Master Paediatrics
for FMGE

Core Concepts

Paediatrics focuses on comprehensive care from birth to adolescence. Key areas for FMGE include:

• Growth & Development: Monitor using WHO charts (<5 years) and CDC charts (>5 years). Milestones (e.g., social smile by 3mo, head control by 4mo, sitting by 6-8mo, walking by 12-18mo, first words by 12-18mo). Red flags for developmental delay are critical.
• Immunization: Adhere to the National Immunization Schedule/IAP guidelines. Key vaccines: BCG, OPV, Hep B (Birth), DPT, Hib, Rotavirus, PCV (6, 10, 14 weeks), Measles/MR, Vit A (9 months), DPT & OPV boosters (16-24 months & 5-6 years).
• Nutrition: Exclusive breastfeeding for 6 months, complementary feeding from 6 months. Common deficiencies: Iron (anaemia), Vitamin D (rickets), Vitamin A (xerophthalmia).
• Fluid & Electrolyte: Assessment of dehydration (mild, moderate, severe). ORS is cornerstone for mild-moderate. IV fluids (Ringer Lactate) for severe dehydration. Maintenance fluid calculation: 4-2-1 rule.
• Neonatal Care: APGAR scoring, thermoregulation, cord care, screening for congenital hypothyroidism and G6PD deficiency (if regional). Physiologic vs. Pathologic Jaundice differentiation.

Clinical Presentation

• Fever: Most common symptom. Crucial to differentiate benign viral fever from serious bacterial infection (SBI), especially in infants <3 months. Febrile seizures (generalized tonic-clonic, 6mo-5yr, short duration, no focal signs, single episode/24hr).
• Respiratory Distress: Tachypnoea, nasal flaring, grunting, chest indrawing, stridor, wheezing. Common causes: Bronchiolitis (infants, wheezing), Croup (barking cough, inspiratory stridor), Pneumonia (cough, fever, tachypnoea, crackles/reduced breath sounds).
• Diarrhea & Vomiting: Assess dehydration (sunken eyes, poor skin turgor, lethargy, decreased urine output). Persistent projectile non-bilious vomiting (pyloric stenosis), bilious vomiting (intestinal obstruction).
• Rashes: Common exanthems (Measles, Rubella, Varicella). Non-blanching rash (petechiae/purpura) is an emergency.
• Jaundice: Neonatal jaundice (physiological after 24h, peaks day 3-5, resolves by 1-2 weeks; pathological within 24h, high rates of rise, prolonged).
• Seizures: Differentiate types (febrile, epilepsy, metabolic). Status epilepticus defined as seizure >5 min or recurrent without recovery of consciousness.

Diagnosis (Gold Standard)

Key diagnostic approaches often involve clinical assessment and targeted investigations:

• Meningitis: Lumbar Puncture (CSF analysis: cell count, protein, glucose, Gram stain, culture).
• Urinary Tract Infection (UTI): Urine culture (suprapubic aspiration or catheter specimen for definitive diagnosis in infants/young children).
• Congenital Hypothyroidism: Newborn screening (TSH and T4 levels).
• Hirschsprung's Disease: Rectal biopsy demonstrating absence of ganglion cells.
• Pyloric Stenosis: Abdominal Ultrasound (identifying thickened pyloric muscle and elongated canal).
• Intussusception: Ultrasound with "target sign" or "pseudokidney sign."
• Growth Faltering/Failure to Thrive: Serial plot of weight, height, head circumference on age/sex-appropriate growth charts.

Management (First Line)

First-line management for common paediatric conditions:

• Dehydration (Diarrhea/Vomiting): ORS (WHO Plan A, B) for mild-moderate. IV Ringer's Lactate for severe dehydration/shock (Plan C).
• Fever: Antipyretics (Paracetamol 10-15mg/kg/dose, Ibuprofen 5-10mg/kg/dose). Treat underlying cause.
• Acute Asthma Exacerbation: Nebulized Salbutamol (SABA). Systemic corticosteroids (oral Prednisolone) for moderate-severe.
• Community Acquired Pneumonia: Oral Amoxicillin (first-line for non-severe). Oxygen therapy for hypoxemia.
• Status Epilepticus: Maintain airway (ABC). First-line: IV Lorazepam/Diazepam or buccal Midazolam.
• Severe Acute Malnutrition (SAM): F-75 milk (stabilization phase) followed by F-100 milk (catch-up growth phase).
• Neonatal Jaundice (Pathological): Phototherapy based on age and bilirubin levels. Exchange transfusion for severe hyperbilirubinemia.
• Anaphylaxis: Intramuscular Adrenaline (epinephrine) is the first-line treatment.

Exam Red Flags