Community Pediatrics, Preventive Care and Ethics/Professionalism
Core concepts
Understand well-child care: growth monitoring, developmental surveillance, immunization schedules, and screening (vision, hearing, anemia, lead, tuberculosis). Know nutrition guidance (breastfeeding, complementary feeding, iron and vitamin D supplementation, obesity prevention). Understand injury prevention (car seats, drowning, falls, safe sleep) and screening for social determinants (poverty, food insecurity, violence). Know the principles of medical ethics: autonomy, beneficence, nonmaleficence, justice; informed consent and assent in minors; confidentiality and its limits; mandatory reporting of child abuse; and end-of-life decision-making. Understand vaccine hesitancy communication and antibiotic stewardship. Recognize child abuse red flags (inconsistent history, patterned injuries, delayed presentation) and the clinician's legal duty.
Traps
- Missing a mandatory reporting obligation because of confidentiality concerns - child protection overrides.
- Obtaining consent from a minor without parental involvement except in specific circumstances (emancipation, emergencies).
- Overlooking social determinants that affect adherence and health outcomes.
- Forgetting that informed assent is important even when parental consent is required.
- Missing abuse because injuries are attributed to accidents without a careful history.
Worked example / rule of thumb
A 6-month-old with a spiral femur fracture and a history that does not fit the injury: recognize the red flag for nonaccidental trauma, obtain a skeletal survey, and report per local law. Rule of thumb: when the history does not match the injury, consider abuse and follow mandatory reporting; confidentiality yields to child protection.