Children's and adolescents' health
Children's and adolescents' health
This domain tests growth and development surveillance, the febrile child, immunisation, safeguarding, and the shift in confidentiality that occurs in adolescence.
Core rules
- Febrile infant under 3 months with a temperature of 38°C or more needs a full septic screen - blood, urine and cerebrospinal fluid - and empirical intravenous antibiotics with admission. Do not send a febrile neonate home because they “look well”.
- Immunisation: the National Immunisation Program schedules doses at 2, 4, 6, 12 and 18 months and 4 years, with school-based HPV and meningococcal ACWY in early adolescence. Catch-up is always preferable to no vaccination; use the current Australian Immunisation Handbook for special-risk groups.
- Development: plot growth and use validated milestones; refer for persistent loss of skills, no social smile by 8 weeks, not sitting by 9 months, or no words by 18 months.
- Safeguarding: unexplained bruising in a non-mobile infant, inconsistent histories or delayed presentation are mandatory reporting triggers in every jurisdiction.
- Adolescent confidentiality: a mature minor can consent to their own care; explain the limits (risk to life, abuse) rather than promising absolute secrecy. Medicare access can be restricted from age 14.
Worked example
A 10-week-old presents at 6 pm with temperature 38.4°C, poor feeding and irritability. The mother asks for “something to bring the fever down at home”.
Reasoning: age under 3 months plus fever mandates admission for septic screen and intravenous antibiotics; the risk of group B streptococcal or E. coli sepsis outweighs the inconvenience. Give antipyretics and fluids, arrange immediate paediatric transfer, and document the counselling. Antipyretics alone would be unsafe.
Traps that cost marks
- Treating a febrile neonate as an outpatient.
- Reassuring a parent about a developmental concern without plotting growth or a formal review.
- Promising absolute confidentiality to a 15-year-old.