Pediatrics: Growth, Development, Fever, and Safeguarding
The Pediatrics domain tests well-child care, growth and development, common acute illnesses, immunization, and the recognition of serious illness in infants and children. The CFPC expects a family physician to plot growth, use developmental milestones, apply the Canadian Immunization Guide, and act on red flags without over-investigating. Parental concern is itself a clinical finding and should be explicitly addressed.
Core rules and concepts
- Growth: plot weight, length or height, and head circumference on the correct chart; calculate weight-for-length or BMI; review growth velocity over time.
- Development: ask about milestones at every well-child visit; use validated tools when concerns arise; refer early for speech, motor, or social delay.
- Fever: age is the key risk stratifier. Infants under 3 months with rectal temperature ≥38.0°C need urgent evaluation, including urine, blood, and cerebrospinal fluid testing, and empiric antibiotics per local protocol.
- Dehydration: assess feeding, urine output, mucous membranes, tears, skin turgor, and weight loss; use oral rehydration when possible.
- Safeguarding: ask about household smoking, safe sleep, car seats, and family violence; document and report suspected maltreatment.
Worked example
A 2-month-old boy is brought in with a rectal temperature of 38.5°C. He fed poorly overnight and is sleepy. He has no focal signs. He received his 2-month immunizations 3 days ago.
Reasoning: age under 3 months makes this a high-risk febrile infant. Do not attribute fever to immunization without excluding serious bacterial infection. Perform a full assessment: vital signs, hydration, fontanelle, respiratory and cardiac exam, and skin. Obtain urine by catheter or suprapubic aspiration, blood culture, CBC, and cerebrospinal fluid analysis; start empiric antibiotics and admit for observation per local protocol. Ask about sick contacts and immunization status. Document the safety plan and follow-up. The key feature is age-based risk stratification and prompt sepsis workup, not the benign appearance alone.
Traps that cost marks
- Reassuring because the infant is “well appearing.”
- Failing to plot growth or calculate weight loss.
- Missing parental concern or delayed milestones.
- Attributing fever to teething or immunization without evaluation.
- Not asking about safe sleep, smoking, or safeguarding concerns.