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Nelson Textbook of Pediatrics, 19th edition: Expert Consult Premium Edition – Enhanced Online Features and Print by Robert M. Kliegman, MD, Bonita F. Stanton, MD, and Richard E. Behrman, MD; Joseph W. St. Geme III, MD, and Nina F. Schor, MD, PhD, (Elsevier Saunders) Nelson Textbook of Pediatrics has been the world's most trusted pediatrics resource for nearly 75 years. Drs. Robert Kliegman, Bonita Stanton, Richard Behrman, and two new editors – Joseph St. Geme, III, MD and Nina Schor, MD, who contribute on the key subspecialties, including pediatric infectious disease and pediatric neurology – continue to provide the most authoritative coverage of the best approaches to care. This streamlined 19th edition covers the latest on genetics, neurology, infectious disease, melamine poisoning, sexual identity and adolescent homosexuality, and psychosis associated with epilepsy. The expanded online access features the regularly updated text, case studies, new references and journal articles, Clinics articles, and exclusive web-only content.

This 19th edition of the book has a mind-boggling 708 chapters. With Nelson Textbook of Pediatrics clinicians are able to:

• Understand the principles of therapy and which drugs and dosages to prescribe for every disease.
• Locate key content and identify clinical conditions thanks to a full-color design and full-color photographs.
• Access the fully searchable and regularly updated text online along with abundant case studies, new references and journal articles, Clinics articles, and exclusive web-only content.
• Stay current on recent developments and hot topics such as melamine poisoning, long-term mechanical ventilation in the acutely ill child, sexual identity and adolescent homosexuality, age-specific behavior disturbances, and psychosis associated with epilepsy.
• Tap into substantially enhanced content with world-leading clinical and research expertise.
• Manage the transition to adult healthcare for children with chronic diseases through discussions of the overall health needs of patients with congenital heart defects, diabetes, and cystic fibrosis.
• Recognize, diagnose, and manage genetic conditions using an expanded section that covers these diseases, disorders, and syndromes extensively.
• Find information on chronic and common dermatologic problems more easily with a more intuitive reorganization of the section.

Editors of Nelson Textbook of Pediatrics and their credentials include: Robert M. Kliegman, MD, Professor and Chair, Department of Pediatrics, Medical College of Wisconsin, Pediatrician-in-Chief, Pamela and Leslie Muma Chair in Pediatrics, Children's Hospital of Wisconsin, Executive Vice President, Children's Research Institute, Milwaukee; Bonita F. Stanton, MD, Professor and Schotanus Family Endowed Chair of Pediatrics, Pediatrician-in-Chief, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit; Nina F. Schor, MD, PhD, William H. Eilinger Professor and Chair Department of Pediatrics, Professor, Department of Neurology, Pediatrician-in-Chief, Golisano Children's Hospital, University of Rochester Medical Center, Rochester; Joseph W. St. Geme III, MD, James B. Duke Professor and Chair Department of Pediatrics, Duke University School of Medicine, Chief Medical Officer, Duke Children's Hospital and Health Center, Durham, NC; and Richard E. Behrman, MD, Nonprofit Healthcare and Educational Consultants to Medical Institutions Santa Barbara, California.

Children are the world's most important resource. Pediatrics is the sole discipline concerned with all aspects of the well-being of infants, children, and adolescents, including their health; their physical, mental, and psychological growth and development; and their opportunity to achieve full potential as adults. Pediatricians must be concerned not only with particular organ systems and biologic processes, but also with environmental and social influences, which have a major impact on the physical, emotional, and mental health and social well-being of children and their families.

Pediatricians must be advocates for the individual child and for all children, irrespective of culture, religion, gender, race, or ethnicity or of local, state, or national boundaries.

According to Stanton and Behrman in Chapter 1 of Nelson Textbook of Pediatrics, in 2006, there were an estimated 133 million births world-wide, 124 million (92%) of which were in developing countries and 4.3 million (3%) of which were in the US.

More than a century ago, pediatrics emerged as a medical specialty in response to increasing awareness that the health problems of children differ from those of adults and that a child's response to illness and stress varies with age.

The health problems of children and youth vary widely between and within populations in the nations of the world depending on a number of often interrelated factors. These factors include (1) economic considerations (economic disparities); (2) educational, social, and cultural considerations; (3) the prevalence and ecology of infectious agents and their hosts; (4) climate and geography; (5) agricultural resources and practices (nutritional resources); (6) stage of industrialization and urbanization; (7) the gene frequencies for some disorders; and (8) the health and social welfare infrastructure available within these countries. Health problems are not restricted to single nations and are not limited by country boundaries; the interrelation of health issues across the globe has achieved widespread recognition in the wake of the SARS (severe acute respiratory syndrome) and AIDS epidemics, expansions in the pandemics of cholera and West Nile virus, war and bioterrorism, the tsunami of 2004, and the global recession beginning in 2008.

Despite global interconnectedness, child health priorities continue to reflect local politics, resources, and needs. The state of health of any community must be defined by the incidence of illness and by data from studies that show the changes that occur with time and in response to programs of prevention, case finding, therapy, and surveillance. To ensure that the needs of children and adults across the globe were not obscured by local needs, in 2000 the international community established 8 Millennium Development Goals (MDGs) to be achieved by 2015. Although all 8 MDGs impact child well-being, MDG 4 ("Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate") is exclusively focused on children. Globally, there has been a 23% reduction in under-5 mortality since 1990, with a 40% reduction in developed countries but only a 21% reduction in the least developed countries. In 62 countries progress was inadequate to meet the goals and 27 countries (including most of those in sub-Saharan Africa) made no progress or declined between 1990 and 2006. There were nearly 13 million under-5 deaths in 1990; 2006 marked the 1st year that there were fewer than 10 million deaths (9.7 million) with a further decrease to 9.0 million in 2007 and 8.8 million in 2008. However, overall progress has not been on target to reach the goal.

In developing countries today, the leading causes of death remains diarrhea, pneumonia, malaria, and measles with much of the reductions in mortality that have occurred resulting from effective vaccine programs, oral rehydration therapy, early diagnosis and treatment of pneumonia, and, treated mosquito nets.

According to Nelson Textbook of Pediatrics, concerns about the problems of children throughout the world have generated three sets of goals. The first set includes that all families have access to adequate perinatal, preschool, and family-planning services; that international and national governmental activities be effectively coordinated at the global, regional, national, and local levels; that services be so organized that they reach populations at special risk; that there be no insurmountable or inequitable financial harriers to adequate care; that the health care of children have continuity from prenatal through adolescent age periods; and that every family ultimately have access to all necessary services, including developmental, dental, genetic, and mental health services. A second set of goals addresses the need for reducing unintended injuries and environmental risks, for meeting nutritional needs, and for health education aimed at fostering health-promoting lifestyles. A third set of goals covers the need for research in biomedical and behavioral science, in fundamentals of bioscience and human biology, and in the particular problems of mothers and children.

Nelson Textbook of Pediatrics provides a dynamic multimedia resource to meet patients' changing needs. This 19th edition continues to provide THE BEST pediatric information with expanded premium multimedia features, extensively revised content, and two new editors. The expanded online access features the regularly updated text, case studies, new references and journal articles, Clinics articles, and exclusive web-only content so that clinicians get even more out of this invaluable reference.

Ethical Conduct Of Clinical Research Involving Children edited by Marilyn J. Field, Richard E. Behrman (National Academies Press) In recent decades, advances in biomedical research have helped save or lengthen the lives of children around the world. With improved therapies, child and adolescent mortality rates have decreased significantly in the last half century. Despite these advances, pediatricians and others argue that children have not shared equally with adults in biomedical advances. Even though we want children to benefit from the dramatic and accelerating rate of progress in medical care that has been fueled by scientific research, we do not want to place children at risk of being harmed by participating in clinical studies. 

Ethical Conduct of Research Involving Children considers the necessities and challenges of this type of research and reviews the ethical and legal standards for conducting it. It also considers problems with the interpretation and application of these standards and recommends steps that researchers, government agencies, and others can take to improve research conduct. The book argues that a robust system for protecting human research participants in general is a necessary foundation for protecting child research participants in particular. The report looks at the need for appropriate pediatric expertise at all stages of the design, review, and conduct of a research project to effectively implement policies to protect children.

Those who care about and for children currently face a dilemma. We want children to benefit from the dramatic and accelerating rate of progress in medical care that is fueled by scientific research. At the same time, we do not want to place any children at risk of being harmed by participating in such research, even though their very involvement may be essential to improving the overall medical care of children. We also want to discourage research that is of minimal value. The concern is how best to balance these potentially conflicting objectives. Five important considerations should guide us as we seek to resolve our dilemma.

First, because of the inherent vulnerabilities arising from their immaturity, infants, children, and adolescents need additional protections beyond what is provided to competent adults when they participate in research. This principle underlies all others.

Second, the design of the research required to improve the health and well-being of infants, children, and adolescents must consider their physical, cognitive, emotional, and social development. Similarly, when children of any age become participants in such research, the protections provided must be appropriate to their stages of development.

Third, sharing in the advances in medical care for this vulnerable group includes a special emphasis on protecting them from harm caused by standard medical procedures and treatments based on research with adults when the benefits and risks for children of different ages have not been established through scientific research involving these populations. Except

when it is not feasible or reasonable, research with animals, and adults should precede studies with children to minimize research risks.

Fourth, the system for protecting infants, children, and adolescents involved in research, while ensuring such protection, should not unreason-ably impede research that may benefit them. The contribution of rules and regulations to desired outcomes as well as possible unintended negative consequences should be considered.

Finally, all of those responsible for research involving infants, children, and adolescents need to understand the special ethical issues that are relevant to the conduct of such research and the additional protection that must be provided. In certain cases, ethical standards will preclude some otherwise desirable research.

Overall, a satisfactory resolution of our dilemma can be achieved. Children involved in research can be appropriately protected as well as share fairly in the increasing benefits of biomedical science. This report suggests ways to balance sometimes conflicting objectives in ways that will contribute to children's health and well-being now and in the future.

 Pediatric Endocrinology: The Requisites in Pediatrics edited by Thomas, Jr. Moshang (The Requisites in Pediatrics Series: Mosby) This practical volume in the Clinical Practice in Pediatric series focuses on the major endocrine disorders found in clinical practice. Each chapter begins with a discussion of normal physiology, providing normative clinical standards and normal lab values for each disorder. Separate sections present information on disorders of hormone deficiency, hormone resistance, and hormone excess. Tables in subchapters inform the reader about diagnosis, laboratory and radiologic studies, therapies, and when to refer to a specialist. Key points at the end of each chapter highlight vital information.

Information and new knowledge pertaining to pediatric endocrinology, as in all of medical science, are expanding at an exponential rate. In fact, new hormones are being discovered to the degree where it is not yet clear how these hormones (such as leptin, resistin, adiponectin, and gherelin) are related to clinical disease. We know that many clinical disorders can be confirmed by analyzing specific genes, yet many of these gene studies are not available except in research laboratories. Specific hor­mones can be measured precisely in microunits, espe­cially important in evaluating developmental changes in children. Yet despite all of the new technology, the genetic advances, and relevant discoveries, there is still a need for understanding the basic paradigms of clinical medicine.

In medicine, the term requisites is interpreted as the basic knowledge that is necessary for practice or board review. This book was designed to be consistent with the premise of the other volumes in the Requisites in Pediatrics series—that there should be a series of books that provide required basic information important for pediatric residents, pediatricians, primary care physi­cians and nurse practitioners caring for children. In that context, this volume of the Requisites series provides a basic tutorial by each of the various authors in areas of pediatric endocrinology that are important for the care of children. Each chapter is to be read as if a trainee wishes to obtain basic information in a certain area in a tutorial fashion, not as a reference text or source book. Although many of the authors are involved in research, all are clinicians with a strong focus on pediatric endocrine care, and they wrote their chapters with cli­nicians in mind.

It is important to include discussion of disorders not previously thought to be within the purview of pediatric endocrinology, such as type 2 diabetes mellitus and osteoporosis. Type 2 diabetes mellitus, previously identi­fied as "adult-onset diabetes mellitus," is increasing in our adolescent patients in epidemic proportions. The chap-ter written by Daniel Hale and Stuart Weinzimer addresses not only the diagnosis and management of type 2 diabetes mellitus in adolescents but also some of the issues of increasing obesity in children. The technol­ogy and information for assessing bone density and osteoporosis are focused on the elderly, thereby making assessment and therapy in children difficult, as well as limiting management options, because of the lack of data in the pediatric population. In fact, even normative data for bone density based on age (because onset of puberty is variable in the normal adolescent population) may be inaccurate.These issues are still to be resolved, but clini­cians caring for children with potential problems of bone formation should be aware of the many different issues as addressed in the section on osteoporosis.

Mosby's Color Atlas and Text of Pediatrics and Child Health by Bill Chaudhry, David Harvey (Mosby) Combines high-quality color photographs, diagnostic images, and explanatory diagrams with concise and clinically focused text. Presents the full range of pediatric disease likely seen in daily practice. Includes core information necessary to succeed in exams.

Covering all aspects of pediatrics and community child health, this book is lavishly illustrated with full-color clinical photographs and consistently organized throughout. Coverage of each condition includes symptoms, signs and diagnostic investigations. Principles of management and general child health issues such as prevention and health promotion, accidents, and abuse are also covered. This well-rounded coverage helps ensure readers' awareness not only of particular organ systems and processes, but also social and environmental influences that have a major impact on the health and well-being of children.

Pediatric medicine is concerned with identifying and managing conditions that disturb the health of children. This involves not only the treatment of established disease but also the promotion of health and prevention of disease. There is increasing awareness that many diseases that were apparently limited to the adult population have their roots in childhood and fetal life. Birth weight and weight at 1 year have been correlated with death from ischaernic heart disease and respiratory morbidity in adult life. Although health can be defined as the absence of disease, the World Health Organization's definition also recognizes the emotional needs and welfare of the child. It is well recognized that emotionally deprived children may have failure to thrive associated with reduced levels of growth hormone (see Chapter 4).

The pediatrician’s daily work load can range from the problems of babies born in the second trimester of pregnancy to the emotional difficulties of adolescents in the second decade of life. The pediatrician must be confident in the management of the preterm and newborn infant, be able to persuade and charm the uncooperative toddler and also be able to relate to teenagers with changing emotional and physical characteristics.

Perhaps the most important difference between pediatrics and other branches of medicine is the continuing growth and development that defines childhood. No pediatric consultation is complete without an assessment of height and weight (length, head circumference and weight in infants) that need to be interpreted on appropriate centile charts. The developmental progress of a child is best determined from parental observations and by watching the child's behavior during play. The developmental progress of older children is largely manifest through education, and information on school progress is invaluable. For example, the sudden onset of unruly behavior may suggest hyperthyroidism whilst clumsiness noted during games and poor handwriting may point to an undiagnosed congenital hemiplegia,

Communication skills are of vital importance in all branches of medicine and more so in childhood. Small children are limited in their vocabulary (Fig. 1.1) and may be unable to explain somatic sensations such as pain. The word `headache' may be learnt from parents and used to indicate discomfort in any part of the body. For many families English is not the first language and the services of an interpreter may be required. It is not unusual, but it is unsatisfactory for an older sibling to provide this service for his or her parents.

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