Paediatrics & Child Health: A Structured Approach for the Written Examination
Core concepts to master
Build your revision around the developmental, physiological and epidemiological frameworks that recur across the syllabus. Understand growth and development milestones (gross motor, fine motor, language, social) with the red flags that mandate referral; immunisation schedules and contraindications; fluid and electrolyte physiology in neonates and children (higher body water, greater insensible losses, immature renal concentrating ability); neonatal transition including jaundice timing, hypoglycaemia and sepsis risk factors; and common acute presentations - bronchiolitis, croup, asthma, gastroenteritis with dehydration, febrile seizures, and the septic-appearing child. Know the age-specific normal ranges for respiratory rate, heart rate and blood pressure, and the structured ABCDE assessment of the unwell child. Understand safeguarding principles and the recognition of non-accidental injury patterns.
Traps examiners use
- Age-dependence: normal values and differential diagnoses shift with age; a heart rate normal in a neonate is tachycardic in a school-aged child.
- Timing clues: jaundice within 24 hours is always pathological; physiological jaundice peaks days 3–5 (later in preterm infants).
- Distinguishing viral from bacterial presentations using duration, focus and systemic features rather than a single test.
- Developmental regression - loss of previously acquired skills is never normal and needs urgent evaluation.
- Dehydration grading: use combined clinical signs (capillary refill, skin turgor, mucous membranes, eyes, behaviour) rather than any single measure.
- Weight-based dosing and fluid calculations - read whether the question asks per dose or per day.
Worked rule of thumb
For a child with acute gastroenteritis, estimate dehydration clinically: mild (<5%) shows thirst and slightly dry mucosa; moderate (5–10%) adds reduced skin turgor, sunken eyes, delayed capillary refill and lethargy/irritability; severe (>10%) adds shock signs. For maintenance fluids, use the Holliday–Segar method: 100 mL/kg/day for the first 10 kg, 50 mL/kg/day for the next 10 kg, and 20 mL/kg/day thereafter. Always reassess after resuscitation boluses.
Exam technique
Read the stem for the age, duration and trajectory of symptoms; these usually discriminate the best answer. Eliminate options that are developmentally inappropriate or that delay urgent escalation in a deteriorating child.