Pediatric and Child Health Nursing
Pediatric questions test growth and development, immunisation, fluid balance, respiratory illness and child protection. Children are not small adults: weight-based dosing and age-specific assessment are essential.
Core rules and concepts
- Milestones: social smile around 6 weeks; sits unsupported 6–8 months; pincer grasp 9–12 months; walks 12–15 months.
- Immunisation: follow the national schedule-BCG and oral polio at birth, pentavalent and oral polio at 6, 10 and 14 weeks, measles at 9 and 15 months.
- Dehydration: sunken fontanelle, dry mucous membranes, reduced urine output, poor capillary refill and lethargy. Weight is the most reliable measure of fluid loss.
- Respiratory illness: croup causes a barking cough; epiglottitis causes drooling and tripod positioning-do not inspect the throat; bronchiolitis is usually caused by respiratory syncytial virus.
- Maintenance fluids: 4-2-1 rule-4 mL/kg/h for the first 10 kg, 2 mL/kg/h for the next 10 kg and 1 mL/kg/h thereafter.
- Child protection: unexplained injuries, inconsistent histories and delayed presentation require mandatory reporting.
Worked example
A 12 kg child needs maintenance fluids. First 10 kg: 10 × 4 = 40 mL/h. Next 2 kg: 2 × 2 = 4 mL/h. Total 44 mL/h. Check the prescription against weight and diagnosis, because children with cardiac or renal disease may need restriction.
Traps that cost marks
- Using adult doses or adult vital-sign ranges.
- Forgetting to weigh the child before calculating fluids.
- Examining the throat in suspected epiglottitis.
- Dismissing parental concern or failing to report safeguarding concerns.