Pediatrics
Core concepts
Paediatrics questions emphasise assessment of the whole child: airway, breathing, circulation, conscious level, hydration and growth. Know the febrile infant pathway, bronchiolitis and asthma, croup, gastroenteritis and dehydration, otitis media, vaccination, developmental milestones and weight-based prescribing. Safeguarding and parental counselling are part of every answer.
Traps
- A febrile infant under 3 months needs urgent full sepsis assessment and empirical antibiotics; do not rely on appearance alone.
- Bronchiolitis: oxygen and supportive fluids; routine bronchodilators, steroids and antibiotics are not indicated.
- Fluid boluses are 20 mL/kg isotonic crystalloid; maintenance follows the 4-2-1 rule (4 mL/kg/h for the first 10 kg, 2 for the next 10, 1 thereafter).
- Aspirin is avoided in children because of Reye syndrome; codeine is contraindicated in young children.
- Dehydration is judged on weight loss, mucous membranes, skin turgor, capillary refill, tears and urine output, not one sign.
- Overlooking non-accidental injury when the history and injury pattern do not fit.
Worked example
An 8-month-old has 2 days of coryza, cough and wheeze, respiratory rate 55, SpO2 91%, and is feeding poorly. This is bronchiolitis. Admit for oxygen and nasogastric or intravenous fluids, suction secretions, and review frequently. Do not give routine salbutamol, steroids or antibiotics; explain to the parents that the illness usually peaks at days 3-5 and resolves over 2-3 weeks.
Rule of thumb
In children, weight drives everything: dose, fluid bolus and maintenance. Calculate from actual weight and recheck the prescription.