Pediatrics and Child Health
Paediatric primary care covers growth and development surveillance, immunisation, nutrition, and the integrated management of the sick child. The Board favours questions on danger signs, dehydration grading, neonatal jaundice, breastfeeding and developmental milestones.
Core rules
- IMCI danger signs (any one means urgent referral): inability to drink or breastfeed, persistent vomiting, convulsions, lethargy or unconsciousness, stridor at rest, severe chest indrawing, severe malnutrition, central cyanosis.
- Growth: plot weight-for-age, length/height-for-age, weight-for-height and head circumference on WHO charts. A child who crosses two major centile lines downwards needs assessment.
- Dehydration: Plan A (no dehydration) extra fluids at home; Plan B (some dehydration: sunken eyes, thirst, slow skin pinch) oral rehydration solution 75 mL/kg over four hours with reassessment; Plan C (severe: lethargy, very sunken eyes, skin pinch over two seconds, unable to drink) intravenous Ringer's lactate. Give zinc for 10 to 14 days in diarrhoea (20 mg daily, 10 mg under six months).
- Nutrition: exclusive breastfeeding for six months, complementary feeding from six months with continued breastfeeding to two years, vitamin D supplementation, iron-rich foods.
- Immunisation: Egypt's Expanded Programme on Immunisation gives BCG, hepatitis B and OPV at birth; pentavalent (DTP-HepB-Hib) plus polio at 2, 4 and 6 months; MMR at 12 and 18 months; DTP boosters at school entry. Always check the current national schedule, which is periodically revised.
Worked example
A 9-month-old has had watery diarrhoea for three days, is thirsty, has sunken eyes and a skin pinch retracting in about 1.5 seconds, and is alert. Reasoning: this is some dehydration (Plan B), not severe, because the child drinks and is alert with no lethargy. Give ORS 75 mL/kg over four hours (about 600 mL for 8 kg), continue breastfeeding, add zinc, teach the mother the four rules of home therapy, and review at four hours or sooner if danger signs appear.
Traps that cost marks
- Calling a lethargic child with a two-second skin pinch only some dehydration.
- Prescribing antibiotics for acute watery diarrhoea or antiemetics instead of ORS.
- Reassuring on jaundice in the first 24 hours of life, which is always pathological.