Paediatrics: Age-Specific Physiology and Escalation
What you must understand
Paediatric items reward age awareness. Key areas: (1) the unwell child - recognition of sepsis, meningitis, bronchiolitis, croup, epiglottitis, pneumonia, dehydration; (2) neonatal problems - jaundice timing, feeding, sepsis, congenital heart disease presenting with cyanosis or shock; (3) growth and development - milestones, growth charts, failure to thrive; (4) common chronic conditions - asthma, eczema, type 1 diabetes, epilepsy; (5) safeguarding - non-accidental injury patterns, delayed presentation, inconsistent history; (6) immunisation schedule and developmental screening.
Traps that appear
- Normal ranges differ by age: heart rate, respiratory rate and blood pressure are age-dependent.
- A child can compensate then crash - normal blood pressure does not exclude shock.
- Jaundice within 24 hours of birth is always pathological.
- Confusing croup (barking cough, stridor, gradual onset) with epiglottitis (drooling, tripod, rapid onset) - never examine the throat if epiglottitis is suspected.
- Dismissing parental concern; a well-looking child can still be seriously unwell.
Rule of thumb
Treat the whole child: feeding, interaction, tone, perfusion, breathing work and hydration. If red flags are present, escalate regardless of a single normal observation.
Worked example
A 3-month-old has fever, poor feeding, irritability and a bulging fontanelle. Which is the most appropriate next step? The answer is urgent assessment for meningitis with immediate senior/emergency involvement and empirical intravenous antibiotics after appropriate cultures - not a wait-and-see approach or oral antibiotics at home.