Child Health / Paediatric Nursing
Domain 5 - Child Health / Paediatric Nursing
This domain tests assessment and care of infants and children, with emphasis on growth and development, immunisation, dehydration, respiratory distress, nutrition, child protection and weight-based medication safety. Children deteriorate quickly and compensate well until they crash, so subtle signs matter.
Core rules
- Normal values change with age: infants breathe 30–50/min and have heart rates of 100–160/min; these fall progressively towards adult values by adolescence. Always use age-appropriate ranges and a paediatric early warning chart.
- Assess using the paediatric assessment triangle (appearance, work of breathing, circulation) then ABCDE. Count respirations for a full minute; look for recession, nasal flaring, grunting and head bobbing.
- Dehydration: assess thirst, skin turgor, eyes, mucous membranes, urine output and mental state. Plan A (no dehydration) - extra fluids at home. Plan B (some dehydration) - oral rehydration solution 75 mL/kg over four hours with small frequent sips, then reassess. Plan C (severe dehydration) - IV Ringer's lactate or normal saline, 100 mL/kg over 24 hours with an initial bolus, plus zinc for diarrhoea.
- Weight-based dosing is mandatory; always weigh the child and check the dose against a paediatric formulary. Never give aspirin to a child because of the Reye's syndrome risk.
- Immunisation: follow the current Fiji expanded programme schedule from the birth doses (BCG, hepatitis B) through infancy to measles-rubella; maintain the cold chain, check contraindications, and report adverse events following immunisation.
- Child protection: unexplained or inconsistent injuries, delay in seeking care, and changes in behaviour must be documented objectively and reported through the child protection pathway.
Worked example
A 12 kg toddler has had watery diarrhoea for two days. He is irritable, thirsty, has sunken eyes, a slow skin pinch and has passed no urine for eight hours. Reasoning: these are signs of some dehydration, so Plan B applies. ORS required: 75 mL/kg × 12 kg = 900 mL over four hours, that is about 225 mL each hour, given by cup and spoon in small frequent amounts. Continue breastfeeding, give zinc, reassess at four hours, and teach the mother the four rules of home care: extra fluids, zinc, continued feeding, and when to return.
Traps
- Estimating a child's weight instead of weighing.
- Using adult drug doses or adult observation ranges.
- Giving plain water instead of ORS for dehydration.
- Dismissing inconsolable crying or a bulging fontanelle as 'just a cry baby'.