Paediatric Nursing
Paediatric nursing questions turn on differences between children and adults: weight-based dosing, developmental milestones, dehydration management and the national immunisation schedule. PGIMER often presents an infant with a sign and asks for the nurse's interpretation.
Development milestones to know
- Social smile at 6 weeks; head holding at 3 months; sitting without support at 6–8 months; pincer grasp at 9 months; walking alone at 12–15 months; two-word sentences at 18–24 months.
- Primitive reflexes: Moro disappears by 3–4 months, grasp by 3 months, tonic neck by 4–6 months; persistence suggests cerebral palsy.
Normal values
- Newborn respiratory rate 40–60/min, heart rate 120–160/min. Weight doubles by 5 months and triples by 1 year.
Dehydration
Assess anterior fontanelle, skin turgor, mucous membranes, urine output and lethargy. Some dehydration is treated with ORS 75 mL/kg over 4 hours plus zinc for 14 days; severe dehydration needs IV Ringer lactate 100 mL/kg.
Worked example
A 10 kg child with diarrhoea, sunken eyes and a slow skin pinch but who is able to drink has some dehydration. ORS volume = 75 × 10 = 750 mL over 4 hours, about 190 mL per hour, given by cup and spoon with reassessment at 4 hours. Reasoning: the classification drives the route; shock or inability to drink would demand IV fluids instead.
Immunisation (National Immunisation Schedule)
Birth: BCG, OPV-0, hepatitis B birth dose. 6 weeks: pentavalent-1, OPV-1, IPV-1, rotavirus-1, PCV-1. 9–12 months: MR-1, JE-1, PCV booster. 16–24 months: MR-2, DPT booster-1.
Traps
Halving adult doses by age rather than weight, waiting for a bulging fontanelle before suspecting dehydration, and giving ORS by bottle with a fast flow to a lethargic child.