AOBP Pediatrics cheat sheet

Normal pediatric vital signs by age: newborn HR 100–160, RR 30–60; infant HR 100–160, RR 20–40; toddler HR 90–150, RR 20–30; school-age HR 70–120, RR 15–20; adolescent HR 60–100, RR 12–20.

Pediatric weight estimation: 1–6 years: weight (kg) = 2 × (age in years) + 8; 7–12 years: weight (kg) = 3 × (age in years) + 7.

Developmental milestones: social smile 6 weeks; head control 3–4 months; sits unsupported 6–8 months; walks alone 12–15 months; two-word phrases 18–24 months; three-word sentences 2–3 years.

Kawasaki disease diagnostic criteria: fever ≥5 days plus 4 of 5 (bilateral conjunctival injection, oral mucosal changes, cervical lymphadenopathy >1.5 cm, polymorphous rash, extremity changes); treat with IVIG 2 g/kg and aspirin.

Acute otitis media antibiotic choice: high-dose amoxicillin 80–90 mg/kg/day divided BID for 10 days (5–7 days if ≥2 years and mild); add clavulanate if recent amoxicillin or treatment failure.

Pediatric dehydration assessment: mild <5% weight loss, moderate 5–10%, severe >10%; use oral rehydration solution 50 mL/kg over 4 hours for mild, 100 mL/kg over 4 hours for moderate.

Febrile seizure criteria: age 6 months–5 years, generalized, <15 minutes, no prior neurologic abnormality; no routine EEG or neuroimaging indicated for simple febrile seizure.

Growth chart interpretation: failure to thrive = weight <5th percentile or crossing ≥2 major percentile lines downward; short stature = height <3rd percentile or <2 SD below mean for age.

Apgar score components (0–2 each): appearance (color), pulse (HR), grimace (reflex), activity (muscle tone), respiration; scores at 1 and 5 minutes; score ≥7 normal, 4–6 moderately depressed, ≤3 severely depressed.

Newborn resuscitation: initial steps (warm, dry, stimulate, position airway) within 30 seconds; if HR <100 or apnea, provide positive pressure ventilation at 40–60 breaths/min; chest compressions if HR <60 after 30 seconds of effective PPV.

Neonatal jaundice: phototherapy threshold for healthy term infants ≥38 weeks: ~12 mg/dL at 24 h, ~15 mg/dL at 48 h, ~18 mg/dL at 72 h; exchange transfusion threshold ~5 mg/dL above phototherapy threshold.

Sepsis risk in neonate: group B Streptococcus most common cause of early-onset sepsis; empiric ampicillin + gentamicin; lumbar puncture before antibiotics if stable.

Respiratory distress syndrome: surfactant deficiency, occurs in preterm <34 weeks; chest X-ray shows ground-glass opacities and air bronchograms; treat with exogenous surfactant and CPAP.

Neonatal hypoglycemia: blood glucose <40 mg/dL in first 4 hours or <45 mg/dL after 4 hours; treat with feeding or IV dextrose 10% 2 mL/kg bolus if symptomatic or <25 mg/dL.

Necrotizing enterocolitis: preterm infant with feeding intolerance, abdominal distension, bloody stools; X-ray shows pneumatosis intestinalis; treat with bowel rest, antibiotics, and surgery if perforation.

Physiologic nadir of hemoglobin: term infant ~11 g/dL at 8–12 weeks; preterm ~8 g/dL at 4–8 weeks; anemia of prematurity may require transfusion if symptomatic or Hgb <7 g/dL.

Anaphylaxis diagnostic criteria: acute onset skin/mucosal involvement plus respiratory compromise or hypotension; or hypotension after exposure to known allergen; treat with IM epinephrine 0.01 mg/kg (max 0.5 mg) in lateral thigh.

Asthma severity classification (≥12 years): mild intermittent symptoms ≤2 days/week; mild persistent >2 days/week but not daily; moderate persistent daily; severe persistent throughout day; stepwise treatment with ICS-formoterol or ICS alone.

Allergic rhinitis: first-line intranasal corticosteroid; add oral second-generation antihistamine for ocular symptoms; avoid first-generation antihistamines due to sedation and anticholinergic effects.

Immunodeficiency red flags: ≥2 pneumonias/year, ≥4 ear infections/year, recurrent deep skin abscesses, failure to thrive, family history of primary immunodeficiency, need for IV antibiotics to clear infections.

Food allergy: IgE-mediated symptoms within minutes to 2 hours; skin prick test or specific IgE; oral food challenge is gold standard; epinephrine autoinjector 0.15 mg for 15–30 kg, 0.3 mg for ≥30 kg.

Eosinophilic esophagitis: symptoms of dysphagia, food impaction, vomiting; diagnosis requires esophageal biopsy with ≥15 eosinophils/high-power field; treat with proton pump inhibitor, swallowed topical steroids, or elimination diet.

Primary immunodeficiency: severe combined immunodeficiency presents in first year with failure to thrive, chronic diarrhea, opportunistic infections; definitive treatment is hematopoietic stem cell transplant.

Drug allergy: penicillin allergy history should be verified by skin testing; <5% of patients with reported penicillin allergy are truly allergic; direct oral challenge may be used in low-risk patients.

Preparticipation physical evaluation: screen for cardiac symptoms (syncope, chest pain, exertional dyspnea), prior concussion, heat illness, and use of performance-enhancing substances; include cardiovascular and musculoskeletal exam.

Concussion management: physical and cognitive rest until asymptomatic, then graduated return-to-play protocol (5 stages: light aerobic, sport-specific, non-contact drills, full-contact practice, game play) with 24 hours between stages.

Ankle sprain: Ottawa Ankle Rules-X-ray if pain in malleolar zone plus inability to bear weight 4 steps or bone tenderness at posterior edge of lateral malleolus, medial malleolus, navicular, or base of 5th metatarsal.

Osgood-Schlatter disease: traction apophysitis of tibial tubercle in adolescents; treat with activity modification, quadriceps stretching, and NSAIDs; self-limited.

Exercise-associated hyponatremia: occurs with excessive fluid intake during endurance events; symptoms include nausea, headache, confusion, seizures; treat with fluid restriction and hypertonic saline if severe.

Female athlete triad: low energy availability, menstrual dysfunction, low bone mineral density; screen with questions about menstrual history, stress fractures, and disordered eating.

ACL injury: positive Lachman test (most sensitive), anterior drawer, and pivot shift; MRI for diagnosis; pediatric patients may require physeal-sparing reconstruction.

Heat illness prevention: acclimatize over 10–14 days, hydrate before/during/after exercise, recognize early signs (cramps, dizziness, nausea); exertional heat stroke is core temp >40°C with CNS dysfunction-cool immediately.

Osteopathic structural exam: TART mnemonic-Tissue texture change, Asymmetry, Restriction of motion, Tenderness; document findings for each body region.

Somatic dysfunction diagnosis: impaired or altered function of related components of the somatic system (skeletal, arthrodial, myofascial); diagnosed by TART findings.

Counterstrain (Jones): position the patient to shorten the involved muscle for 90 seconds to reduce tender point; use for acute somatic dysfunction.

Muscle energy technique: patient actively contracts muscle against physician counterforce from a barrier; used to improve motion and reduce restriction.

High-velocity low-amplitude (HVLA) technique: thrust applied at restrictive barrier; contraindicated in fracture, dislocation, severe osteoporosis, malignancy, or infection at site.

Myofascial release: apply sustained pressure or traction to fascial restrictions until release; useful for chronic pain and restricted motion.

Lymphatic pump: rhythmic compression of thoracic and abdominal areas to enhance lymphatic flow; indicated for edema, infection, and postoperative recovery.

Cranial osteopathy: evaluate cranial rhythmic impulse (CRI) at 10–14 cycles/min; use gentle manipulation for somatic dysfunction of cranial bones; evidence limited but used for headaches and colic.