Pediatrics: Development, Dehydration, and the Febrile Infant
Priority concepts
Core areas are growth and developmental surveillance, nutrition, immunisation, common respiratory and gastrointestinal illness, and the recognition of the sick child. Learn developmental milestones in domains (gross motor, fine motor, language, social) and remember the red flags: loss of skills, persistent asymmetry, no social smile by around 8 weeks, no babbling by 6 months, and failure of expected weight gain.
Dehydration assessment uses a combination: reduced feeding, reduced urine output, altered consciousness, sunken eyes, delayed capillary refill, and skin turgor. In mild to moderate dehydration, oral rehydration solution is first line; intravenous fluid is reserved for shock, altered consciousness, or failed oral therapy.
Traps
Age thresholds drive management and are frequent distractors. A febrile infant under about 3 months has an immature immune response and warrants a low threshold for full sepsis evaluation and admission. Jaundice appearing in the first 24 hours is always pathological, whereas physiological jaundice peaks around days 3 to 5. Bronchiolitis is usually supportive care - antibiotics and routine bronchodilators do not help.
Worked example
A 2-month-old, previously well, temperature 38.3 °C, feeding poorly. The correct answer is not 'observe at home'. This is a young febrile infant: obtain blood, urine, and cerebrospinal fluid cultures, start empirical intravenous antibiotics, and admit. The threshold for lumbar puncture falls as age falls.
Rule of thumb
Weight-based dosing is non-negotiable - recalculate in kilograms every time, and check the maximum adult dose before prescribing. When a child looks unwell but has no localising signs, trust the gestalt of the experienced observer and escalate.