Pediatrics and Child Health
Core concepts
Paediatrics rewards knowledge of normal variation: growth charts, developmental milestones, age-specific vital signs and weight-based dosing. High-yield topics include neonatal resuscitation and jaundice, breastfeeding and complementary feeding, integrated management of childhood illness, dehydration and oral rehydration, pneumonia, malaria, diarrhoea, severe acute malnutrition, immunisation schedules and common congenital problems.
Traps
Applying adult doses or adult fluid boluses; forgetting that a blood pressure normal in an adult may represent shock in a child; missing malnutrition because weight-for-age looks acceptable, when mid-upper-arm circumference and oedema are the correct screening tools; and giving iron to a child with severe acute malnutrition before stabilisation. Another trap is attributing fever only to respiratory infection when malaria, urinary tract infection or meningitis may be present. Always use the age-specific normal ranges for pulse and respiratory rate.
Worked example
A 10 kg child with some dehydration: WHO Plan B gives 75 mL/kg of oral rehydration solution over 4 hours, which is 750 mL, given by cup and spoon with hourly reassessment. If the child instead develops shock, give a 20 mL/kg isotonic crystalloid bolus and reassess before repeating.
Rule of thumb
Children are not small adults: recalculate every dose and fluid volume by weight, and reassess after every bolus. A child who is lethargic, has a weak pulse or cold extremities needs immediate resuscitation regardless of a single blood pressure reading.