Pediatrics and Child Health
Pediatrics tests the sick child, growth and development, immunization, and age-specific prescribing. The exam expects you to recognize when a common symptom is a red flag and to avoid adult assumptions.
Core rules
- Fever in an infant younger than 28 days (rectal ≥38.0°C) is a sepsis screen until proven otherwise: full blood count, blood and urine cultures, cerebrospinal fluid analysis, and empirical intravenous antibiotics after admission.
- Bronchiolitis is supportive: oxygen, fluids, suction. Do not routinely give bronchodilators, corticosteroids, or antibiotics.
- Croup responds to a single dose of oral dexamethasone; nebulized adrenaline is for stridor at rest.
- Gastroenteritis: oral rehydration solution is first-line. Do not use antidiarrheal agents; ondansetron may reduce vomiting but does not replace rehydration.
- Never give aspirin to a child with fever (Reye syndrome risk).
Worked example
A 4-week-old presents with temperature 38.4°C, poor feeding, and irritability. Reasoning: age below 28 days makes this a high-risk febrile infant. Perform a full sepsis evaluation including lumbar puncture, start empirical ampicillin plus gentamicin or a third-generation cephalosporin, and admit. A normal initial white cell count does not exclude sepsis, and antipyretics do not change the workup.
Traps
- Reassuring a parent because the child is still feeding.
- Missing a non-blanching rash or prolonged capillary refill.
- Prescribing adult-strength cough medicines to toddlers.
- Forgetting to plot weight and head circumference.