The Harriet Lane Handbook: A Manual for Pediatric House Officers

The Harriet Lane Handbook, 23rd edition.
Copyright © 2024 by Elsevier, Inc. All rights reserved.

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Editors

CAMILLE C. ANDERSON, MD
SUNAINA KAPOOR, MD, MPH
TIFFANY E. MARK, MD

Dedication

To our families
Bill and Robin Anderson, thank you for encouraging me to dream big and pursue a life that brings me meaning and joy. You have helped me every step of the way and I love you more than I can say. Tess Anderson, you inspire me every day with your unending well of kindness and generosity – thank you for being a wonderful sister. Jordan Perry, you make all hard things seem possible; I couldn’t have done this without you. To the friends who have supported me like family, thank you for being on this journey with me.

Atul and Nupur Kapoor, thank you for the endless sacrifices, constant support, and unconditional love that allowed me to live out my dreams – I owe it all to you. Anirudh Arun, thank you for being the most caring and supportive husband – I cherish our journey of becoming physicians, life partners, and parents together. Ankit Kapoor, thank you for always challenging me to be the best sister, daughter, and doctor I can be. Sheela Kapoor, thank you for being my biggest cheerleader, my fund of virtue, and my rock – I miss you dearly. Mowgli and Meeko, you bring us endless joy. And finally, to my son Ishaan, this is all for you – you are the bright star in our future.

Charlie and Elizabeth Mark, thank you for being my greatest source of encouragement in pursuing my dreams of becoming a medical doctor. I would not be where I am today without your unwavering support all these years. To my brother, Patrick Mark, thank you for being the greatest and most caring older brother, always showing me the importance of family and love. To my extended family and friends, thank you for all the encouragement, kind words, laughter, and joy throughout my life – you all have made this journey possible.

To our patients and their families
Thank you for teaching us and for trusting in us. You have made us pediatricians.

To our residents
Your tireless advocacy and care for our patients inspires us constantly.
Thank you for all of the sacrifices you have made.

To the wonderful pediatricians who trained us, especially
Nicole Shilkofski

To the Children’s Center leaders we have learned from
Margaret Moon, Tina Cheng, and George Dover

To the frontline providers of the COVID-19 pandemic
Thank you for your bravery in a time of uncertainty.

Preface

“Why this child? Why this disease? Why now?” —Barton Childs, MD

The Harriet Lane Handbook was first developed in 1953 after Harrison Spencer (chief resident in 1950–1951) suggested that residents should write a pocket-sized “pearl book.” As recounted by Henry Seidel, the first editor of The Harriet Lane Handbook, “Six of us began without funds and without [the] supervision of our elders, meeting sporadically around a table in the library of the Harriet Lane Home.” The product of their efforts was a concise yet comprehensive handbook that became an indispensable tool for the residents of the Harriet Lane Home. Ultimately, Robert Cooke (department chief, 1956–1974) realized the potential of the Handbook and the fifth edition was published for widespread distribution by Year Book. Since that time, the handbook has been regularly updated and rigorously revised to reflect the most up-to-date information and available clinical guidelines. It has grown from a humble Hopkins resident “pearl book” to become a nationally and internationally respected clinical resource. Now translated into many languages, the handbook is still intended as an easy-to-use manual to help pediatricians provide current and comprehensive pediatric care.

Today, The Harriet Lane Handbook continues to be updated and revised by house officers for house officers. Recognizing the limit to what can be included in a pocket guide, additional information has been placed online and for use via mobile applications. The online-only content includes references, expanded text, and additional tables, figures, and images.

In addition to including the most up-to-date guidelines, practice parameters, and references, we will highlight some of the most important improvements in the twenty-third edition of The Harriet Lane Handbook:

The Traumatic Injuries chapter now contains a detailed description of considerations for the primary survey, as well as emergent labs.

The Neurology chapter has been reorganized into emergent and chronic or progressive diagnoses and includes a new section on functional neurologic disorders.

The Analgesia and Procedural Sedation chapter has a new section detailing the evaluation of pain in children with significant neurological impairment.

The Infectious Disease chapter now includes a summary of parasitic and fungal infections.

The Cardiology and Rheumatology chapters now include information on diagnosis and management of multisystem inflammatory syndrome in children (MIS-C).

The Biostatistics chapter has been restructured to reflect principles of practicing evidence based medicine (EBM).

The Development, Behavior, and Developmental Disability chapter now includes information about adverse childhood experiences.

Also new to The Harriet Lane Handbook this year are supplemental Harriet Lane Audio Companion Case Files. These audio files adopt a case-based interview format with content experts in order to take a more conversational and discussion-based approach into important topics within pediatrics (see Audio P.1).

The Harriet Lane Handbook, designed for pediatric house staff, was made possible by the extraordinary efforts of this year’s Johns Hopkins Harriet Lane Pediatric Residency Program senior resident class. It has been an honor to watch these fine doctors mature and refine their skills since internship. They have balanced their busy work schedules and personal lives while authoring the chapters that follow. We are grateful to each of them, along with their faculty advisors, who selflessly dedicated their time to improve the quality and content of this publication. The high quality of this handbook is representative of our residents, who are the heart and soul of our department.

Faculty Advisor

1. Emergency and Critical Care Management

Tai Kyung S. Hairston, MD
LeAnn McNamara, PharmD

Justin M. Jeffers, MD, MEHP
Nicole Shilkofski, MD, MEd

2. Traumatic Injuries

Radhika Ghodasara, MD

Jennifer F. Anders, MD
Paul D. Sponseller, MD, MBA

Sophie Crinion, MD

Elizabeth Hines, MD

Maite E. Del Valle Rolón, MD

Thuy Ngo, DO, MEd

5. Adolescent Medicine

Amitte Rosenfeld, MD

Yasamin Ege Sanii, MD

Rachel H. Alinsky, MD, MPH
Renata Arrington Sanders, MD, MPH,
ScM

6. Analgesia and Procedural Sedation

Alexander Jaksic, MD
Divya Madhusudhan, MD

Rajeev Wadia, MD

Alexander Tang, MD
James Ting, MD

Caridad M. de la Uz, MD
William Ravekes, MD
W. Reid Thompson III, MD

Katherine Cummings, MD
Allison Haley, MD

Bernard Cohen, MD

9. Development, Behavior, and Developmental Disability

Brenna M. Beck, MD, MEd

Christle Nwora, MD

Harolyn Belcher, MD

Rashmi Pashankar, MD

Kristin Arcara, MD

11. Fluids and Electrolytes

Joniqua Ceasar, MD

Leonard S. Feldman, MD

Elshaddai Ephrem, MD

Darla Shores, MD, PhD

13. Genetics: Metabolism and Conditions with Distinctive Appearance

Jacqueline Wood, MD, MA

Joann Bodurtha, MD, MPH
Ada Hamosh, MD, MPH

James F. Casella, MD
Courtney Elizabeth Lawrence, MD, MS
Emily S. Rao, MD, MA, MS

15. Immunology and Allergy

Samantha Leong, MD, PhD

Lindsay Sheets, MD, MPH

Pranita D. Tamma, MD, MHS

17. Microbiology and Infectious Disease

Amali Gunawardana, MD
Ashley Wallace Wu, MD

Alice Jenh Hsu, PharmD
Sanjay K. Jain, MD
John McAteer, DO, MPH
Nadine Peart, MD
Erica Prochaska, MD

Elizabeth Lee, MD

Maureen M. Gilmore, MD

Ryan Handoko, MD

Jeffrey Fadrowski, MD, MHS
Cozumel Pruette, MD, MHS, MS

Hannah E. Edelman MD, PhD
Maera J. Stratton, MD

Matthew J. Elrick, MD, PhD
Eric H. Kossoff, MD
Christopher Oakley, MD
Lisa R Sun, MD

21. Nutrition and Growth

Audrey Companiony Hopkins, MD

Darla Shores, MD, PhD
Jennifer Thompson, MS, RD, CSP, LDN

Lawrence Gersz MD, MBA
Rebecca Xi, MD

Nicole Arwood, PharmD
Stacy Cooper, MD

23. Palliative Care

Melanie L. Brown, MD, MSE
Matt Norvell, MDiv, BCC

Jelina Marie V. Castillo, MD, MPH

25. Pulmonology and Sleep Medicine

Saskia Groenewald, MD

Laura M. Sterni, MD

Urveel Mukesh Shah, MD

Emily A. Dunn, MD

Emma Vaimberg, MD

Ekemini Akan Ogbu, MD, MSc

28. Blood Chemistry and Body Fluids

Camille C. Anderson, MD

Nadia Ayala-Lopez, PhD
Lori Sokoll, PhD

29. Biostatistics and Evidence-Based Medicine

Michael R. Rose, MD, MPH

Leonard S. Feldman, MD

30. Drug Dosages

Carlton K.K. Lee, PharmD,
MPH

31. Drugs in Kidney Failure

Elizabeth A.S. Goswami,
PharmD
Katherine Hapgood, PharmD

Carlton K.K. Lee, PharmD, MPH

The Formulary is complete, concise, and up-to-date thanks to the tireless efforts of Carlton K.K. Lee, PharmD, MPH. With each edition, he carefully updates, revises, and improves the section. His herculean efforts make the Formulary one of the most useful and cited pediatric drug reference texts available.

We are grateful and humbled to have the opportunity to build on the great work of the preceding editors: Drs. Henry Seidel, Harrison Spencer, William Friedman, Robert Haslam, Jerry Winkelstein, Herbert Swick, Dennis Headings, Kenneth Schuberth, Basil Zitelli, Jeffery Biller, Andrew Yeager, Cynthia Cole, Peter Rowe, Mary Greene, Kevin Johnson, Michael Barone, George Siberry, Robert Iannone, Veronica Gunn, Christian Nechyba, Jason Robertson, Nicole Shilkofski, Jason Custer, Rachel Rau, Megan Tschudy, Kristin Arcara, Jamie Flerlage, Branden Engorn, Helen Hughes, Lauren Kahl, Keith Kleinman, Lauren McDaniel, and Matthew Molloy. Many of these previous editors continue to make important contributions to the education of the Harriet Lane house staff, none more than Dr. Nicole Shilkofski, our residency program director. Her dedication to the residents and to educating future pediatricians impresses us constantly. As recent editors, Drs. Keith Kleinman, Lauren McDaniel, and Matthew Molloy also have been instrumental in helping us to navigate this process. We are honored to follow in their footsteps.

An undertaking of this magnitude could not have been accomplished without the support and dedication of some extraordinary people. First, we would like to thank Dr. Nicole Shilkofski, our residency program director, and our associate residency program directors: Drs. Jeffrey Fadrowski, Marquita Genies, Cozumel Pruette, and Nakiya Showell. Thank you for entrusting us with the opportunity to serve as chief residents and The Harriet Lane Handbook editors. We would also like to offer special thanks to our program coordinators: Kathy Mainhart and Yinka Omosule, invaluable assets to our program. We are so appreciative of your support and without you, we would be lost. And finally, thank you to our Department Director, Dr. Margaret Moon, for your tireless leadership of the Children’s Center.

Residents
Saher Ali
Halei Benefield
Anna Bitners
Kyla Cordrey
Edward Corty
Rachel Darko
Ian Drummond
Rebecca Dryer
Tolulope Fatola
Devki Gami
Megan Gates
Ross Gilbert
Jillian Heckman
Laura Henderson
Kaysha Henry
Molly Himmelrich
Zainab Khan
Andrew Kleist
Matthew Kosasih
Jacqueline Kruglyakova
Fred Lam
Vianca Masucci
Maria Molinaro
Teresa Oszkinis
Roshni Patel
Kristen Penberthy
Mallika Rajamani
Maneesha Sakhuja
Nisha Shah
Andrea Silvas
Nathaniel Silvestri
William Squiers
Alexander Testino
Nadav Weinstock
Katelyn Williams

Interns
Ricci Allen
Danielle Amundsen
Sarah Benett
Alec Berman
David Berman
Rikiara Brown
Carolei Bryan
Amber Bulna
Cecilia Di Caprio
Chizorbam Diribe
Sarah Ehrenberg
Rafi Faria
Whitney Fidelis
Jeanette Freeman
Elena Georges
Rachel Gilbert
Dana Goplerud
Adrienne Johnson
Juliet Joseph
Adam Ketchum
Andrew Koltun
Chiara Pandolfi de Rinaldis
Zaw Phyo
Megan Rescigno
Claire Rhee
Harper Robinson
Sarika Sachdeva
Raquel Sofia Sandoval
Vincent Shieh
Rohan Soman
Anthony Spellman
Melissa Trofa
Sarah Vogel
Priscilla Yong

Camille C. Anderson
Sunaina Kapoor
Tiffany E. Mark

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Citation

Hughes, Helen K., and Lauren K. Kahl, editors. "The Harriet Lane Handbook: a Manual for Pediatric House Officers." Harriet Lane Handbook, 21st ed., Elsevier, 2018. Harriet Lane, www.unboundmedicine.com/harrietlane/view/Harriet_Lane_Handbook/309000/all/.

The Harriet Lane Handbook: A Manual for Pediatric House Officers. In: Hughes HKH, Kahl LKL, eds. Harriet Lane Handbook. Elsevier; 2018. https://www.unboundmedicine.com/harrietlane/view/Harriet_Lane_Handbook/309000/all/. Accessed September 6, 2024.

The Harriet Lane Handbook: A Manual for Pediatric House Officers. (2018). In Hughes, H. K., & Kahl, L. K. (Eds.), Harriet Lane Handbook (21st ed.). Elsevier. https://www.unboundmedicine.com/harrietlane/view/Harriet_Lane_Handbook/309000/all/

The Harriet Lane Handbook: a Manual for Pediatric House Officers [Internet]. In: Hughes HKH, Kahl LKL, editors. Harriet Lane Handbook. Elsevier; 2018. [cited 2024 September 06]. Available from: https://www.unboundmedicine.com/harrietlane/view/Harriet_Lane_Handbook/309000/all/.

* Article titles in AMA citation format should be in sentence-case Copy Download

TY - ELEC T1 - The Harriet Lane Handbook: A Manual for Pediatric House Officers ID - 309000 ED - Hughes,Helen K, ED - Kahl,Lauren K, BT - Harriet Lane Handbook UR - https://www.unboundmedicine.com/harrietlane/view/Harriet_Lane_Handbook/309000/all/ PB - Elsevier ET - 21 DB - Harriet Lane DP - Unbound Medicine ER -

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