Management and Treatment of Acute and Chronic Pediatric Conditions
Evidence-based management
Management questions test guideline-concordant care and safe prescribing. Know first-line and step-up therapy for asthma, ADHD, otitis media, pharyngitis, UTI, bronchiolitis, acne, and common mental health conditions. Use weight-based dosing, check maximum doses, renal and hepatic adjustments, and contraindications. Apply antibiotic stewardship: no antibiotics for viral URI, bronchiolitis, or influenza unless bacterial coinfection is suspected; treat streptococcal pharyngitis only with confirmed or strongly supported infection.
Chronic care
For chronic conditions, emphasize control assessment, adherence, self-management education, school action plans, and coordinated referrals. In asthma, assess impairment and risk, review inhaler technique, and provide an action plan. In ADHD, monitor symptoms, growth, blood pressure, and sleep. In diabetes and obesity, use family-centered goals and screen for comorbidities.
Question traps
Traps include choosing antibiotics for bronchiolitis, giving albuterol routinely for uncomplicated bronchiolitis, treating asymptomatic bacteriuria, using adult dosing, ignoring maximum dose, omitting follow-up, and failing to address adherence before escalating therapy. Distinguish not routinely recommended from contraindicated.
Worked example and rule of thumb
A 5-month-old with cough, wheeze, and mild retractions after a URI likely has bronchiolitis; management is supportive, including hydration, nasal suction, and monitoring, not routine antibiotics, steroids, or bronchodilators. Rule of thumb: match treatment to diagnosis, severity, age, and weight; then plan follow-up and safety netting.