Preface to the Seventh Edition
This edition of the Essential Pediatrics marks the completion of more than 25 years of its existence as a beacon of art and science of pediatrics in the country and beyond. Essential Pediatrics began in 1982 with Dr. OP Ghai as its lead author and founder editor. He directed and steered this book until his sudden passing away in May 2008. Dr. Ghai was actively involved in the preparation of this edition, which continues to bear an indelible imprint of his creative instinct and scholarship.
The present edition comes at a time of unprecedented focus and investments on child survival and health in the country. There is a heightened interest in child health education and training and a global endeavour for improving child health. It also comes at a juncture when subspecialties of pediatrics are taking root in the country. The coming years will mark a transition of pediatrics from the existing priorities such as nutrition and infectious diseases to emerging areas such as genetics, adolescence, intensive care and care of children with chronic systemic diseases.
This edition upholds and advances the traditional core values, focus and scope of the book even as it encompasses significant changes. There are major revisions in most chapters, aimed at meeting the contemporary needs of undergraduate and postgraduate medical and nursing students, and pediatricians. The chapters on growth and development have been rewritten with inclusion of fresh illustrations and WHO growth norms. Chapters on nutrition and neonatology have been completely revised with emphasis on practical and evidence-based management of common conditions. The chapter on infections has also been rewritten keeping in view their relevance for physicians practising in developing countries. The chapters on hematological, endocrine, nervous system and renal disorders have been thoroughly updated and reorganized. New sections on hypertension, interventional cardiology, newer vaccines, poisonings and accidents, national and WHO guidelines on management of common conditions and IMNCI are incorporated. The inclusion of multiple diagnostic and therapeutic algorithms shall serve as a useful educational resource. Fresh chapters on skin and ocular disorders, practical procedures and rights of children provide a comprehensive review on issues pertaining to the care of children.
Some of the best-known academics have contributed to Essential Pediatrics and we are indebted to them for their scholarly writings. They all have a remarkable understanding of the learning needs of the students, and their chapters reflect the essence of their knowledge and experience. We are grateful to Dr Aditi Sinha for meticulous work at every stage of the preparation of this edition. Through tireless effort, she ensured accuracy of contents and quality of presentation of this edition. Mrs Veena Arora accomplished the composing with great patience. We thank the technical team at our publishers, CBS Publishers & Distributors, for their tremendous effort in improving the presentation of this book.
Humbled by the faith reposed by the successive waves of our readers, we are ever conscious of our responsibility in ensuring this book’s relevance in the changing health scenario, and in the backdrop of the advances in knowledge. We hope this edition would succeed in continuing to make a genuine and lasting contribution towards the health and well-being of children.
About the Author
Prof. Om Prakash Ghai had a distinguished academic tenure at the All India Institute of Medical Sciences, New Delhi. He started the Department of Pediatrics in 1959 with six beds for children. Under his leadership, the department evolved into a multispecialty centre of international repute.
After his retirement as Dean of the Institute and Professor and Head of the Department of Pediatrics, he chaired the Department of Pediatrics at the University College of Medical Sciences, Delhi, where he served until 1991.
Prof. Ghai was President of the Indian Academy of Pediatrics in 1978 and President of the International College of Pediatrics from 1987 to 1990. The International Pediatric Association presented him the prestigious ‘Insignia of Merit Medallion’ (1977) for his outstanding contributions to child welfare. The Indian Council of Medical Research awarded him the Dr. Kamla Menon Prize (1983) and Amrut Mody Prize (1985). The Medical Council of India bestowed on him the Dr. BC Roy Memorial Award for ‘Eminent Medical Teacher’ (1987). He was also awarded the Dr. KC Choudhry Oration by Calcutta University (1984) and Prof. JB Chatterjee Oration (1990) by the Calcutta School of Tropical Medicine. He was awarded the honorary fellowships of the American Academy of Pediatrics, the National Academy of Medical Sciences and the Indian Academy of Pediatrics.
Prof. Ghai served as a short-term consultant to the World Health Organization and Asian Development Bank. He was a member of the Technical Advisory Group of the Control of Diarrheal Diseases Program of the World Health Organization, Geneva (1987-89). He has been a member of the Scientific Advisory Boards of the National Institutes of Nutrition, Cholera and Enteric Diseases, Public Cooperation and Child Development. He was member of the National Children’s Board and several expert groups of the Government of India, UNICEF and Indian Council of Child Welfare. He was the editor of Indian Pediatrics and World Pediatrics and Child Care and member of the editorial advisory boards of the Annals of National Academy of Medical Sciences and Indian Journal of Pediatrics.
Professor Ghai was a teacher par excellence, an inspiring leader and a true visionary. His name shall always remain etched in the annals of pediatrics of our country.
Preface to the First Edition
The health problems of the children in the third world are the most pressing. Physicians in these countries often have to work under constraints of poor resources and a lack of access to the modern diagnostic aids. They, therefore, of necessity require a more exhaustive training in clinical skills and a sharper clinical acumen than their counterparts more fortunately placed. The present textbook is primarily aimed to fulfil this need.
This book covers a broad spectrum of the subject, laying a special emphasis on the nutritional and infectious disorders. Rare diseases are referred to only briefly. This has helped to restrict the size of the book to a manageable level so that the undergraduate medical students may find it handy and useful.
The sections on the applied aspects of anatomy and physiology of the various body systems and path physiology of the disease processes affecting them will appeal to the postgraduate medical students. These may help them in understanding the biological basis of diagnosis and management. The sections on the use of drugs, clinical approach to the diagnosis and details of diagnostic and therapeutic procedures will be useful especially for the general practitioners and clinical residents.
Most references used in the preparation of the manuscript have been cited but if some have been left out through oversight, I offer my sincere apologies. I thank Prof. MMS Ahuja for the permission to include some excerpts from the chapter on “Nutrition” written by Dr. Tara Gopaldas and me from the book Progress in Clinical Medicine, Series IV, published by Arnold Heinemann, New Delhi.
I acknowledge my gratitude to all my colleagues in the department who gave me unstinted support and stood solidly beside me in our joint endeavour for upgrading the status of pediatric services in India. The erudition and scholarship of Professors KL Wig and V Ramalingaswami have been a great source of inspiration to me. I am grateful to Professors PN Taneja and Harish Chandra, who encouraged me to write this book.
I take this opportunity to thank Dr. PSN Menon, my erstwhile student, now a dear colleague, who helped me at every stage of preparation of this edition. The book bears an indelible imprint of his meticulous efforts. I am grateful to my colleague Dr. HS Wasir for his valuable suggestions on the section on hypertension. Drs RK Menon, Vedanarayanan and Anil Gupta read through several sections and made helpful suggestions.
Many medical students, especially Mr. Gurkirpal Singh, helped at several stages in preparation of the book. I am grateful to Messrs Ganguly, Mitra, Ghosh and Awasthi for their help in artwork. Shri Suraj Bhan did the typing work with great patience. Shri JN Mathur of Mehta Offset Works toiled painstakingly to give the finishing touches to the book. Shri SN Mehta, our publisher, was very co-operative and took a special pride in publishing this volume.
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