Egyptian Board Pediatrics cheat sheet

Mid-parental height: boys = (father + mother + 13 cm)/2; girls = (father + mother − 13 cm)/2; target range ±8.5 cm.

Growth velocity thresholds: 0–1 yr about 25 cm/yr, 1–2 yr 12 cm/yr, 2–4 yr 7–8 cm/yr, 4 yr to puberty 5–6 cm/yr; height velocity <4 cm/yr after age 4 warrants evaluation.

Length/height below −2 SD, height velocity fall across ≥2 percentile lines, or height >3 SD below mid-parental target = red flags for pathologic short stature.

Weight-for-length or BMI >85th–94th percentile = overweight; ≥95th percentile = obesity in children ≥2 yr; <5th percentile = underweight.

Denver-style milestones: social smile 6 wk, head control 3 mo, sits unsupported 6–8 mo, pincer grasp 9–10 mo, walks alone 12–15 mo, 2-word phrases 18–24 mo, tricycle 3 yr.

Language red flags: no babbling by 9 mo, no single words by 16 mo, no 2-word phrases by 24 mo, any loss of skills at any age → audiology and developmental assessment.

Autism spectrum disorder: impaired social communication plus restricted/repetitive behaviors; screen at 18 and 24 mo; M-CHAT-R/F is the common screening tool.

ADHD diagnosis requires symptoms before age 12, in ≥2 settings, ≥6 months, causing functional impairment; first-line pharmacotherapy in children ≥6 yr is a stimulant (methylphenidate or amphetamine).

Breath-holding spells: cyanotic (frustration-provoked) and pallid (reflex asystole) types; iron deficiency is a treatable association; EEG is not routinely indicated with a classic history.

Apgar is scored at 1 and 5 min (0–10) on Appearance, Pulse, Grimace, Activity, Respiration; it guides resuscitation but does not define asphyxia or predict outcome alone.

Neonatal resuscitation: warm, dry, stimulate; positive pressure ventilation for apnea or heart rate <100/min; chest compressions at 3:1 ratio if heart rate <60/min after effective ventilation.

Surfactant is indicated for respiratory distress syndrome with FiO2 requirement (early rescue for infants <30 wk or worsening); antenatal corticosteroids (betamethasone) at 24–34 wk reduce RDS, IVH, and mortality.

Physiologic jaundice appears after 24 h, peaks day 3–5 (day 5–7 in preterm); jaundice within 24 h, direct hyperbilirubinemia, or rise >5 mg/dL/day is pathologic.

Kernicterus risk rises with hemolysis, prematurity, sepsis, and acidosis; treat with intensive phototherapy, and exchange transfusion for severe or failing phototherapy per hour-specific nomograms.

Sepsis risk: group B Streptococcus and E. coli predominate in early-onset disease; empiric ampicillin plus gentamicin is standard, with cesarean section not removing GBS risk if membranes ruptured or labor occurred.

Necrotizing enterocolitis: preterm, feeding intolerance, abdominal distension, bloody stools, pneumatosis intestinalis; treat by stopping feeds, nasogastric decompression, antibiotics, and surgery for perforation.

Hypoglycemia threshold in the first 48 h is <45 mg/dL (screen infants of diabetic mothers, LGA, SGA, preterm); persistent hypoglycemia requires evaluation for hyperinsulinism.

Retinopathy of prematurity screening: infants ≤30 wk gestation or ≤1500 g birth weight, starting at 4–6 weeks postnatal age; plus retinopathy of prematurity in unstable larger infants per local criteria.

Fever without focus: <3 mo old with rectal temperature ≥38 °C needs full sepsis workup and empiric antibiotics; 3–36 mo with a toxic appearance also needs cultures and treatment.

Kawasaki disease: fever ≥5 days plus ≥4 of conjunctivitis, oral changes, cervical lymphadenopathy, rash, extremity changes; treat with IVIG 2 g/kg plus aspirin; coronary artery assessment by echocardiography.

Measles: Koplik spots, cough-coryza-conjunctivitis, cephalocaudal rash; vitamin A is given in deficiency-endemic areas or severe cases; airborne isolation and post-exposure vaccination or immunoglobulin.

Mumps: parotid swelling, orchitis in postpubertal males; aseptic meningitis is the commonest complication; supportive care with droplet precautions for 5 days after parotitis onset.

Rubella: postauricular/occipital lymphadenopathy and rash; infection in the first trimester causes congenital rubella syndrome (cataract, deafness, cardiac defects).

Pertussis: paroxysmal cough with inspiratory whoop and post-tussive vomiting; lymphocytosis; azithromycin for treatment and prophylaxis; acellular vaccine does not give lifelong immunity.

Vaccine schedule anchors: BCG and hepatitis B at birth; DTaP, IPV, Hib, PCV, rotavirus at 2, 4, and 6 mo; MMR and varicella at 12–15 mo; booster DTaP at 4–6 yr; Tdap at 11–12 yr.

Tuberculosis: tuberculin skin test ≥5 mm is positive in close contacts, HIV, or immunosuppression; ≥10 mm in high-risk children; ≥15 mm in low-risk; interferon-gamma release assays are preferred ≥2 yr.

Antibiotic stewardship: amoxicillin is first line for acute otitis media and community-acquired pneumonia in children; add amoxicillin-clavulanate for treatment failure, recent antibiotics, or purulent conjunctivitis.

Asthma diagnosis: recurrent wheeze, cough, and reversibility with bronchodilator or improvement with controller therapy; spirometry shows FEV1/FVC <0.85–0.90 in children.

Asthma step-up: short-acting beta-agonist as needed plus low-dose inhaled corticosteroid; add long-acting beta-agonist only at ≥5 yr after inadequate control on medium-dose ICS.

Acute asthma severity: peak expiratory flow <50% predicted, inability to speak in sentences, silent chest, cyanosis, or altered consciousness = severe/life-threatening; give oxygen, inhaled beta-agonist, ipratropium, and systemic steroids.

Croup: barking cough, hoarseness, inspiratory stridor; dexamethasone 0.15–0.6 mg/kg once; nebulized epinephrine for moderate-severe stridor or retractions.

Bronchiolitis: <2 yr, viral (RSV), wheeze/crackles; treatment is supportive (oxygen, hydration, suction); bronchodilators, steroids, and antibiotics are not routinely recommended.

Epiglottitis: drooling, muffled voice, tripod position, high fever; do not inspect the throat; secure the airway in the operating room with anesthesia and ENT present.

Anaphylaxis: epinephrine 0.01 mg/kg (max 0.5 mg) intramuscularly in the anterolateral thigh, repeat every 5–15 min; adjuncts are antihistamines and steroids, not first-line.

Allergic rhinitis: intranasal corticosteroids are the most effective monotherapy; oral antihistamines help sneezing and itching but not congestion.

Cystic fibrosis: sweat chloride ≥60 mmol/L is diagnostic; 30–59 mmol/L is intermediate; newborn screening is immunoreactive trypsinogen with DNA testing.

Innocent murmur features: systolic, soft (grade ≤2), no click, normal S2, varies with position, no radiation, no thrill, asymptomatic child.

Cyanotic congenital heart disease with decreased pulmonary flow = tetralogy of Fallot; squatting and hypercyanotic spells are treated with knee-chest position, oxygen, morphine, fluids, and beta-blocker.

Cyanotic congenital heart disease with increased pulmonary flow and normal or increased pulmonary vascularity suggests transposition of the great arteries, truncus arteriosus, or total anomalous pulmonary venous return.

Duct-dependent lesions (transposition, critical coarctation, interrupted arch, severe pulmonary stenosis/atresia) respond to prostaglandin E1 infusion; watch for apnea and hypotension.

Ventricular septal defect: holosystolic murmur at the left lower sternal border; small defects may close spontaneously; large defects cause failure to thrive and pulmonary hypertension.

Coarctation of the aorta: upper-limb hypertension, weak femoral pulses, radio-femoral delay, rib notching later; associated with bicuspid aortic valve and Turner syndrome.

Acute rheumatic fever: Jones criteria with evidence of preceding group A Streptococcus; carditis, migratory polyarthritis, chorea, erythema marginatum, subcutaneous nodules; treat with penicillin.

Infective endocarditis prophylaxis is limited to the highest-risk lesions (prosthetic valve, prior endocarditis, unrepaired cyanotic disease, residual shunt) before dental procedures.

Congestive heart failure in infants: tachypnea, poor feeding, sweating, hepatomegaly, failure to thrive; treat with diuretics, afterload reduction, and digoxin in selected cases.

Acute gastroenteritis: oral rehydration solution 50 mL/kg over 4 h for mild dehydration; 100 mL/kg over 4 h for moderate; use low-osmolarity solution (245 mOsm/L) and continue breastfeeding.

Severe dehydration signs: lethargy, sunken eyes, very slow skin pinch, inability to drink; give isotonic saline 20 mL/kg boluses intravenously and reassess.

Zinc supplementation 10–20 mg/day for 10–14 days shortens diarrhea duration in children in resource-limited settings.

Gastroesophageal reflux disease: lifestyle and thickened feeds first; proton pump inhibitors reserved for proven esophagitis or persistent symptoms; avoid in uncomplicated regurgitation.

Celiac disease: tissue transglutaminase IgA with total IgA; duodenal biopsy shows villous atrophy and crypt hyperplasia; lifelong gluten-free diet.

Intussusception: colicky pain, vomiting, currant-jelly stool, sausage-shaped mass; air or contrast enema is both diagnostic and therapeutic if no peritonitis or perforation.

Hypertrophic pyloric stenosis: 3–6 weeks old, nonbilious projectile vomiting, hypochloremic hypokalemic metabolic alkalosis; ultrasound shows pyloric thickness ≥3 mm and length ≥15 mm.

Hirschsprung disease: delayed meconium, abdominal distension, explosive stool after rectal examination; diagnosis by rectal biopsy showing absent ganglion cells.

Neonatal cholestasis: direct bilirubin >1 mg/dL with conjugated fraction >20% of total; biliary atresia is the key diagnosis (Kasai portoenterostomy best before 60 days).

Nephrotic syndrome: edema, proteinuria >40 mg/m²/h or urine protein/creatinine >2, albumin <2.5 g/dL; minimal change disease is commonest; treat with prednisolone 60 mg/m²/day.

Nephritic syndrome: hematuria, hypertension, oliguria, edema; post-streptococcal glomerulonephritis follows 1–3 weeks after pharyngitis or 3–6 weeks after skin infection with low C3.

Acute kidney injury staging uses creatinine rise and urine output; prerenal causes improve with fluid, intrinsic causes show muddy brown casts, and postrenal causes need bladder decompression.

Hemolytic uremic syndrome: microangiopathic anemia, thrombocytopenia, acute kidney injury after bloody diarrhea (Shiga toxin E. coli); avoid antibiotics and antimotility agents in suspected cases.

Urinary tract infection: obtain urine by catheter or suprapubic aspiration in infants; treat febrile infants <3 mo intravenously; renal ultrasound after first febrile UTI in children <2 yr.

Vesicoureteral reflux grading I–V; low grades often resolve; antibiotic prophylaxis and surgical reimplantation for high-grade or breakthrough infections.

Hypospadias: do not circumcise; repair at 6–18 months; associated with undescended testis and inguinal hernia.

Cryptorchidism: orchidopexy by 12–18 months to reduce infertility and malignancy risk; spontaneous descent is uncommon after 6 months.

Nocturnal enuresis: alarm or desmopressin after age 6–7; daytime symptoms, polyuria, or urinary tract infection require further evaluation.

Congenital hypothyroidism: newborn screening with thyroid-stimulating hormone and free T4; treatment with levothyroxine 10–15 mcg/kg/day started within 2 weeks prevents intellectual disability.

Type 1 diabetes presentation: polyuria, polydipsia, weight loss, ketoacidosis; initial management includes isotonic fluid resuscitation, insulin infusion after potassium is ≥3.5 mEq/L, and monitoring for cerebral edema.

Diabetic ketoacidosis: total body potassium is depleted despite normal serum values; insulin shifts potassium intracellularly, so replace potassium early.

Congenital adrenal hyperplasia (21-hydroxylase deficiency): virilization in females, salt-wasting crisis with hyponatremia and hyperkalemia; treat with hydrocortisone and fludrocortisone.

Short stature evaluation: bone age, insulin-like growth factor 1, thyroid function; growth hormone stimulation testing for suspected deficiency; treat with recombinant growth hormone.

Precocious puberty: breast or pubic hair before 8 yr in girls or 9 yr in boys; gonadotropin-releasing hormone analog for central precocious puberty.

Turner syndrome: short stature, webbed neck, coarctation, streak ovaries; treat with growth hormone and estrogen replacement; karyotype is diagnostic.

Klinefelter syndrome: 47,XXY, tall stature, gynecomastia, small testes, infertility; testosterone replacement at puberty.

Phenylketonuria: newborn screening, dietary phenylalanine restriction, avoid aspartame; untreated causes intellectual disability and musty odor.

Microcytic anemia: iron deficiency (low ferritin, high total iron-binding capacity), thalassemia (normal ferritin, normal or high iron, target cells), and anemia of chronic disease (low iron, low total iron-binding capacity).

Iron deficiency anemia: treat with oral ferrous sulfate 3–6 mg/kg/day of elemental iron; reticulocytosis within 1–2 weeks; continue 3 months after hemoglobin normalizes.

Sickle cell disease: hydroxyurea reduces crises; penicillin prophylaxis from 2 months to 5 years; pneumococcal vaccination; acute chest syndrome is the leading cause of death.

Acute chest syndrome: fever, chest pain, hypoxia, new infiltrate; treat with oxygen, antibiotics, incentive spirometry, and transfusion for severe cases.

Thalassemia major: regular transfusions with iron chelation; monitor ferritin and cardiac iron; splenectomy only for increasing transfusion needs.

Immune thrombocytopenia: isolated thrombocytopenia with petechiae in a well child; treat only for significant bleeding; IVIG or steroids for severe cases; intracranial hemorrhage is rare.

Hemophilia A: factor VIII deficiency, prolonged partial thromboplastin time; treat bleeding with factor replacement; desmopressin for mild hemophilia A.

von Willebrand disease: mucocutaneous bleeding, prolonged bleeding time; desmopressin for type 1; factor concentrate for severe.

Acute lymphoblastic leukemia: peak age 2–5 yr; bone marrow with ≥20% blasts; treatment includes induction, consolidation, maintenance, and central nervous system prophylaxis.

Febrile seizures: age 6 months–5 years, fever without central nervous system infection; simple = generalized, <15 min, once in 24 h; complex = focal, prolonged, or recurrent.

Status epilepticus: benzodiazepine first (lorazepam or diazepam), then phenytoin/fosphenytoin or levetiracetam; check glucose and electrolytes.

Infantile spasms: flexor or extensor spasms in clusters, hypsarrhythmia on EEG; treat with adrenocorticotropic hormone or vigabatrin (especially with tuberous sclerosis).

Meningitis: neck stiffness, bulging fontanelle, Kernig and Brudzinski signs; lumbar puncture after stabilizing; empiric ceftriaxone plus vancomycin, add ampicillin for neonates.

Cerebral palsy: nonprogressive motor impairment from early brain injury; associated with epilepsy, hearing and vision problems, and intellectual disability; treat spasticity with botulinum toxin or baclofen.

Guillain-Barré syndrome: ascending symmetric weakness, areflexia, albuminocytologic dissociation in cerebrospinal fluid; treat with IVIG or plasma exchange.

Bell palsy: acute unilateral facial weakness; prednisolone within 72 h improves outcome; protect the eye with lubricants.

Migraine in children: often bilateral, shorter duration; treat with nonsteroidal anti-inflammatory drugs and triptans; preventive therapy for frequent attacks.

Head trauma: Glasgow Coma Scale ≤13, focal deficit, or worsening symptoms warrant imaging; observe for epidural hematoma (lucid interval) and subdural hematoma.

Pediatric basic life support: 30:2 compression-to-ventilation for one rescuer, 15:2 for two rescuers; rate 100–120/min; depth one-third of chest diameter.

Weight estimation: (age in years + 4) × 2 kg for children 1–10 years; use length-based tapes in emergencies.

Fluid resuscitation: 20 mL/kg isotonic crystalloid boluses for shock; reassess after each bolus; blood products for hemorrhagic shock.

Anaphylaxis: epinephrine 0.01 mg/kg intramuscularly (max 0.5 mg) into the anterolateral thigh; repeat every 5–15 min; oxygen and fluids.

Paracetamol overdose: N-acetylcysteine is the antidote; use the Rumack-Matthew nomogram at 4 h post-ingestion; treat if level above the treatment line or liver injury present.

Salicylate toxicity: tinnitus, hyperventilation, mixed respiratory alkalosis and metabolic acidosis; treat with sodium bicarbonate and urine alkalinization; hemodialysis for severe cases.

Organophosphate poisoning: cholinergic crisis (salivation, lacrimation, urination, diarrhea, bradycardia, bronchorrhea, miosis); treat with atropine and pralidoxime.

Iron poisoning: vomiting, bloody diarrhea, metabolic acidosis, hepatic failure; treat with deferoxamine.

Carbon monoxide poisoning: headache, confusion, cherry-red skin late; treat with 100% oxygen; hyperbaric oxygen for severe poisoning or pregnancy.

Breastfeeding: exclusive for 6 months, continue with complementary foods to 2 years; vitamin D 400 IU/day and vitamin K at birth for all infants.

Lead screening: blood lead level ≥5 mcg/dL requires follow-up; ≥45 mcg/dL needs chelation; remove the source and provide iron-sufficient diet.

Injury prevention: car seat rear-facing until age 2 or seat limit; booster seat until 4 ft 9 in; helmet use; water safety and pool fencing; safe sleep on the back.

Newborn screening: heel prick at 24–72 h; repeat after transfusion; includes congenital hypothyroidism, phenylketonuria, cystic fibrosis, hemoglobinopathies, and hearing screening.

Immunization ethics: assent from children, consent from parents/guardians, and best-interest standard; confidentiality in adolescents with exceptions for harm.

Child abuse: unexplained injuries, inconsistent history, delay in seeking care; mandatory reporting to child protection authorities.

Adolescent confidentiality: contraception and sexually transmitted infection care may be confidential per local law; always assess safety and encourage parental involvement.

Screening: vision at 3–5 years, hearing at school entry, anemia and lead risk assessment at 12 months, and autism screening at 18 and 24 months.

Ethical principles: beneficence, nonmaleficence, autonomy, justice; assent for research in children with parental permission; minimal-risk research allowed without direct benefit.

Breast milk provides about 67 kcal/100 mL; infant formula about 67 kcal/100 mL; term infants need 100–120 kcal/kg/day.

Failure to thrive: weight <5th percentile or crossing ≥2 major percentile lines; evaluate intake, absorption, and increased losses; hospitalize for severe malnutrition or abuse concern.

Vitamin D deficiency: rickets with bowing, widened wrists, low phosphate, high alkaline phosphatase; treat with vitamin D and calcium.

Vitamin A deficiency: night blindness, Bitot spots, xerophthalmia; treat with vitamin A; measles increases risk.

Vitamin K deficiency bleeding: prevent with intramuscular vitamin K 1 mg at birth; late-onset bleeding occurs at 2–12 weeks in exclusively breastfed infants without prophylaxis.

Breast milk jaundice: unconjugated hyperbilirubinemia after the first week in breastfed infants; usually benign; continue breastfeeding.

Hepatitis B: perinatal transmission risk highest with HBeAg-positive mothers; give hepatitis B vaccine and immunoglobulin within 12 h of birth.

Acute liver failure: coagulopathy (international normalized ratio ≥1.5) with encephalopathy; treat with N-acetylcysteine and supportive care; transplant evaluation.

Constipation: functional in >95% of children; treat with polyethylene glycol; avoid cow's milk in refractory cases.

Growth hormone deficiency: height <−2.5 SD, low insulin-like growth factor 1, delayed bone age; treat with recombinant growth hormone.

Hypothyroidism: congenital screening with thyroid-stimulating hormone; acquired hypothyroidism causes growth failure, constipation, and bradycardia; treat with levothyroxine.

Diabetes mellitus: type 1 is commonest in children; type 2 associated with obesity and acanthosis nigricans; screen with hemoglobin A1c or fasting glucose.

Diabetic ketoacidosis: pH <7.3, bicarbonate <15 mEq/L, ketonemia; fluid resuscitation with isotonic saline; insulin after potassium ≥3.5 mEq/L; monitor for cerebral edema.

Hypoglycemia in infants: <45 mg/dL in first 48 h; evaluate for hyperinsulinism if persistent; treat with glucose and feed.

Congenital adrenal hyperplasia: 21-hydroxylase deficiency causes virilization and salt wasting; treat with hydrocortisone and fludrocortisone; monitor 17-hydroxyprogesterone.

Precocious puberty: gonadotropin-releasing hormone stimulation test; treat central precocious puberty with gonadotropin-releasing hormone analog.

Turner syndrome: short stature and ovarian failure; treat with growth hormone and estrogen; monitor for coarctation and thyroid disease.

Obesity: body mass index ≥95th percentile; screen for hypertension, dyslipidemia, and type 2 diabetes; treat with family-based lifestyle intervention.

Anemia: microcytic (iron deficiency, thalassemia), normocytic (acute blood loss, chronic disease), macrocytic (B12, folate deficiency).

Iron deficiency anemia: low ferritin, high total iron-binding capacity; treat with oral iron; continue 3 months after hemoglobin normalizes.

Sickle cell disease: hydroxyurea, penicillin prophylaxis, pneumococcal vaccination; acute chest syndrome is a leading cause of death.

Thalassemia: microcytic anemia with normal ferritin; beta thalassemia major requires transfusions and iron chelation.

Immune thrombocytopenia: isolated thrombocytopenia with petechiae; treat only for significant bleeding; IVIG or steroids for severe cases.

Hemophilia A: factor VIII deficiency; prolonged partial thromboplastin time; treat with factor replacement; desmopressin for mild cases.

von Willebrand disease: mucocutaneous bleeding; desmopressin for type 1; factor concentrate for severe.

Acute lymphoblastic leukemia: peak age 2–5 years; bone marrow blasts ≥20%; treatment includes induction, consolidation, maintenance, and central nervous system prophylaxis.

Wilms tumor: abdominal mass in a young child; nephrectomy and chemotherapy; associated with WAGR syndrome and Beckwith-Wiedemann syndrome.

Febrile seizures: simple = generalized, <15 min, once in 24 h; complex = focal, prolonged, or recurrent; no routine EEG or imaging for simple febrile seizures.

Status epilepticus: benzodiazepine first, then phenytoin or levetiracetam; check glucose and electrolytes.

Infantile spasms: clusters of flexor or extensor spasms, hypsarrhythmia; treat with adrenocorticotropic hormone or vigabatrin.

Meningitis: neck stiffness and bulging fontanelle; lumbar puncture after stabilizing; empiric ceftriaxone plus vancomycin, add ampicillin for neonates.

Cerebral palsy: nonprogressive motor impairment; associated with epilepsy and hearing/vision problems; treat spasticity with botulinum toxin or baclofen.

Guillain-Barré syndrome: ascending symmetric weakness, areflexia, albuminocytologic dissociation; treat with IVIG or plasma exchange.

Bell palsy: acute unilateral facial weakness; prednisolone within 72 h improves outcome; protect the eye.

Migraine in children: often bilateral and shorter; treat with nonsteroidal anti-inflammatory drugs and triptans; preventive therapy for frequent attacks.

Head trauma: Glasgow Coma Scale ≤13, focal deficit, or worsening symptoms warrant imaging; observe for epidural and subdural hematoma.

Pediatric basic life support: 30:2 for one rescuer, 15:2 for two rescuers; rate 100–120/min; depth one-third of chest diameter.

Weight estimation: (age in years + 4) × 2 kg for children 1–10 years; use length-based tapes in emergencies.

Fluid resuscitation: 20 mL/kg isotonic crystalloid boluses for shock; reassess after each bolus; blood products for hemorrhagic shock.

Anaphylaxis: epinephrine 0.01 mg/kg intramuscularly (max 0.5 mg) into the anterolateral thigh; repeat every 5–15 min.

Paracetamol overdose: N-acetylcysteine is the antidote; use the Rumack-Matthew nomogram at 4 h post-ingestion.

Salicylate toxicity: tinnitus, hyperventilation, mixed respiratory alkalosis and metabolic acidosis; treat with sodium bicarbonate; hemodialysis for severe cases.

Organophosphate poisoning: cholinergic crisis; treat with atropine and pralidoxime.

Iron poisoning: vomiting, bloody diarrhea, metabolic acidosis, hepatic failure; treat with deferoxamine.

Carbon monoxide poisoning: headache, confusion, cherry-red skin late; treat with 100% oxygen; hyperbaric oxygen for severe poisoning.

Breastfeeding: exclusive for 6 months, continue with complementary foods to 2 years; vitamin D 400 IU/day and vitamin K at birth.

Lead screening: blood lead level ≥5 mcg/dL requires follow-up; ≥45 mcg/dL needs chelation; remove the source.

Injury prevention: rear-facing car seat until age 2 or seat limit; booster seat until 4 ft 9 in; helmet use; pool fencing; safe sleep on the back.

Newborn screening: heel prick at 24–72 h; includes congenital hypothyroidism, phenylketonuria, cystic fibrosis, hemoglobinopathies, and hearing screening.

Immunization ethics: assent from children, consent from parents/guardians, best-interest standard; confidentiality in adolescents with exceptions for harm.

Child abuse: unexplained injuries, inconsistent history, delay in seeking care; mandatory reporting to child protection authorities.

Adolescent confidentiality: contraception and sexually transmitted infection care may be confidential per local law; assess safety and encourage parental involvement.

Screening: vision at 3–5 years, hearing at school entry, anemia and lead risk assessment at 12 months, autism screening at 18 and 24 months.

Ethical principles: beneficence, nonmaleficence, autonomy, justice; assent for research in children with parental permission.