The practice of pediatric medicine, both community- and hospital-based pediatricians will tell you, is constantly evolving. Whether prompted by groundbreaking research findings, dramatic increases in conditions such as adolescent concussions or substance use disorders — or even a pandemic life-threatening infection — pediatricians frequently adapt to new evidence-based protocols to treat patients appropriately. These new practice approaches are published periodically in medical journals and bulky textbooks, but they can also be found in The Johns Hopkins Hospital’s Harriet Lane Handbook, a pocket-size reference book easily accessible by the pediatrician in practice or training.

“There are plenty of resources that exist, but the things you’d have to search for in primary medical literature, along with the clinical pearls gleaned from pediatric practice, we have all in one place,” says chief resident Keith Kleinman, who with fellow chief residents Matthew Molloy and Lauren McDaniel, are the editors of this 22nd edition of the handbook.

Published every three years since 1953, The Harriet Lane Handbook is written by residents, in consultation with faculty advisers, over the span of their three-year residency. The chief residents organize and edit the chapters, trimming and expanding content to highlight the most relevant changes in pediatric medicine. The nephrology chapter, for example, includes recent updates to pediatric hypertension guidelines.

“We did do a lot of cutting down and restructuring of chapters to highlight information we felt was difficult to obtain through other references and sources,” says McDaniel. “We also tried to collate it in a user-friendly manner to make it more useful for the practicing pediatrician.”

Kleinman says the chiefs’ approach was to first challenge and validate any new information, and then reduce redundancies and eliminate unnecessary content. At the end of the day, they reduced the size of the book by some 100 pages.

“The size of the handbook has been growing; often more information is better, but we have to remember that the book is designed for what the pediatrician needs in the moment,” says Kleinman.

In previous editions, one or two chief residents took on the editor role. However, this 2020 handbook marks the first edition co-edited by three chief residents, which in their minds gave them greater bandwidth to refine the book’s 31 chapters.

“We thought of it as an opportunity for each of us to individually spend more time to think about the chapters and make some changes,” says Molloy.

Among those changes is reorganized information on emergency medicine, critical care management and trauma care, and the consolidation of a previous chapter called “Development, Behavior, and Mental Health” into “Development, Behavior, and Developmental Disability” along with an entirely new chapter titled “Child Psychiatry.”

“That really increases the amount of material we have in the book on mental health and child psychiatry, which is of growing importance to the general pediatrician,” says Molloy.

Also new is a section on COVID-19, thanks to input from pediatric infectious disease specialists Sanjay Jain and Oren Gordon and eleventh-hour inserts by McDaniel.

“Don’t quote me on this, but The Harriet Lane Handbook may be the first medical textbook to reference [this pandemic disease],” McDaniel says.

COVID-19 and social distancing rules disrupted party plans to celebrate yet another publication of The Harriet Lane Handbook, but for the chief residents the joy was in the journey.

“It was really such an honor to be asked to be a chief resident during one of the handbook years, knowing I would have the opportunity to edit and shape the 22nd edition,” says Molloy, who says he has relied on it daily through medical school and residency. “For me, the handbook has always been the bible of pediatrics.”

Kleinman and McDaniel agree.