Pediatrics: Growth, Development, and Acute Illness
Pediatric questions hinge on age-specific norms and the fact that children compensate well until they decompensate suddenly. Know growth milestones, developmental stages, immunization schedules, and the classic presentations of pediatric respiratory, gastrointestinal, and infectious disease.
Concepts to master
- Growth charts: weight, length, head circumference, and crossing percentiles as a red flag.
- Development: motor, language, and social milestones; red flags for autism and cerebral palsy.
- Respiratory distress: retractions, grunting, nasal flaring; croup vs. epiglottitis vs. bronchiolitis vs. asthma.
- Dehydration: clinical scoring, oral vs. intravenous rehydration, and the danger of rapid correction.
- Fever in the infant: age-based workup (especially under 3 months) and when to treat empirically.
Traps
Questions often present a child who looks well but has a serious sign (e.g., stridor at rest, toxic appearance, petechiae). Another trap is applying adult dosing or adult vital-sign thresholds. Be alert to age cutoffs in fever workup and to the fact that a "quiet" infant may be more ill than a crying one. Do not forget vaccination status and the possibility of a vaccine-preventable disease.
Worked rule of thumb
For fever in an infant: under 28 days, full sepsis workup and admission; 29–90 days, risk-stratify with labs and consider admission; older children, focus on source and toxicity. For dehydration: mild to moderate can often be managed with oral rehydration solution; severe dehydration with shock requires isotonic fluid boluses and reassessment.