan! Kunhan ei olisi tuota lihaa liian vähän!» Haistaessaan
sitten tuoretta lihaa rupesi kissa luontonsa mukaan kovasti ja
vihaisesti marmattamaan, jolloin karhu taas kuiskasi uteliaalle
sudelle: »Ei ole iso tuo herra Vinkkeli väkimies, vaan maa silti tärisee
jalkain alla, kun kävelee!» — »Jos se väheksii ruokaa?» pelkäsi siinä
susi ja koetti katsoa, mutta ei nähnyt mitään, kun oli selin kissaan.
Kettu huomaa suden ja suhahtaa hänelle: »Kyllä siinä on poikaa,
saa nähdä vain, ettei tässä vielä tule oudot paikat!» Kun kissa söi
ahnaasti, marahteli, sähisi että »vähä, vähä, vähä», jolta se kuulosti
karhun korvissa, ja liikautteli salaperäisesti häntäänsä, suhahti karhu
ketulle: »Mikä sillä tuossa liikkuu?» — »Se on hänen miekkansa,
jolla hän kaulan katkaisee», kuiskasi kettu vastaan. »Millainen se
lienee otus, kun se noin pelottelee?» ihmetteli susi siellä risuläjässä
eikä enää malttanut, vaan rupesi hiljalleen kääntyä sovittelemaan,
että saisi hänkin edes vilahduksen siitä nähdä. Kissa kuuli ratinan ja
pörhisti häntänsä ja kaikki karvansa pystyyn sekä katsoi risukkoon
tarkasti, että mikä siellä. Silloin kävi sudelle onnettomasti.
 Vaikka hän koettikin varovaisesti kääntyä risukasassaan, sattui
hännän pää kuitenkin vilahtamaan kissan silmiin. Kissillä nousi heti
vanha luonto ja hän puhaltautui kuin salama sen luulemansa hiiren
niskaan. Kauhistus valtasi silloin hukka paran kokonaan ja
parkaisten hätähuudon: »Tuli minuhun käsiksi nyt tämä!» hän lähti
menemään minkä käpälistä irti sai, parkuen surkeasti mennessään:
»Tule, Mikko, hätiin! Tule, Mikko, hätiin!» Mutta eipä ollut itse
kissakaan vähemmän hädän vallassa. »Mikä tämä näin suuri elävä!»
säikähti hän kokonaan ja karkasi lähimpään puuhun kuin paukku.

Nähdessään kissan hyppäävän suden niskaan ja tämän lähtevän

pakoon täyttä karkua sekä kissan siinä samassa törmäävän hänen
puuhunsa, kierähti karhulla maailma pari kertaa silmissä ympäri ja
aivoissa vilahti hätäinen ajatus: »Hukka pääsi tuon topakan elävän
kynsistä ja nyt se tulee minua syömään!» Kumeasti parkaisten
loikkasi hän puusta korentona maahan ja huusi Mikkoa hätiin sekä
läksi surkeasti nilkuttaen ja kylkiluitansa tunnustellen pakoon hänkin
kiireimmän kyytiä. Mutta yhtä säikähtyneenä kissa istua kökötti
oksan juurella, häntä paksuna ja karvat pörhöllään, sekä kiukkuisena
sähisi pakenijoiden jälkeen:

»Pyssy sunkin pyyhkäisevi,

Reikärauta raiskoavi
Miehen mahtavan käsissä!
Sepä nahan nauloavi,
Puun on päällä pelttoavi,
Pakkasen pakottimeksi,
Herrain turkin kaulukseksi!»

Nauruunsa ihan pakahtuen oli kettu liuvari katsellut tätä kohtausta

ja suden sekä karhun paetessa muka huutanut kissalle aivan
kauhistuneena: »Mittymys! Mitäs teet! Ole noiden raukkojen kanssa
siivolla! Sinäpä olet oikein hävytön: toiset kutsuvat sinut kestinkiin ja
sinä nyt isäntiäsi rupeat tappamaan!» Mutta kun susi ja karhu olivat
kadonneet näkyviltä ja kuuluvilta, muuttikin kettu äänen kelloonsa ja
sanoi riemuiten: »Kotsa Muilovits, meidän oli voitto! Tule vain pois
sieltä liharuoan ääreen!» Ja kissakin pian rauhoittuu, laskeutuu
maahan ja tuumii juron tyytyväisesti: »Hyvähän tästä tulikin meille
kauppa!» Aletaan syödä ja syödään kylläkään, ihan viikkoja
syödään, mutta karhu ja susi eivät pitkään aikaan tarjenneet mennä
koko seudulle. Eivät, vaan ensi kertaa toisensa tavatessaan he
keskustelivat asiasta yhä entistä enemmän ymmällä. »Ei se kumma
ole», sanoi susi, »että se on ennenkin suden tappanut, kun niin äkkiä
minutkin löysi risuläjästä, töytäsi päälle ja oli viedä kokonaan!»
Siihen arveli karhu: »No, sehän nyt ei vielä kumma ollut, että löysi
sinut sieltä risuläjän alta, mutta se oli jo vallan ihmeellistä, että se
tiesi minun olevan siellä puussa! Ja kun kerkesi siinä lyödä minua
miekallaan, että vieläkin ovat kylkeni kipeät!»

Ja he kiittivät onneaan, kun olivat päässeet hengissä pakenemaan

sen ihmeellisen ja pelottavan herra Vinkkelin, Katal Ivantsan, Kotsa
Muilovitsin kynsistä, jolla on niin monta outoa nimeä, joka on paljon
ulkomailla matkustellut ja joka on nyt tullut käymään veljensä Kettu
Repolaisen luona täällä kaukaisessa Metsolassa.

Mutta nähdä se pitäisi saada, oikein kyllältään sitä katsoa. Se oli

kaikesta huolimatta karhun ja suden salainen ja vielä täyttymätön
toivomus.
XXXV.

EI SE OLE HULLU, JOKA NARRAA, VAAN JOKA ITSENSÄ NARRATA ANTAA.

Pian hurskas hullummalla

Salmen syvän sauvottaapi —
Itse soutavi matalan.

Eletään sitten yhä edelleen kettu ja kissa yhtenä talona ja hyvin

tullaankin toimeen. Loppui kuitenkin kerta ruoka ja ketulla rupesi
himoittamaan tuoretta kalaa. Hän muisti Piippolan äijän suurta
kalansaalista ja ajatteli, että mitenkähän saisi taaskin kyllältänsä
kalaa syödä. Ei muuta kuin lähti juoksentelemaan sinne Piippolan
järven rannalle ja löysikin sieltä rannalta kalan, mutta eipä
syönytkään sitä. Ei, vaan koppoi sen leukoihinsa ja läksi
juoksentelemaan Piippolan pihalle, siitä ikkunan alta mennä litvitteli
kala suussa, ajatellen: »Minäpä narraan Piippolan äidin ulos
tuvasta!» Akka huomasikin hänet ja kysyi: »Mistä sinä, kettu kulta,
olet kaloja saanut?» — »Järvestä, järvestä», vastasi kettu ja meni
menojansa. Rupesi akan tekemään kalaa mieli ja hän meni ukkonsa
luo, joka oli pellolla ojaa luomassa, ja sanoi: »Mennään mekin kaloja
pyytämään, koska ketullakin on». — »Mennään vain», mukautui
ukko ja niin lähdettiin kalalle, ja saatiinkin runsas saalis. Mutta kettu
piti varansa, varasti niitä kaloja kaksi, joista toisen antoi kissille ja
varoitti kovasti: »Älä sano kenellekään!» Mutta kissipä ei
malttanutkaan, vaan kävi sanomassa rengille, renki sanoi piialle,
piika sanoi emännälle, ja emäntä sanoi isännälle. Isäntä siitä
haukkumaan kettua ja kettu haukkumaan kissiä, joka hyppäsi isoon
puuhun. »Kyllä minä sinut sieltä tavoitan!» vannoi kettu ja pudisti
puuta, jolloin kissi putosi sieltä hänelle suuhun. Riemuissaan sanoi
kettu silloin: »Luulin olleen sokeripalan, mutta olikin valkoinen katti ja
katin kala!» Ei kuitenkaan raahtinut Mittymykselle pahaa tehdä, otti
siltä vain kalan pois, mutta tästä kissa suuttui julmasti ja läksi
takaisin kotiinsa Ilmolaan, ja siihen loppui se ketun ja kissan
yhteinen talous. Eikä kettu sitä surrut, vaan luikki takaisin metsään
iloissaan, kun oli taas saanut kaloja syödä.

Kulki kettu siinä, litvitteli, pitkin Metsolan maita, ainainen koiruus

mielessä, kun tulivatkin hänelle vastaan susi ja karhu. »Mitenkäs nyt
renkisi jaksaa?» kysyi susi heti. »Hyvin jaksaa», vastasi kettu,
»mutta niin on tullut laiskaksi, ettei muuta kuin ontossa hongassa
makaa ja itseään syötättää.» — »Missä!» tohahtivat heti karhuja susi
uteliaina, »jokohan tuon nyt saisi nähdä, kun se nukkuu siellä
hongan sisässä?» — »Eihän hongan sisään voi nähdä», nauroi
kettu, »mutta jos se sieltä hyvinkin saataisiin pois lähtemään.
Tulkaahan auttamaan, jos mikä hyvä keino siihen keksittäisiin.»
Lähdetään ketun suurelle, kaatuneelle hongalle, jonka sisään Kattes-
Johannes oli muka äkäytynyt, ja kettu varaa vahvan köyden
mukaansa. Tullaan paikalle ja kettu sanoo: »Pannaan tämä köysi
kiinni tuohon honkaan ja vedetään se koskeen, niin eiköhän sieltä
tule Mittymykselle lähtö.» — »Ka, miksi ei», sanoi karhu, »tehdään
vain niin», ja sitten kettu valjasti hukan ja karhun honkaan, sitoen
heidät molemmat lujasti kiinni. Itsehän istui hongan päälle ja käski
toisten vetää, hän kun muka työnsi sieltä takaa.
 Tultiin sitten kosken rannalle, jolloin kettu pudottautui pois hongan
päältä ja kehoitteli karhua ja sutta: »Minä työnnän, menkää vain
veteen, ei siinä syvä ole, vetäkää honkaa koskeen; kyllä sen sitten
koski vie, kun se joutuu virran niskaan!» Toiset tekevät kuten kettu
käskee, ja menevät koskeen vesikiviä myöten, kunnes honka tulikin
veden varaan ja virta läksi sitä viemään, raastaen Pekan ja hukan
mukanaan. Surkea parku pääsi silloin molemmilta ja he rupesivat
huutamaan: »Tule, Mikko kulta, apuun, täällä tulee kuolema!» Mutta
kettu vastasi siihen, että joka koskeen menee, se saa koskessa olla,
eikä hän tohdi tulla sinne. Karhu ja susi saivat siten laskea koko
kosken, mutta pelastuivat kuitenkin onnettomat hukkumasta, purivat
köyden poikki ja uivat suvantoon päästyään maihin. Kettu liuvari
juoksi kotiinsa.

Mutta siellä häntä odottikin suuri hämmästys. Kääpälän vaari, joka

oli kova metsämies, oli osunutkin hänen pesälleen ja oli juuri
rupeamassa hänen poikiaan tappamaan, kun Mikko joutui paikalle.
Hätääntyneenä sanoi Mikko heti: »Kun et ota minun poikiani, niin
minä neuvon sinulle hukan pesän». Vaari suostui siihen, meni ketun
neuvokin mukaan hukan pesälle ja tappoi hukan poika parat kaikki.
Mutta kettu ryntäsi täyttä karkua takaisin koskelle hakemaan hukkaa
ja karhua, kertoakseen heille, mitä oli tapahtunut. Pian hän tapasikin
heidät ja huusi: »Kattes-Johannes on mennyt Kääpälään takaisin ja
Kääpälän vaari on tappanut kaikki hukan pojat!»

Silloin sanoi hukka synkästi: »Tästä tulee sota!»

XXXVI.

EI SE SOTA MITÄÄN, VAAN NE HANKKEET.

Sorea sotahan kuolla,

Kaunis miekan kalskehesen,
Äkin poika pois menevi,
Laihtumatta lankeavi.

Raivoissaan siinä karhu ja susi kiroava ilmolaisia ja heidän pahoja

tekojaan sekä uhkaavat sodalla; kettu kavalana vieressä heitä yhä
enemmän usuttaa. »Tuolla on salolla», sanoo hän, »Ilmolan karjaa
laitumella. Isketään siitä lehmä, niin on aluksi meillä sotaeväitä».
»Isketään!» tulistuivat siitä toiset, »mennään lehmikarjaan, sillä kovin
tässä nyt himoittaisi lehmä sortaa!» Ja karhu varsinkin kopristelee
kynsiään innoissaan, että nyt! Mennään siitä lehmikarjan luo ja kettu
näreiköstä piilosta rupeaa katsomaan, kun karhu ryhtyy lehmää
kaatamaan.

Karhu nousee haolle, kohoaa kahdelle käpälälle ja valmistautuu

hyppäämään lehmän selkään. Jopas hyppääkin, mutta ei laskekaan
innoissaan voimiaan oikein, vaan oistona lehmän yli lennähtää ja
lehmä pääsee pakoon. Samalla kettukin sieltä syrjästä tekee kiusaa,
räsähtää ja arvelee: »Jo tuli talon isäntä lehmää vahtiin!» Silloinpa
pelko tapasi sekä karhun että suden ja he lähtevät mennä
kaapaisemaan pakoon, laukkaavat virstaa viisitoista, ennen kuin
pysähtyvät, kettu viivana perässä. Pysähdytään viimein ja kontio
rupeaa pahoittelemaan, kun ei saanutkaan lehmää. Kiukustuu siinä
kovasti uudelleen, nousee haolle ja siitä taas hypätä hurauttaa. »Kun
olisin näin hypännyt», sanoi hän, »niin saanut myös olisin!» —
»Mitäpä siitä turhasta hyppelemisestä», sanoo nyt kettu, »ethän sillä
kuitenkaan lehmää saa. Oikea sota tässä on pystyyn pantava, sillä
eivät niiltä muuten pahat konstit lopu!» »Mitenkä sitä sitten
sodittaisiin?» kysyvät karhu ja susi. Kettu vastasi: »Kootkaa te kaikki
metsän elävät, niin minä kokoan kaikki kylän elävät, ja ruvetaan
sotimaan.» No toiset suostuivat siihen.

Ruvetaan sitten sotajoukkoa molemmat puolet kokoamaan. Kettu

menee Ilmolan kylään ja selittää siellä kaikille kotieläimille asian,
sanoo, että suuren sodan nyt panevat alkuun ilmolaisia vastaan
karhu ja susi. Siitäpä kylän eläimet puolestaan ryhtyvät puuhiin ja
kootaan kaikki koirat, kissat, kanat ja rotat, ja kettu ne järjestää
komppanioiksi ja kaikille antaa passit mukaan. Ottaapa isotkin
eläimet, härät, lehmät, lampaat ja siat, ja kissan sekä koiran panee
koko sotajoukolle kenraaleiksi, kehuen, että siinä on kaksi oikein
vahvaa miestä. Susi ja karhu puolestaan kokoavat kaikki eläimet,
mitä metsässä on, karhuja, susia, ilveksiä, jäniksiä, oravia ja jos
mitä. Niin on molemmilla puolilla ankarat sotajoukot pian koossa,
eikä muuta sitten kuin marssimaan toisiaan vastaan. Karhu on
kenraalina metsän elävillä.

Tuli siinä torapaikalle mennessä kotieläimille vastaan iso joki ja

alkoi ylimeno. Rotat menivät ensiksi, panivat passit suuhunsa ja niin
pääsivät kauniisti yli. Katsottuaan taaksensa he näkivät kissain
komppanian tulevan rannalle ja vuorostaan harkitsevan ylimenoa,
Rotat silloin huusivat toiselta rannalta: »Pankaa passit häntänne alle,
teillä on niin iso häntä!» Kissat arvelivat että siten tehdenpä taitavat
passit säilyä kuivina ja noudattivat neuvoa. Mutta siinä samassa, kun
he uimasilleen joutuivat, hännät nousivatkin pystyyn, ja niin vei virta
heiltä passit hännän alta. Nolostuneina ja kiukustuneina siitä kissat
uhkasivat: »Kyllä me petämme koirat, koska kerran meitäkin
petettiin!» Tulivat koirat sitten kissain perässä rantaan ja miettivät
vuorostaan ylimenoa. Silloinpa kissat huusivat heille: »Pankaa passit
häntänne alle, teillä on niin leveä häntä!» »Ahaa!» ilostuivat koirat,
»sitenpä ne taitavatkin säilyä kuivina», noudattivat neuvoa ja lähtivät
uimaan. Mutta heti kun he olivat päässeet veteen, lensivätkin hännät
päin pilviä ja passit pitkin jokea. Kovasti siitä koirat suuttuivat, niin
että kun he vihdoin pääsivät toiselle rannalle, oli koko sotakuri
höltyä, kun alkoi siinä aivan tavaton tappelun rähinä ja nujakka,
jossa molemmat puolet vannoivat toisilleen ikuista vihaa. Saatiin
kuitenkin vihdoin järjestys palautetuksi ja jatkettiin marssia
sotakentälle.

Lähestytään sitten sotapaikkaa ja toinen ylikenraali, koira, rupeaa

pitämään tuumaa kissalle sanoen: »Ota sinä nyt — se työntää
kuitenkin susi karhun etukynteen — mene sinä nyt hyvin alaksittain.»
Koiralla itsellään oli hiukan jalka kipeä, jonka vuoksi hän nilkutti
mennessään ja kissa piti häntäänsä, pörhistäen sitä, korkealla
pystyssä. Sen huomatessaan neuvoi kettu: »Pannaan nyt jokainen
hännät hyvin pystyyn, kun mennään!» ja niin tehtiinkin. Kun karhu
näki kaukaa vihollisen sotajoukon tulevan ja paljon piikkejä pystyssä,
säikähti hän ja sanoi: »Oi voi, kun on noin paljon pyssyjä jokaisella
— siellähän tulee yksi iso edellä ja tuhat tuhatta pientä perässä,
sapelit kaikilla pystyssä — kyllä nyt on parasta, että lykätään pakoon
vain!» Ja susi osoitti kissaa ja koiraa huomauttaen: »Kas, tuolla kun
on sapelipystyssä ja tuo noukkii kiviä!» Miehistyttiin siinä vielä
kuitenkin ja karhu lähtee johtamaan sotajoukkoaan vihollista
vastaan.

Kissi nyt tulla lutmii, lutmii alaksittain karhua vastaan ja orava

huutaa karhulle: »Varo, varo! Se vetää riukua perässään!» Mutta
ennen kuin karhu ehtii paljon huomatakaan matalana hiipivää kissiä,
on tämä jo töytännyt hänen mahansa alle ja alkaa häntä kurkusta
topistaa. Karhu säikähtää, kämähtää paikalla selälleen ja rupeaa
huutamaan: »Kuka kurkkuani topistaa!»

Pelko valtasi silloin koko metsän eläinten armeijan, kun näkivät,

että tuossa on nyt itse iso kenraali töppöset taivasta kohti, täyttä
kurkkua huutamassa. Orava karkasi pakoon puuhun ja ihmetteli
sieltä, lyöden kahta kämmentä: »Voi kummaa, kun nyt kaikkein
pienin elävä meidän vahvimman viskasi selälleen! Toden totta, Kies
auta, nyt ei ole oikea jalassa!» Ja niin pian kuin karhu pääsi pystyyn
taas, komensi hän armeijansa pakoon huutaen että pelastakoon
itsensä ken voi, ja näytti itse miehistölleen esimerkin siitä, kuinka
voittoisan vihollisen edestä on paettava. Niin hajaantui koko armeija.
Juostuaan niin kauan, että varmasti tiesi olevansa turvassa, pääsi
karhu vasta rauhoittumaan tuumien lopuksi: »Kylässä on kylän
kalut!»

Sitten karhu tunsi kyllästyvänsä koko tähän alituiseen vaivaan ja

seikkailuun, jossa aina kävi niin onnettomasti. Hän katsoi
ympärilleen, huomasi kellastuneiden lehtien putoilevan puista,
näkipä myöskin, kuinka ensimmäiset lumihiutaleet hiljaa leijailivat
alas syksyiseltä taivaalta, ja tunsi, kuinka häntä rupesi makeasti
nukuttamaan. »Ei, pois minä katoan Metsolan synkimpään saloon
pahan maailman jaloista, sinne menen talvitalolleni ja lyöttäyn
maata». Näin päätteli karhu ja läksikin heti talvipirttiään kohti. Ja
varmasti hän olisikin siinä samalla päätöksensä toteuttanut, ellei
eräs odottamaton ja outo tapahtuma olisi häntä vielä vähän aikaa
viivyttänyt.
XXXVII.

MITENKÄ KÄVI KÄRPÄN NYLKY, ORAVASTA NAHKAN OTTO?

Puhas putki valkolainen,

Kaunis talven karvallinen,
Ainoa ahokananen,
Kukka kuusen juurellinen.

Edellisessä on jo tullut mainituksi, että Kääpälän vaari oli kova

metsämies, joka ihan täytti koko Metsolan susihaudoillaan ja
karhunloukuillaan, käpylaudoillaan ja linnunpermillään. Niinpä hän
heti tänäkin syksynä, kun vain satoi ensimmäisen vitilumen, että
metsän juoksijain jäljet rupesivat näkymään, ryhtyi kiireesti
virittelemään kärpänrautojaan, koska kärpännahat silloin olivat
hyvässä hinnassa. Mutta tästäkös kaikki metsän kärpät häntä
kovasti vihasivat ja toivoivat, että hän kerta itse joutuisi omiin
rautoihinsa ja saisi tuntea, minkälaista on niiden kipeä ja kuolettava
puristus. Salaa he aina ukon kintereillä luikkivat ja pitivät silmällä,
eikö kerrankin sattuisi pahan onnen siipi äijän ryökälettä
sipaisemaan.
 Ja jopas kerran sattui. Läksi ukko tapansa mukaan eräänä
aamuna, kun oli vielä hämärä, kärpänrautojaan kokemaan, kulkea
kahnusteli ohuessa syyslumessa ja kaukaa aina raudoillensa
kurkisteli, vieläkö oli vireessä ja oliko syötti koskematta. Näytti sitten
eräässä syötti joutuneen vikaan ja olevan korjauksen tarpeessa.
Ukko tulee ääreen, kurkottaa kädellänsä ottaakseen rautansa, kun
samassa jalka lipeääkin liukkaassa lumessa. Ukko kompastuu siihen
rautansa päälle, joka laukeaakin hänelle kurkkuun kiinni, ja
samallapa siihen vielä töytää pensaikosta kärppä surmaraudan
avuksi äijälle niskaan. Ei auttanut mikään, henki siinä nitistettiin
Kääpälän vaarista. Voitonriemuisena kärppä nousi ukon päälle
seisomaan ja kiljaisi:

»Itse puuttui pihtilöihin,

Latsistihe lautasihin!»

»Mitähän tuolla ukko-pahuksella nyt tekisi?» mietti hän

sitten touhuissaan, kunnes näki samassa ukon kelkan.
Mitäpäs siinä sen enempää miettimistä: kärppä viskasi ukon
ruumiin kelkkaan ja läksi oikein aika miehenä sitä vetämään
pitkin Metsolan lumista tanhuata.

Sattui silloin tulemaan jänis vastaan, istahti

hämmästyneenä, kun näki kärpän toimessaan kelkalla
raahaavan perässään Kääpälän vaaria, ja kysyi silmät
muljollaan: »Mitäs vedät, kärppä rukka, näin varhain
aamulla?» No sepäs kysymys oli nyt kärpälle mieluinen
vastattava, kun sai kerrankin purkaa vihansa mokomaa
kiusallista ja vaarallista pyytömiestä kohtaan ja samalla
kerskaten kertoa, miten ukolle lopuksikin kävi. Nopeasti hän
 kavahti ukon niskalle istumaan, pyyhkäisi viiksiänsä ja alkoi
herjata ukkoa.

»Sitähän minä tässä», murisi hän, »kannan kantamista ja

riuhdon riuhtomista, kun tuo vanha iänikuinen äijän käni pisti
piikkinsä ja pihtinsä pirtin päälle, laski lautaset latikan päälle,
eikä totellut, jumalaton, vaikka kiellettiin».

Hän selitti asian jänikselle ja kehoitti, kun jänis

innostuneena pyysi päästä mukaan ukkoa vetämään: »Ka
tule, kanssani. Haukkaa pala ja käy vetämään»! Niin
lähdetään yhdessä ukkoa vetää junnaamaan.

Vedetään, vedetään siinä hartaasti hetken aikaa, niin jo

kopeutuu
eteen itse Mikko mielevä mies, Repolainen, hämmästyy kovin
mokomata
kulkuetta ja kysyy sirosti ja kohteliaasti kuten aina:

»Mitä vedät, jänöjukka,

Jäljessäsi jylkyttelet?»

Ei vastaa jänis, kärpälle vain viittaa, ja tämäpäs piukaiseekin

vastauksensa niin komeasti, ettei paremmasta apua.

»Kannan tätä kantamista,

Riuhdon tätä riuhtomista,
Ukkoa, pahoa miestä.
Kun tuo vanha äijä-reppu
Pani pihdit pirtin päälle,
Lautaset latikan päälle,
Meille metsän juoksijoille,
 Huutehen vilostajille,
Hämärässä häksäjille,
Pimeässä piksajille,
Kastehessa kahlojille,
Rahakarvan kantajille,
Päällä puiden puikkiville…»

»Mutta», ja tähän kärppä pysähtyi, että kettu kerkesi kysyä, miten

ukko oli joutunut tuohon kelkkaan hengettömäksi, jolloin hän ylpeästi
lopuksi julisti entiseen tapaan:

»Itse puuttui pihtilöihin, latsistihe lautasihin!»

»No jopa nyt peräti!» ihmetteli kettu. »Saisiko tulla mukaan?» —

»Ka tule, kanssamme! Haukkaa pala ja käy vetämään!» Haukkasi
kettu silloin aimo palan ja alkoi myhäillen toisten kanssa vetää
junnata ukkoa edelleen. Tulee siinä taas uusi tulokas vastaan,
hukka, ja eipäs muuta kuin että hukkakin haukkaa aimo palan ja
yhtyy muiden kanssa ukkoa vetää junnaamaan. Mennään siinä taas
hyvän aikaa, kun jo nähdään itse kontion tulla jylkyttelevän vastaan.

»Mitäs, veikkoset, vedätte, jäljessänne jylkytätte?»

kysyy kontio ylen ällistyneenä mokomasta kulkueesta, kun on siinä

kelkka, kelkassa kuollut ukko ja kelkan jutkossa kärppä, jänis, kettu
ja susi. Kovin oli karhu ihmeissään kuultuaan kärpän selityksen.
Häntäkin haastettiin nyt mukaan vetämään ja vaikka hänen
makuullemeno-matkansa täten keskeytyikin, innostui hän kuitenkin
yhteiseen asiaan, haukkasi suuntäyteisen palan ukosta ja liittyi
jutkoon hänkin junnaamaan. Kuljetaan siinä taas hyvän aikaa,
vakaina kaikin jutkosta kelkkaa vedetään, kun jo puuttuu orava
vastaan, narskuttaa ihmeissään oudolle kulkueelle ja pyytää tietoa,
mihin siinä nyt mennä jylkytetään. Selitetäänhän asia oravallekin
aivan tarkalleen, ei kitsastella, käsketään hänenkin haukata pala ja
tarttua vain jutkoon, tätä Kääpälän pahaa ukkoa vetää junnaamaan.
Ja liittyihän orava joukkoon, jutkoon tarrasi hänkin kiinni ja lähti vetää
vänkäämään hartaasti omalta osaltaan, haukattuaan tulopalan ukon
kyljestä.

Kuljetaan siten hyvässä sovussa, vedetään ukkoa ja aina väliin

haukataan hänestä palanen. Kului siinä täten päivä lopulleen ja
pianpa ei ollut ukosta jäljellä muuta kuin housunpuntit. Tuntuipa jo
vähän väsyttävänkin, ja kettu rupesi tuumailemaan, minnekäs tässä
nyt yöksi joudutaan. »Tuolla on, minä tiedän, vanha susihauta»,
neuvoi karhu, »mennään vaikka sinne, niin ei ainakaan tuuli koske».
»No mennään vain», mukautuivat toisetkin ja niin mentiin vanhaan
susihautaan yöksi.

Haukoteltiin nyt siinä susihaudassa miehissä, käännettiin kylkeä ja

koetettiin päästä unesta kiinni, mutta ei tulekaan unonen. Illan tuuli
vain suhajaa Metsolan korkeissa puissa ja pilvet vaeltavat taivaalla,
kuuhuen niiden lomista silloin tällöin esiin kurkistellessa. Sanoo
kettu: »Ei tulekaan meille vielä uni. Tässä tarinoikaamme ja siten
iltaa rattoisasti viettäkäämme. Kuka ensimmäisen tarinan kertoo?»
Toisistakin oli ketun tuuma veikeä ja orava kohta innostuu: »Minä
kerron, tarinan tiedän ylen soman!»
XXXVIII.

SIINÄ SE PIENIKIN PISTELEIKSE, MISSÄ SUURIKIN KÄÄNTELEIKSE.

Oravainen kumman kukka,

Kummun kultainen omena,
Oksalla ojenteleikse
Lehvällä levätteleikse.

»Olipa kerran», alotti kertoja — »orava sellainen, ettei moista, —

minun ukkovaarini se olikin. Siltä olivat menneet housut rikki, niin
lähti neulaa lainaamaan, että saisi paikata pöksynsä. Haki neulaa,
etsi, kunnes löysi koiran, joka oli turkkiaan ompelemassa oikein
hyvällä neulalla. Mitäpäs muuta kuin orava kärttämään koiralta
neulaa lainaksi, sanomaan: 'Lainaa sinä sitä neulaasi, että saan
housuni paikata.' Koira, joka oli siihen aikaan hyväluontoinen,
lainasikin, ja niin ukkovaarini paikkasi pöksynsä eheiksi ja hyviksi.
Mutta siinä hän oli huomannutkin neulan niin teräväksi, ettei
raskinutkaan siitä enää luopua, vaan arvellen, että lienee noita
koiralla neuloja liikenemäänkin, karkasi kuuseen neuloineen. Koira
siitä kuitenkin vihastui kovasti ja rupesi vaatimaan kiivaasti neulaa
takaisin, niin äkäisesti, että ukkovaarikin jo suuttui ja pilkkasi:
'Teeppäs nyt turkki!' Tästä syntyi koiran ja oravan välille ikuinen viha,
niin että kun koira vain oravan näkee, niin heti ajaa sen puuhun ja jo
ennen haukkumistaan vinkuu ja vikisee: 'Neulanrosvo, neulanrosvo!'

»Mitäs ollakaan. Sai sitten tämä orava kauniit poikaset, ihan

yhdeksän poikaa sai, ja niitä pesässään korkean kuusen kyljessä
keinutteli, hoiteli ja soudatteli. Tulipa sitten harmajan nahan aika ja
orava sekä poikaset, jotka eivät enää pesässään maanneet, vaan
siinä vaiheilla vain hyppivät, näkivät miehen tulevan koirineen. Jo
osuu mies huomaamaan pesän, sanoo koiralleen: 'Taitaa olla pesä',
keikkailee puuta kirveellä: 'Tyhjä on', sanoo, ’ei ole mitään'. Silloinpa
ukkovaarinikin heräilee, kun kuulee miehen puhetta, ja käskee:
'Menkääpäs katsomaan, mittyiset on siellä ampujat, mittyiset
haukkujat!' Pojat menevät, katsovat tarkkaan ja palaavat vaarille
sanomaan: 'Hyvin on hyvä koira, sileä on ja lihava kuin mikähän
vain, karvat kiiltävät.' — 'Entä mies?’ kysyy orava. 'Mies on', sanovat
pojat, 'hyvin hyvässä sovassa, ja pyssy on hyvin kaunis, vaskella
puolitiehen silattu.' — 'Pankaa maata vain', määrää silloin vanha
orava, 'ei tule mitään.' Ja niine hyvineenhän mies siitä ulkousikin.

»Makaa sitten orava makeasti poikineen sen yön, kun jo

seuraavana päivänä taaskin ilmestyy mies puun tyvelle ja koira siinä
vierellä räyskää. Keikkailee mies puuta ja arvelee, että pitäisi oravan
pesä saada sieltä käsiin. Orava-ukko kuitenkin vain rauhassa
venytteleksen, haukottelee ja sanoo pojilleen: 'Menkääpäs
katsomaan, mittyiset on siellä ampujat, mittyiset haukkujat.' Menevät
pojat, katsovat, ja törmäävät sanomaan: 'Lihava on koira, hyvin
kaunis, ja mieskin on hyvässä sovassa, vaikka ei moinen kuin eilen,
ja pyssykin on hyvä, vaikka ei niin kaunis kuin eilen, ei ole vaskea
yhtään.— 'Maatkaa edelleen', urahti silloin ukkovaari, 'ei tule mitään'.
Ja eikös lähtenytkin mies siitä tiehensä, hylännyt puuta! Kintaansa
vain unohti puun juurelle.
 »Maataan kolmanteen päivään ja aamun tullen saapuu taas puun
juurelle koira, haukkuu, räyskäilee karulla äänellä kuin väsynyt
ainakin. Hetipä havahtuukin siitä itse ukko-orava, pörhistelee
korviansa, pyörittelee silmiänsä ja määrää: 'Menkää, veikkoset pojat,
katsomaan, mittyiset ovat siellä ampujat, mittyiset haukkujat!' Pojat
menevät ja siinä samassa tulevat takaisin kertomaan: 'Hyvin on
huono koira, karva takussa riippuu, nälkään on kuolemassa',
sanovat, 'ja mieskin on huono semmoinen, että on nuttu kaikki
repeillyt vyöhön saakka, ja pyssyssä ei ole puuta ensinkään, tyhjä
piippu on vain pahanpäiväinen!' Silloinpa ukkovaari säikähti kovasti
ja huusi pojilleen: 'Voi juojat! Nyt se kumma tulee, kaikki korvet se
tutkii, kunhan ei vain käsiinsä saisi! Nyt silitkää tiehenne, minne vain
kerennette!'

»Ei kuitenkaan tavoittanut mies ukkovaariani, minkä lienee pojista

tavoittanut, sitä en tiedä. Ukko-orava palasi entiselle pesälleen ja
kun hän nyt katselee omaisuuttaan, on hänellä kaksi mieleistä kalua:
neula ja kinnas. Hän niitä hyvänä pitää ja ihan veljikseen puhuttelee,
ja veljeksinä aivan siinä pesässä ruvetaankin elämään. Alkaa heillä
sitten kerta saalista himoittua. Silloin päätetään lähteä miehissä
saaliin etsintään. Kävellään! siitä kukin omalle haaralleen ja määrä
on huutaa toisille, jos kuka sattuu saaliin löytämään.

»Kuljetaan siinä niin ja etsitään saalista, niin mitäs ollakaan: jo

rupeaa kuulumaan metsästä neulan kimeä, piipitys, jotta ihan näin:

»Kiidä, kiidä kintahaisein,

Oiottele, oravaisein,
Löyti neula löytösen,
Saipa neula saalihin.
 »Riemastutaan siitä kovasti kinnas ja orava sekä juostaan
touhuissansa neulan saalista katsomaan. Tullaan paikalle,
katsotaan, kysytään: 'Missä saalis?' Neula osoittaa tyytyväisen
vesirapakkoa: 'Ka tuossa!' — 'Ka tämäkö sinun saaliisi olikin!'
ärjäisevät siinä toiset toverukset, karkaavat neulan niskaan ja
pieksävät hänet pahanpäiväiseksi, että tämmöinen tällä muka oli
saalis ja siitä oikein huudon nosti. Hukkaan oli mennyt se päivä ja
noloina palataan pesälle taas nukkumaan.

»No mitäpä siitä! Seuraavana päivänä lähdetään paremmalla

onnella ja kävellään kukin haaralleen saaliin etsintään. Eivät ole
kinnas ja orava vielä kovinkaan kauas ehtineet, kun kuulevat jo
neulan kovalla äänellä heitä kutsuvan. Ihan muka kiitää pitäisi
kintaan ja oikotietä saapua oravan, kun on hän, neula, löytänyt
saaliin taas. Epäilevät orava ja kinnas koko asiaa, mutta eivät
kuitenkaan malta, vaan tulla huristavat hengästyneinä paikalle, että
missä saalis. Voitonriemuisena taas neula osoittaa heille saalistaan,
tervaskantoa, jonka muka oli löytänyt. Nuolena siitä kinnas ja orava
karkaavat neulan niskaan, haukkuvat, että vai tällainen sinulla taas
on saalis, ja antavat neula parkaa selkään minkä suinkin jaksavat.
Suivautuneina koko saaliin etsintään lähtevät he sitten kaikin kotiin
harmissaan makaamaan.

»Nukutaan taas yö, virkistytään eikä enää malteta, vaan päätetään

uudelleen lähteä saalista etsimään, toivossa, että vihdoinkin parempi
onni riipaisisi. Kävellään, kävellään, erotaan toisistaan kukin omalle
haaralleen. Neula terävänä mennä puikkii ruohokossa, kuuntelee ja
katselee, niin jopas huomaakin: peurat järvessä syövät kortteikossa.
Mitäs ollakaan. Neula mennä puikkii, puikkii, järveen luikaisee, siellä
itsensä kortteen solmuun pistältää ja odottelee. Jopas tulee peura,
hamuilee kortteita suuhunsa, kunnes nielaiseekin neulan vatsaansa.