Child and Adolescent Medicine
Milestones and screening
Know the findings that make a milestone abnormal: no social smile by 2 months, no babbling by 6 months, no sitting without support by 9 months, no single words by 16 months, no two-word phrases by 24 months, and loss of skills at any age. Regression always warrants evaluation. Autism screening (M-CHAT) occurs at 18 and 24 months, lead screening at 12 and 24 months for at-risk children, and universal newborn hearing screening requires documented follow-up.
Acute illness traps
- Febrile infants ≤28 days need a full sepsis evaluation and hospitalization regardless of appearance.
- Bronchiolitis is supportive care; no routine albuterol, steroids, or antibiotics.
- Acute otitis media in children ≥2 years with mild symptoms may be observed 48–72 hours; amoxicillin is first-line when treating, with high-dose amoxicillin-clavulanate after recent amoxicillin exposure or severe disease.
- Group A strep pharyngitis: treat only with confirmed or strongly suspected strep; cough, coryza, and hoarseness argue against it.
- Never prescribe codeine or promethazine to young children; cough and cold products are not recommended under age 6.
Adolescent care
Screen for depression, anxiety, and substance use, and provide confidential time alone with the clinician. HPV vaccination can begin at age 9 and is recommended at 11–12.
Rule of thumb
In pediatrics, age and appearance drive urgency more than the measured temperature. A well-appearing 3-year-old at 39°C is usually viral; a 21-day-old at 38.0°C is an emergency.
Worked example: a 5-year-old with 2 days of rhinorrhea and a low-grade fever, now with ear pain and a bulging tympanic membrane - treat with amoxicillin; the antecedent cold does not change the diagnosis.