PREFACE
This edition was created in the midst of several pandemics, one caused by a virus and
one focused on advancing social justice to overcome structural and personal racism. The
many challenges highlighted by these pandemics are resulting in acceleration of nec-
essary changes in medical education. These changes must be built on a foundation of
evidence-based knowledge and heightened awareness. Our goal as the editors and authors
of this textbook is not only to provide the classic, foundational knowledge we use every day,
but also to include recent advances in a readable, searchable, and concise text for medical
learners at all levels. Mastering this knowledge, when combined with mindful experiences
in the rapidly changing world of medicine, will allow our readers to develop the practical
wisdom needed to serve our patients and their families.
We hope that this text will help you investigate the common and classic pediatric disor-
ders in a time-honored, logical format, helping you to both acquire and apply knowledge
needed to provide high value care. We are honored to be part of the journey of the thou-
sands of learners who rotate through pediatrics, those who will become new providers of
pediatric care in the years to come, and those who continue to build on their knowledge.
CARE OF CHILDREN IN SOCIETY
Health care professionals need to appreciate the interactions
between medical conditions and social, economic, and envi-
ronmental influences associated with the provision of pediat-
ric care. New technologies and treatments improve morbidity,
mortality, and the quality of life for children and their families,
but the costs may exacerbate disparities in medical care. The
challenge for pediatricians is to deliver care that is socially equi-
table; integrates psychosocial, cultural, and ethical issues into
practice; and ensures that health care is available to all children.
CURRENT CHALLENGES
Challenges that affect children’s health outcomes include access
to health care; health disparities; supporting their social, cogni-
tive, and emotional lives in the context of families and commu-
nities; and addressing environmental factors, especially poverty.
Early experiences and environmental stresses interact with the
genetic predisposition of every child and, ultimately, may lead
to the development of diseases seen in adulthood. Pediatricians
have the unique opportunity to address not only acute and
chronic illnesses but also environmental and toxic stressors to
promote wellness and health maintenance in children.
Many scientific advances have an impact on the growing role
of pediatricians. Newer genetic technologies allow the diagnosis
of diseases at the molecular level, aid in the selection of medi-
cations and therapies, and may provide information on prog-
nosis. Prenatal diagnosis and newborn screening improve the
accuracy of early diagnosis and treatment, even when a cure is
impossible. Functional magnetic resonance imaging allows a
greater understanding of psychiatric and neurologic problems.
Challenges persist due to the increasing incidence and prev-
alence of chronic illness. Chronic illness is now the most com-
mon reason for hospital admissions among children (excluding
trauma and newborn admissions).
In older children, mental
illness is the main non–childbirth-related reason for hospital-
ization. Pediatricians must also address the increasing concern
about environmental toxins and the prevalence of physical,
emotional, and sexual abuse, and violence. World unrest, ter-
rorism, and a global pandemic have caused an increased level of
anxiety and fear for many families and children.
To address these ongoing challenges, many pediatricians
now practice as part of a health care team that includes psy-
chiatrists, psychologists, nurses, and social workers. This
patient-centered medical home model of care is designed to
provide continuous and coordinated care to maximize health
outcomes. Other models, such as school-based health and
retail medical facilities, may improve access but may not sup-
port continuity and coordination of care.
Childhood antecedents of adult health conditions, such
as alcoholism, depression, obesity, hypertension, and hyper-
lipidemias, are increasingly recognized. Infants who are rela-
tively underweight at birth due to maternal malnutrition are
at higher risk of developing certain health conditions later
in life, including diabetes, heart disease, hypertension, met-
abolic syndrome, and obesity. Improved neonatal care results
in greater survival of preterm, low birthweight, or very low
birthweight newborns, increasing the number of children with
chronic medical conditions and developmental delays with
their lifelong implications. Childhood exposure to adverse
experiences such as abuse, divorce, and violence increases the
risk of diabetes, cardiovascular disease, and mental health dis-
orders in adults.
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