RACP DWE Paediatrics flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Apgar score components

Five components scored 0-2 each at 1 and 5 minutes: heart rate, respiratory effort, muscle tone, reflex irritability and colour. Total out of 10; it summarises newborn condition but does not direct individual resuscitation steps.

Physiological neonatal jaundice

Unconjugated hyperbilirubinaemia appearing after 24 hours, peaking around day 3-5 in term infants, due to immature hepatic conjugation and higher red cell turnover. Treated with phototherapy when levels exceed age-in-hours thresholds.

Kernicterus

Bilirubin-induced neurological damage from unconjugated hyperbilirubinaemia crossing the blood-brain barrier, causing acute lethargy, poor feeding, hypertonia and later choreoathetoid cerebral palsy and sensorineural deafness. Prevention is by timely phototherapy or exchange transfusion.

Holliday-Segar maintenance fluids

Daily fluid requirement calculated as 100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg and 20 mL/kg for each kilogram above 20 kg. Applies to children requiring intravenous maintenance fluids.

Paediatric resuscitation fluid bolus

Isotonic crystalloid (0.9% sodium chloride) given at 10-20 mL/kg as a rapid bolus for shock, with reassessment of heart rate, perfusion and liver size after each bolus to detect fluid overload.

Normal term birth weight

Approximately 2.5 to 4.0 kilograms for a singleton at term. Birth weight below 2.5 kg is low birth weight; above 4.0 kg is macrosomia and raises concern for maternal diabetes.

Social smile milestone

A responsive smile to a human face typically appears around 6 weeks of age. Its absence by 8-10 weeks warrants developmental review, as it is an early marker of social and neurological development.

Pincer grip milestone

Fine pincer grasp using thumb and index finger develops between 9 and 12 months. It precedes deliberate release of objects and is a key marker of fine motor and neurological maturation.

Independent walking milestone

Most children walk unsupported between 12 and 18 months. Persistent inability to walk by 18 months warrants developmental and neurological assessment, including hip and muscle examination.

Two-word phrase milestone

Combining two words meaningfully typically emerges between 18 and 24 months. Absence of two-word phrases by 24 months is a language red flag requiring audiology and developmental assessment.

Head circumference growth rate

Head circumference averages about 35 cm at birth and increases roughly 2 cm per month in the first three months, then slows. Serial plotting detects hydrocephalus or microcephaly earlier than single measurements.

Fever in infant under 3 months

Temperature of 38 degrees Celsius or higher in an infant under 3 months requires a full septic screen including blood, urine and cerebrospinal fluid cultures, plus empirical intravenous antibiotics, because clinical signs of serious bacterial infection are unreliable.

Live vaccine contraindications

Live attenuated vaccines such as MMR, varicella, rotavirus and BCG are contraindicated in significant immunosuppression and during pregnancy. Inactivated, toxoid and subunit vaccines are safe in these groups.

Paediatric assessment triangle

A rapid first-impression tool using appearance, work of breathing and circulation to skin. It categorises illness severity within seconds of seeing a child, before vital signs or history are obtained.

Normal infant respiratory rate

A newborn breathes 30-60 times per minute, falling to 30-50 in infancy, 20-40 at 1-5 years, 18-30 at 6-12 years and 12-20 in adolescence. Values should be counted over a full minute.

Grunting in respiratory distress

Expiratory grunting is produced by partial glottic closure to maintain functional residual capacity. It signals severe respiratory compromise and impending failure, requiring immediate senior review and respiratory support.

Capillary refill interpretation

Central capillary refill normally under 2 seconds. Prolonged refill with mottling, cool peripheries and reduced conscious state indicates poor perfusion and possible shock, prompting fluid resuscitation and escalation.

Infant dehydration threshold

Acute weight loss of about 5% in an infant or 10% in an older child suggests significant dehydration. Combined with reduced turgor, sunken eyes and absent tears, it guides the choice of oral or intravenous rehydration.

Safeguarding injury red flags

Injury in a non-mobile infant, injury inconsistent with developmental stage, delayed presentation, changing explanations and repeated injuries all raise concern for abuse. Record the history verbatim and escalate to child protection.

Metaphyseal corner fracture

A small avulsion fracture at the metaphyseal corner, seen in infants subjected to forceful twisting or pulling. It is highly specific for non-accidental injury and requires skeletal survey and safeguarding referral.

Posterior rib fracture significance

Posterior rib fractures in infants result from forceful anteroposterior compression of the chest, typically from squeezing. They are highly suspicious for non-accidental injury and rarely caused by accidental trauma.

Status epilepticus definition

A convulsion lasting more than 5 minutes, or recurrent seizures without regaining consciousness between them. Treated with a benzodiazepine first, repeated once, followed by second-line anticonvulsant therapy.

Paediatric anaphylaxis adrenaline dose

Intramuscular adrenaline 0.01 mg/kg (maximum 0.5 mg) into the anterolateral thigh, repeated every 5 minutes if needed. Given early alongside airway support, oxygen, intravenous fluids and supine positioning.

Weight estimation formula

For children aged 1-5 years, weight in kilograms approximates 2 x (age in years + 5). For infants 0-12 months, weight approximates (age in months + 9) divided by 2. Used when weight is unknown in emergencies.

Normal developmental progression

Head control at 3 months, sitting unsupported at 6-8 months, pincer grip at 9-12 months and walking at 12-18 months. Delay in one domain prompts assessment of hearing, vision, neurology and the social environment.

Fontanelle closure timing

The anterior fontanelle normally closes between 9 and 18 months. A bulging fontanelle suggests raised intracranial pressure; a widely open or sunken fontanelle may indicate skeletal or nutritional problems or dehydration.

Jaundice requiring investigation

Jaundice present within 24 hours of birth, lasting beyond 14 days, or with conjugated hyperbilirubinaemia always requires investigation. Conjugated jaundice in infancy is never physiological and needs urgent hepatobiliary assessment.

Tachypnoea in pneumonia

Raised respiratory rate is the most sensitive clinical sign of childhood pneumonia, more reliable than auscultatory crackles. It should be counted over one minute with the child calm, using age-specific thresholds.

Recession in respiratory distress

Subcostal, intercostal and suprasternal indrawing reflects increased negative intrathoracic pressure from airway obstruction or stiff lungs. Combined with tracheal tug and nasal flaring, it grades severity of respiratory distress.

Meningococcal rash

A non-blanching petechial or purpuric rash in a febrile child suggests meningococcal septicaemia. It may be absent early, so any febrile child with a non-blanching rash needs urgent parenteral antibiotics and assessment.

Kawasaki disease criteria

Fever for 5 or more days plus 4 of: conjunctivitis, oral mucosal changes, cervical lymphadenopathy, rash, and extremity changes. Treated with intravenous immunoglobulin and aspirin to prevent coronary artery aneurysms.

Acute otitis media management

Bulging tympanic membrane with acute onset ear pain or fever. Most cases in children over 2 years resolve spontaneously; antibiotics are indicated in infants under 2 years, severe illness, or bilateral infection.