Frequently Asked Questions in Pediatric & Adolescent Practice A Parthasarathy, Dhanya Dharmapalan, Alok Gupta, Anupama S Borker
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1Frequently Asked Questions in PEDIATRIC AND ADOLESCENT PRACTICE (Your Questions Answered)2
3Frequently Asked Questions in PEDIATRIC AND ADOLESCENT PRACTICE (Your Questions Answered)
EDITORIAL BOARD Editor-in-Chief A Parthasarathy Senior Consultant Pediatrician AP Child Care, Chennai Former Distinguished Professor The Tamil Nadu Dr MGR Medical University, Chennai Retired Senior Clinical Professor Madras Medical College, Chennai Deputy Superintendent Institute of Child Health and Hospital for Children Chennai Tamil Nadu India Associate Editors Anupama S Borker Consultant Pediatric Hematologist/Oncologist Somaiya Ayurvihar-Asian Institute of Oncology Mumbai, Maharashtra, India Alok Gupta Pediatrician and Counselor Pediatric Specialties Clinic, Jaipur, Rajasthan, India Formerly, Assistant Professor (Pediatric Medicine) Mahatma Gandhi Medical College and Hospital Jaipur, Rajasthan, India Chairperson, Environment and Child Health Group (ECHG) President, Indian Academy of Pediatrics Dhanya Dharmapalan Consultant Pediatrician Dr Yewale's Multispecialty Hospital for Children Navi Mumbai, Maharashtra, India Forewords S Sachidananda Kamath Vijay N Yewale
4
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Frequently Asked Questions in Pediatric and Adolescent Practice
First Edition: 2015
9789351526834
Printed at
5Dedicated to
The Authors and their Patients—Newborn,
Infant, Child and Adolescent
who have contributed rich learning material for
Pediatric and Adolescent Practice6
7Foreword
I have much pleasure to introduce the publication. Frequently Asked Questions in Pediatric and Adolescent Practice, edited by my esteemed senior teacher and very much cherished elder brother Professor A Parthasarathy.
The questions are formatted as clinical vignettes and is organized into sections that focus on topics of significance to practicing pediatricians. Coverage is straightforward and practical, with explicit recommendations given for treatment, whenever possible. The authors and editors have made every effort to ensure that relevant content is included in the textbook to answer every question. The book will definitely enrich your clinical experiences and serve as a useful companion, as you learn the fundamental concepts of the specialty, and apply them in clinical settings. Remember, the knowledge we gain is not just abstract learning—it provides the foundation for the care of our patients, who deserve only the best!
The book will serve practicing pediatricians and family physicians as a table reference in their clinical practice.
I am sure that the pediatricians will appreciate the magnanimous and magnificent effort taken by the Editor-in-Chief, Dr A Parthasarathy; Associate Editors, Drs Anupama S Borker, Alok Gupta, Dhanya Dharmapalan; and all the contributors in bringing out this wonderful book.
S Sachidananda Kamath
President
Indian Academy of Pediatrics (IAP) 2015
8
9Foreword
It is with great satisfaction that I introduce Frequently Asked Questions in Pediatric and Adolescent Practice. The book covers most of the commonly encountered questions right from neonatal to adolescent age group with additional important topics such as imaging, investigations, interpretation of laboratory values, rational drug therapy, etc. The question-answer format provides a unique focussed reading, where important and relevant queries regarding the condition, are aptly answered by the best experts known in same field.
I deeply admire and congratulate the teacher of teachers, Dr A Parthasarathy, who untiringly and successfully produces marvellous pieces of dedicated work year after year. I also appreciate the efforts of his team of Editors, Dr Anupama S Borker, Dr Alok Gupta and Dr Dhanya Dharmapalan, and the authors who have put in sincere labor in this compilation.
I am certain that the book will prove to be a valuable asset of knowledge for students and practitioners.
My best wishes
Vijay N Yewale
President
India Academy of Pediatrics (IAP) 201410
11Preface
Pediatric and Adolescent Practice is really a challenging task for practicing pediatricians. The innumerable doubts and clarifications asked by the parents and adolescent patients are an educating experience by itself. What the pediatrician has not learnt in medical colleges during his undergraduate and postgraduate days, learns new information and gains his own experience through interaction with his parent clients. Attending several Continuing Medical Education (CME) programs, seminars and conferences, no doubt enriches the practicing pediatrician's learning skills. At the same time, after attending the continuing medical education lectures and discussions, the doctors develop further curiosity to gain more knowledge through interaction with experts.
It is with this objective in mind, I conceived the idea of coming out with a series of 3 books, viz Case Scenarios, Frequently Asked Questions, and Management Protocols in Pediatric and Adolescent Practice. The second title is now in your hands. The 3rd title is targeted for the year 2016. A formidable team of national and international experts joined hands with me with the sole objective of educating the upcoming country practicing pediatricians by sharing the rich experience, they gained from their own archives. Being luminaries in their own field, they share their practical knowledge to benefit the readers purely out of academic interest without expecting any remuneration whatsoever.
This treatise which is now in your hands has more than 600 FAQs, answered from newborn to adolescent care including several subspecialty disciplines with 30 chapters in about 1000 pages. The answers which have come out of the experts’ own rich experience over decades. I am confident this book will serve as a desk-top reference volume.
No publication will be perfect without the cooperation of the Publisher, M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, renowned for titles with perfection and state-of-the-art presentation matching international standards, have executed wonderful job accomplishment, at a record time to which I am grateful to Shri Jitendar P Vij (Group Chairman) and his production team. We will strive our best to improve the standard of the title in its subsequent editions.
A Parthasarathy
Editor-in-Chief
12
13Acknowledgments
We acknowledge with gratitude the painstaking efforts of all our contributors for so meticulously presenting the FAQs from their own archives. Our grateful thanks go to all of them who have toiled to send their respective files by burning the midnight oil.
The Editor-in-Chief is indebted to all the Associate Editors, who undertook the review and edition of the allotted sections in batches often modified by the author incorporating latest information and changes. All of them did marathon race competing with each other to ensure perfection at the cost of their academic and professional schedules by burning midnight oil at odd hours; but for their untiring job execution, the book would not have seen the light of day.
For secretarial assistance, the Editor-in-Chief is grateful to Mrs Nirmala Parthasarathy (PRO), AP Child Care; Dr (Mrs) Prathiba Janardhnan; Mrs Kavitha Balaji; Miss Shruthi Pavana; Miss Swathi Pavana; Miss Kavya Balaji; Miss Mahiya Balaji; Mr R Janardhanan; Mr P Balaji; Mr A Sriramulu, Chennai, Tamil Nadu, India; and Dr Sweta Gupta and Dr Anant Gupta, Jaipur, Rajasthan, India, for secretarial assistance rendered.
Our grateful thanks go to Mr Hariharaputhran, Ajaykumar, Shukla, Prakash, Abhilash and Mrs Padmaja, Chennai, Tamil Nadu, India, for coordination in correspondence.
As in the past Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director-Publishing), Mrs Samina Khan (PA to Director–Publishing), Mr KK Raman (Production Manager), Mr Omkar Singh (Coordinator), Mr Paras Verma (Coordinator), Mr Vijay (Graphic Designer), Mr Hemant Kumar (Typesetter), and Ms Kamlesh Rawat (Proofreader) had taken personal interest and painstaking efforts to produce yet another state-of-the-art book from the house of reputed international publisher, M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, to whom we are indebted.
A Parthasarathy
Editor-in-Chief
14
15Contributors
  • Akanksha Chichra
  • Pediatric Hematologist Oncologist
  • Somaiya Ayurvihar-Asian Institute
  • of Oncology
  • KJ Somaiya Hospital Campus, Off
  • Mumbai, Maharashtra, India
  • Mobile: 9004920555
  • Alok Gupta
  • Pediatrician and Counselor
  • Pediatric Specialties Clinic
  • Jaipur, Rajasthan, India
  • Formerly, Assistant Professor in
  • Pediatric Medicine
  • Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
  • Mobile: 9414062700
  • Anagha Bhagwat
  • Post Doctoral Fellow in Pediatric Neurology
  • Department of Pediatric Neurology
  • Government Medical college
  • Triruvananthapuram, Kerala, India
  • Mobile: 9656975143
  • Anand K Shandilya
  • Consultant Pediatrician
  • Dr Anand's Hospital for Children
  • Mumbai, Maharashtra, India
  • Mobile: 9820309947
  • Anisha Sawkar Tandon
  • Consultant Pediatric Radiologist
  • Sakra World Hospital
  • Bengaluru, Karnataka, India
  • Mobile: 9343109495
  • Anjali Saxena
  • Senior Consultant of Paediatrics
  • Max Superspeciality Hospital
  • Saket, New Delhi, India
  • Mobile: 9810174567
  • Anup Mohta
  • Director
  • Chacha Nehru Bal Chikitsalaya
  • Geeta Colony, Delhi
  • Mobile: 9810478187
  • Anupama S Borker
  • Consultant Pediatric Hematologist/Oncologist
  • Somaiya Ayurvihar-Asian Institute of Oncology
  • Mumbai, Maharashtra, India
  • Mobile: 9869084466
  • YK Amdekar
  • Medical Director
  • Wadia Children's Hospital
  • Mumbai, Maharashtra, India
  • Mobile: 9820502368
  • A Parthasarathy
  • Senior Consultant Pediatrician
  • AP Child Care, Chennai
  • Former Distinguished Professor
  • The Tamil Nadu Dr MGR Medical University, Chennai
  • Retired Senior Clinical Professor
  • Madras Medical College, Chennai
  • Deputy Superintendent
  • Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India
  • Mobile: 9042260053
  • 16Arbinder Kumar Singal
  • Stecker Fellow, Pediatric Urology
  • Consultant Pediatric Urologist and Hypospadiologist
  • MITR Hospital and Hypospadias Foundation, Navi Mumbai
  • MGM University of Health Sciences
  • Navi Mumbai, Maharashtra, India
  • Mobile: 9930902944
  • Bharat Agarwal
  • Head
  • Department of Pediatric Hematology and Oncology
  • BJ Wadia Hospital for Children
  • Mumbai, Maharashtra, India
  • Mobile: 9820051571
  • Bhavin Jankharia
  • Consultant Radiologist
  • Jankharia Imaging Center
  • Mumbai, Maharashtra, India
  • Mobile: 9833424411
  • Deep Thacker
  • 2nd Year Resident
  • Department of Pediatrics
  • RD Gardi Medical College
  • Ujjain, Madhya Pradesh, India
  • Mobile: 9440859028
  • Devaraj V Raichur,
  • Consultant Pediatrician
  • Susbruta Multispeciality Hospital
  • Former Professor of Pediatrics
  • Karnataka Institute of Medical Sciences
  • Hubli, Karnataka, India
  • Mobile: 9449864828/7411777495
  • Dhanya Dharmapalan
  • Consultant Pediatrician
  • Dr Yewale's Multispecialty Hospital for Children
  • Navi Mumbai, Maharashtra, India
  • Mobile: 9820274280
  • Gisi Shibu
  • Post Doctoral Fellow in Pediatric Neurology
  • Department of Pediatric Neurology
  • Government Medical College
  • Thiruvananthapuram, Kerala, India
  • Mobile: 9387834443
  • Govindaraj M
  • Professor of Pediatrics
  • Medical Superintendent
  • Indira Gandhi Institute of
  • Child Health
  • Bengaluru, Karnataka, India
  • Mobile: 9449033243
  • drgovindraj@yahoo.co.in
  • Jayakar Thomas
  • Professor and Head
  • Department of Skin and STD
  • Sree Balaji Medical College
  • Chennai, Tamil Nadu, India
  • Mobile: 9841038484
  • 17Jeeson C Unni
  • National Convenor, IAP Poor Scholastic Performance Program 2007/2011
  • Consultant Pediatrician
  • Dr Kunhalu's Nursing Home
  • Cochin, Kerala, India
  • Mobile: 9847245207
  • Ketan Parikh
  • Consultant
  • Pediatric Surgeon and Laparoscopist
  • Tara Neo-Surg Hospital
  • Mumbai, Maharashtra, India
  • Mobile: 02221021603/9821010035
  • Madhulika Kabra
  • Professor
  • Division of Genetics
  • Department of Pediatrics
  • All India Institute of Medical Sciences
  • New Delhi, India
  • Mobile: 9868397541
  • Mahantesh Matti
  • Assistant Professor
  • Department of Pediatrics
  • SDM College of Medical Sciences
  • and Hospital
  • Karnataka, India
  • Malathi Sathiyasekaran
  • Consultant Pediatric Gastroenterologist
  • Kanchi Kamakoti Childs Trust Hospital, Sundaram Medical Foundation Hospital
  • Chennai, Tamil Nadu, India
  • Mobile: 9841041991
  • Meenakshi Swaminathan
  • Senior Consultant
  • Department of Pediatric Ophthalmology and Strabismus
  • Sankara Nethralaya
  • Chennai, Tamil Nadu, India
  • Mobile: 9840143813
  • drms@snmail.org
  • MKC Nair
  • Vice Chancellor
  • Kerala University for Health Sciences
  • Thiruvananthapuram, Kerala, India
  • Mobile: 9447121689
  • MR Lokeshwar
  • Consultant Pediatrician
  • Lilavati Hospital and Research Center
  • Mumbai, Maharashtra, India
  • Mobile: 9821031496
  • M Zulfikar Ahamed
  • Professor and Head
  • Department of Pediatric Cardiology
  • Government Medical College
  • Thiruvananthapuram, Kerala, India
  • Mobile: 9447797979
  • Naveen Jain
  • Senior Neonatal Consultant
  • In-charge
  • Department of Neonatology
  • Kerala Institute of Medical
  • Sciences (KIMS)
  • Thiruvananthapuram, Kerala, India
  • Mobile: 9387814568
  • 18Naveen Thacker
  • Director
  • Deep Children Hospital and Research Centre
  • Gandhidham, Gujarat, India
  • Mobile: 90426217314
  • Nazrin Mohamed Ismail
  • Junior Resident
  • Department of ENT, Head and
  • Neck Surgery
  • Sri Ramchandra University
  • Chennai, Tamil Nadu, India
  • Mobile: 9500154687
  • NC Gowrishankar
  • Deputy Head (Pediatrics)
  • Pediatric Pulmonologist and Bronchoscopist
  • Mehta Children's Hospital
  • Chennai, Tamil Nadu, India
  • Mobile: 9444047740
  • Neerja Gupta
  • Consultant Scientist
  • Division of Genetics
  • Department of Pediatrics
  • All India Institute of
  • Medical Sciences (AIIMS)
  • New Delhi, India
  • Mobile: 9999995630
  • PA Mohammed Kunju
  • Professor and Head
  • Department of Pediatric Neurology
  • Government Medical College
  • Thiruvananthapuram, Kerala, India
  • Mobile: 9447246333
  • Parimalam Kumar
  • Professor and Head
  • Department of Dermatology
  • Thanjavur Medical College
  • Thanjavur, Tamil Nadu, India
  • Mobile: 9841159279
  • P Ramachandran
  • Professor
  • Department of Pediatrics
  • Sri Ramachandra Medical College
  • Chennai, Tamil Nadu, India
  • Mobile: 9840471901
  • PS Rajakumar
  • Associate Professor
  • Department of Pediatrics
  • Sri Ramachandra Medical College
  • Chennai, Tamil Nadu, India
  • Mobile: 9941821207
  • 19Ravikumar T
  • Senior Consultant
  • Department of Pediatrics
  • Kanchi Kamakoti Child Trust Hospital
  • Chennai, Tamil Nadu, India
  • Mobile: 9841081382
  • Rhishikesh Thakre
  • Professor
  • Department of Pediatrics
  • MGM College and Hospital
  • Director
  • Neonatology Division
  • Neo Clinic and Hospital
  • Aurangabad, Maharashtra, India
  • Mobile: 9325212131
  • Rose Mary Lawrence
  • Post Doctoral Fellow in
  • Pediatric Neurology
  • Department of Pediatric Neurology
  • Government Medical College
  • Thiruvananthapuram, Kerala, India
  • Mobile: 9495396313
  • Ruchi Nadar
  • Clinical Research Associate
  • Hirabai Cowasji Jehangir Medical Research Institute
  • Pune, Maharashtra, India
  • Mobile: 8015041504
  • Sagar Bhattad
  • Senior Resident (DM 1st year)
  • Pediatric Allergy Immunology Unit
  • Advanced Pediatrics Centre
  • Postgraduate Institute of Medical Education and Research (PGIMER)
  • Chandigarh, India
  • Mobile: 9779433934
  • Somu Lakshmanan
  • Additional Professor
  • Department of ENT, Head and
  • Neck Surgery
  • Sri Ramachandara Medical College
  • and Hospital
  • Chennai, Tamil Nadu, India
  • Mobile: 9840041597
  • Srikanth R
  • Associate Consultant
  • Department of Pediatric Ophthalmology and Strabismus
  • Sankara Nethralaya
  • Chennai, Tamil Nadu, India
  • Mobile: 9677046201
  • S Thangavelu
  • Former Reader/Assistant Professor
  • Pediatric Intensive Care
  • Institute of Child Health and Hospital
  • for Children
  • Madras Medical College
  • Chennai, Tamil Nadu
  • Currently, Consultant Pediatrician
  • and Head
  • Mehta Children's Hospital
  • Chennai, Tamil Nadu, India
  • Mobile: 9790970772
  • 20C Thangadorai
  • (Retd) Senior Clinical
  • Professor (Pediatrics)
  • Madras Medical College and
  • Pediatric Physician
  • Institute of Child Health and Hospital
  • for Children
  • Chennai, Tamil Nadu, India
  • Mobile: 9444048384
  • Sudhakar K
  • Post Doctoral Fellow in Pediatric Neurology
  • Department of Pediatric Neurology
  • Government Medical college
  • Thiruvananthapuram, Kerala, India
  • Mobile: 9495363178
  • Sumathi Bavanandam
  • Assistant Professor
  • Department of Pediatric Gastroenterology
  • Institute of Child Health and Hospital
  • for Children
  • Madras Medical College
  • Chennai, Tamil Nadu, India
  • Mobile: 9841371490/9043879235
  • Surjit Singh
  • Professor
  • Department of Pediatrics
  • Advanced Pediatrics Center
  • Postgraduate Institute of Medical Education and Research (PGIMER)
  • Chandigarh, India
  • Mobile: 9872283832
  • Surpreet Nagi
  • Consultant
  • Dr Anand's Hospital for Children
  • Mumbai, Maharashtra, India
  • Mobile: 9819421667
  • Swati Y Bhave
  • Executive Director
  • Association of Adolescent and Child Care in India (AACCI)
  • Mumbai, Maharashtra, India
  • Mobile: 02222854860
  • Vaman Khadilkar
  • Pediatric Endocrinologist
  • Jehangir Hospital, Pune and Bombay Hospital
  • Mumbai, Maharashtra, India
  • Head, Division of Pediatric Endocrinology
  • Bharati Vidyapeeth Hospital and
  • Medical College
  • Pune, Maharashtra, India
  • Mobile: 9850244305
  • Vinod H Ratageri
  • Associate Professor of Pediatrics
  • Karnataka Institute of Medical Sciences
  • Hubli, Karnataka, India
  • Mobile: 09448278480
  • Vishesh Jain
  • Assistant Professor
  • Department of Pediatric Surgery
  • Chacha Nehru Bal Chikitsalaya
  • New Delhi, India
  • Mobile: 9540951519
  • VP Anitha
  • Consultant Pediatric Intensivist
  • Mehta Children's Hospital
  • Chennai, Tamil Nadu, India
  • Mobile: 9884394885
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