Master Paediatrics
for PLAB 1

Core Concepts

Paediatrics focuses on the health and medical care of infants, children, and adolescents. Key areas include understanding normal growth and development (milestones, growth charts), the importance of routine immunisation schedules, and recognising the spectrum of common childhood illnesses. A crucial aspect is child safeguarding, identifying and acting upon concerns of non-accidental injury (NAI) or neglect. Neonatology covers the unique challenges of newborns, including prematurity, neonatal jaundice, and sepsis. Paediatric emergencies like sepsis, asthma exacerbations, anaphylaxis, and apparent life-threatening events (ALTEs)/brief resolved unexplained events (BRUEs) require prompt recognition and management.

Clinical Presentation

• History Taking: Always include presenting complaint (PC), history of presenting complaint (HPC) covering ICE (Ideas, Concerns, Expectations), relevant past medical history (PMH), drug history (DH), allergies (AH), family history (FH), and social history (SH). Specifically for paediatrics, inquire about birth history, developmental milestones, feeding, immunisation status, and safeguarding concerns.
• Symptoms:
  • Fever: Common, assess for associated symptoms (rash, vomiting, lethargy, work of breathing).
  • Respiratory: Cough, wheeze, stridor, shortness of breath, grunting (e.g., bronchiolitis, asthma, croup, pneumonia).
  • Gastrointestinal: Vomiting, diarrhoea, abdominal pain, poor feeding (e.g., gastroenteritis, appendicitis, intussusception).
  • Rashes: Characterise type, distribution, blanching status (e.g., viral exanthems, meningococcal rash, purpura, eczema).
  • Developmental Delay: Concerns regarding motor, speech, social, or cognitive milestones.
  • Irritability/Lethargy: Non-specific but concerning, especially in infants.
• Examination: Begin with general observation (alertness, colour, hydration, respiratory effort). Systemic examination focusing on vital signs (HR, RR, T, BP, SpO2), growth parameters (weight, height, head circumference plotted on centile charts), and relevant system examination (e.g., chest auscultation, abdominal palpation, neurological assessment including fontanelles).

Diagnosis (Gold Standard)

Diagnosis in paediatrics often relies heavily on clinical assessment supported by targeted investigations. For many common conditions (e.g., bronchiolitis, viral exanthems, gastroenteritis), the diagnosis is purely clinical. For suspected infections like sepsis, the gold standard involves blood cultures, alongside FBC, CRP, lactate, and urine MC&S; CSF analysis for meningitis. UTI is diagnosed by urine dipstick and MC&S. Developmental delay often requires formal assessment by a paediatrician and may involve genetic testing or neuroimaging. Child abuse investigations necessitate a thorough history, physical examination, skeletal survey (X-rays), and ophthalmological assessment.

Management (First Line)

First-line management in paediatrics prioritises supportive care and addressing emergencies. The ABCDE approach is crucial for acutely unwell children. Hydration (oral rehydration solution for mild-moderate dehydration, IV fluids for severe), antipyretics (paracetamol/ibuprofen), and pain relief are fundamental. Specific treatments include: salbutamol and oral steroids for asthma exacerbations; adrenaline for anaphylaxis; broad-spectrum IV antibiotics and fluid resuscitation for suspected sepsis; nebulised adrenaline and dexamethasone for croup; supportive care with oxygen and nasogastric feeds for bronchiolitis; phototherapy for significant neonatal jaundice; and age-appropriate antibiotics for UTI. Always ensure immunisation status is up-to-date. For safeguarding concerns, immediate documentation and referral to social services are paramount.