Preventing HIV infection in adults decreases the incidence of infection in children. Adult prevention results from behavior changes such as safe-sex practices, decrease in intravenous drug use, and needle exchange programs. Prevention of pediatric AIDS includes avoidance of pregnancy and breastfeeding (in developed countries) in high-risk women. Screening of blood donors has almost eliminated the risk of HIV transmission from blood products. HIV infection almost never is transmitted in a casual or nonsexual household setting.
Feigin RD, Cherry J, Demmler GJ, et al: Textbook of Pediatric Infectious
Diseases, ed 6, Philadelphia, 2009, Saunders
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Kliegman RM, Stanton BF, Behrman RE, et al: Nelson Textbook of Pediatrics, ed 19, Philadelphia, 2007, Saunders
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The Digestive System
Warren P. Bishop and Dawn R. Ebach 17
After identifying the major gastrointestinal (GI) symptom, onset and progression should be determined (improved, unchanged, worsening). Characterization of signs and symptoms should identify factors such as triggers; actions that alleviate the symptom; timing, frequency and duration of symptoms; relationship to meals and defecation; and associated symptoms (e.g., fever or weight loss). Other key history includes exposures to others (family, school contacts), travel, environmental exposure, and impact of illness on the child (school absences).
The history may suggest a diagnosis and direct the evaluation, which should include a full examination as well as a thorough abdominal examination. Extraintestinal disorders may produce GI manifestations (e.g., emesis with group A streptococcal pharyngitis, abdominal pain with lower lobe pneumonia). The examination should begin with a careful external inspection for abdominal distention, bruising or discoloration, abnormal veins, jaundice, surgical scars, and ostomies. Abnormalities of intensity and pitch of bowel sounds can occur with bowel obstruction. When palpating for tenderness, the examiner should note location, facial expression, guarding, and rebound tenderness. Palpation can also detect enlargement of the liver or spleen as well as feces and masses. If detected, organomegaly should be measured (with a tape measure), noting abnormal firmness or contour. A rectal examination, including inspection for fissures, skin tags, abscesses, and fistulous openings, should be performed for children with history suggesting constipation, GI bleeding, abdominal pain, chronic diarrhea, and suspicion of inflammatory bowel disease (IBD). Digital rectal examination should include assessment of anal sphincter tone, anal canal size and elasticity, tenderness, extrinsic masses, presence of fecal impaction, and caliber of the rectum. Stool should be tested for occult blood.