Management of Chronic and Complex Pediatric Conditions
This domain tests longitudinal management: control assessment, stepwise therapy, self-management support, care coordination, and planned transition to adult care.
Core rules
- Chronic conditions are managed in a medical home with a written care plan, defined roles, and a shared agenda with the family.
- Asthma: assess control with symptom frequency, nighttime awakening, activity limitation, and short-acting beta-agonist use. Step therapy up or down based on control; check adherence, inhaler technique, and spacer use before escalating. Every patient needs a written asthma action plan and annual influenza vaccination.
- Type 1 diabetes: monitor growth, injection sites, hypoglycemia, school plan, and mental health; involve a multidisciplinary team.
- Epilepsy: seizure type drives medication choice; counsel on safety, rescue medication, and school accommodations.
- ADHD: behavioral parent training is first-line for preschool children; medication plus behavioral therapy for school-age children.
- Complex care: anticipate equipment, home nursing, emergency plans, and social needs; use closed-loop referrals and warm handoffs.
- Transition: start discussing adult care in early adolescence, build self-management skills, and transfer with a summary by the late teens.
Worked example
A 9-year-old with asthma reports nighttime symptoms three times a month, uses albuterol three days a week, and has an ACT score of 15. Reasoning: this is not well controlled. Before stepping up, observe inhaler technique, confirm adherence, and review triggers and influenza status. If technique and adherence are adequate, step up inhaled corticosteroid therapy, update the action plan, and recheck in 2–6 weeks.
Traps
Escalating medication without checking adherence or technique; omitting an action plan; managing obesity or ADHD without addressing sleep and mental health; forgetting school accommodations; delaying transition planning until age 18.