RACP DWE Paediatrics cheat sheet

Neonatal jaundice: unconjugated hyperbilirubinaemia is treated by phototherapy; exchange transfusion is reserved for levels near kernicterus thresholds or rapid rise despite phototherapy. Conjugated jaundice beyond 2 weeks always requires investigation.

Paediatric weight estimation: 0-12 months ~ (age in months + 9)/2 kg; 1-5 years ~ 2 x (age in years + 5) kg. Normal term birth weight 2.5-4.0 kg; regain birth weight by 10-14 days.

Fluid maintenance (Holliday-Segar): 100 mL/kg/day for first 10 kg, 50 mL/kg/day for next 10 kg, 20 mL/kg/day thereafter. Resuscitation bolus is 10-20 mL/kg crystalloid, reassessed after each bolus.

Developmental milestones: social smile 6 weeks; head control 3 months; sits unsupported 6-8 months; pincer grip 9-12 months; walks 12-18 months; two-word phrases 18-24 months; three-word sentences by 3 years.

Growth: birth length ~50 cm, birth head circumference ~35 cm. Head circumference increases ~2 cm/month in first 3 months, then slows; crossing centiles downward warrants investigation.

Apgar score assesses heart rate, respiratory effort, muscle tone, reflex irritability and colour at 1 and 5 minutes; it predicts neonatal outcome but does not guide individual resuscitation decisions.

Fever in infants under 3 months is a red flag: full septic screen (blood, urine, CSF) and empirical intravenous antibiotics are standard, since clinical signs of serious bacterial infection are unreliable at this age.

Immunisation schedule principle: live attenuated vaccines (MMR, varicella, rotavirus, BCG) are contraindicated in significant immunosuppression and pregnancy; inactivated and subunit vaccines are safe.

Paediatric assessment triangle: appearance, work of breathing, circulation to skin - used to triage severity before any vital signs are taken.

Normal paediatric respiratory rates: newborn 30-60, infant 30-50, 1-5 years 20-40, 6-12 years 18-30, adolescent 12-20 breaths/min. Tachypnoea is the most sensitive sign of pneumonia.

Signs of respiratory distress: tracheal tug, subcostal and intercostal recession, nasal flaring, grunting, head bobbing. Grunting indicates impending failure and warrants urgent senior review.

Dehydration assessment: reduced skin turgor, delayed capillary refill over 2 seconds, sunken eyes, absent tears, altered conscious state. Weight loss of 5% (infant) or 10% (child) indicates significant dehydration.

Safeguarding red flags: injury in a non-mobile infant, injury inconsistent with the developmental stage, delayed presentation, changing or inconsistent history, and repeated injuries. Document verbatim and escalate.

Fracture patterns suggesting non-accidental injury: posterior rib fractures, metaphyseal corner fractures, multiple fractures of differing ages, and femoral fractures in infants not yet walking.

Status epilepticus: convulsion lasting over 5 minutes, or repeated seizures without regaining consciousness. First-line is a benzodiazepine (midazolam buccal or IV, or diazepam PR), repeated once, then second-line agent.

Anaphylaxis: intramuscular adrenaline into the anterolateral thigh at 0.01 mg/kg (max 0.5 mg), repeated every 5 minutes as needed, with airway, oxygen, IV fluids and positioning as adjuncts.