Paediatrics
Domain focus
This domain tests child development, family-centred practice, paediatric assessment and rehabilitation for conditions such as cerebral palsy, developmental coordination disorder and orthopaedic problems. The exam expects you to distinguish normal variation from red flags and to adapt communication and consent to the child's age.
Core rules and concepts
- Development follows sequences but varies in timing. Gross motor, fine motor, communication, social and cognitive domains are assessed together.
- Red flags include loss of skills, persistent asymmetry, abnormal tone, poor head control after expected age, not walking by around 18 months, and unexplained regression. These need medical review.
- Family-centred care means shared goals with parents and carers, practical home strategies and respect for cultural and school contexts.
- Cerebral palsy is a disorder of movement and posture due to a non-progressive lesion; associated impairments include epilepsy, vision, hearing and feeding difficulties. GMFCS describes gross motor function.
- Play and functional tasks are treatment media. Strengthening and practice must be dosed for the child's age and engagement.
- Consent involves parental permission and child assent according to age and understanding.
Worked example
An 18-month-old is not walking independently. He was born preterm, has persistent toe-standing and one hip appears less abducted. Reasoning: not walking at 18 months is a red flag, and asymmetry plus toe-standing warrants medical review for hip, neurological or neuromuscular causes. Do not label it as lazy or late walking. Take a developmental history, observe play and transitions, check range and tone, and discuss referral with the family while offering safe positioning and movement practice.
Traps that cost marks
Applying adult norms directly to children; missing regression or asymmetry; ignoring feeding, vision or hearing; and writing goals that belong to the therapist rather than the family. Another trap is treating a child without assent or without explaining to the carer.
Key points
- Assess all developmental domains.
- Regression and asymmetry are red flags.
- Use family-centred, play-based goals.
- GMFCS describes gross motor function in cerebral palsy.
- Seek parental consent and child assent.