Master Pediatrics
for DHA

Core Concepts

Pediatrics encompasses health and medical care for infants, children, and adolescents. Key areas include preventative care, growth and development monitoring, immunizations, and management of acute and chronic diseases. Growth charts (WHO for 0-5 years, CDC for >2 years) are essential for tracking physical development. Developmental milestones (gross motor, fine motor, language, social) must be assessed regularly, with delays prompting further investigation (e.g., Denver II, ASQ-3). Immunization schedules are crucial for disease prevention (e.g., DTaP, Polio, Hib, PCV, MMR, Varicella, Hep B, Rotavirus). Newborn screening (Guthrie test for metabolic disorders like PKU, G6PD, Hypothyroidism; hearing screen; critical congenital heart disease screen using pulse oximetry) is vital. Ethical considerations in pediatric practice involve parental consent, child assent (when appropriate), confidentiality, and safeguarding.

Clinical Presentation

• Respiratory:
  • Bronchiolitis (infants <2y): Viral prodrome, wheezing, cough, tachypnea, retractions. RSV common.
  • Asthma: Recurrent cough, wheezing, shortness of breath, chest tightness, often triggered.
  • Croup (Laryngotracheobronchitis): Barking cough, inspiratory stridor, hoarseness. Viral aetiology.
  • Pneumonia: Fever, cough, tachypnea, increased work of breathing, crackles/diminished breath sounds.
• Gastrointestinal:
  • Gastroenteritis: Vomiting, diarrhea (watery/bloody), fever, dehydration. Viral most common.
  • Pyloric Stenosis (infants 2-8 wks): Projectile non-bilious vomiting, visible peristalsis, olive-shaped mass.
  • Intussusception (infants 3-12 mos): Sudden onset intermittent colicky abdominal pain, 'currant jelly' stool, sausage-shaped mass.
• Neurological:
  • Febrile Seizures (6 mos-5 yrs): Generalized tonic-clonic seizure during febrile illness, no CNS infection.
  • Meningitis: Fever, headache, neck stiffness, photophobia, lethargy, irritability, non-blanching rash (meningococcal).
• Cardiac:
  • Congenital Heart Disease: Murmur, cyanosis, poor feeding, failure to thrive, tachypnea, sweating with feeds.
• Renal/Urinary:
  • UTI: Fever (unexplained in infants), dysuria, frequency, urgency, abdominal/flank pain.
• Infectious Diseases:
  • Common Childhood Rashes: Measles (Koplik spots, maculopapular rash spreading cephalocaudal), Rubella (milder, postauricular LAD), Varicella (pruritic vesicles 'dewdrops on a rose petal').

Diagnosis (Gold Standard)

Clinical assessment, history, and physical examination are paramount. Specific diagnostic tests include:

• **Growth/Development:** WHO/CDC charts, Denver II/ASQ-3.
• **Respiratory:** CXR for pneumonia, spirometry for asthma (if age-appropriate), nasopharyngeal aspirate for RSV/viral PCR in bronchiolitis.
• **Gastrointestinal:** Abdominal ultrasound for pyloric stenosis, air/barium enema for intussusception (diagnostic & therapeutic). Stool culture/PCR for persistent gastroenteritis.
• **Neurological:** Lumbar puncture for suspected meningitis (CSF analysis, culture, PCR). EEG for recurrent seizures.
• **Cardiac:** Echocardiography for congenital heart disease.
• **Renal/Urinary:** Urine culture (suprapubic aspirate/catheter sample preferred in infants/young children) for UTI.
• **Hematology:** CBC for anemia (e.g., Iron Deficiency Anemia).

Management (First Line)

Management principles often involve supportive care, symptom control, and targeted interventions:

• **General:** ABCs (Airway, Breathing, Circulation), IV fluids for dehydration, antipyretics for fever.
• **Respiratory:**
  • Bronchiolitis: Supportive care (hydration, oxygen if SpO2 <90%), nasal suctioning. No routine bronchodilators/steroids.
  • Asthma: Short-acting beta-agonists (SABA) for acute attacks, inhaled corticosteroids (ICS) for maintenance.
  • Croup: Dexamethasone (oral single dose), nebulized adrenaline for moderate-severe.
  • Pneumonia: Amoxicillin (first-line for community-acquired bacterial pneumonia).
• **Gastrointestinal:**
  • Gastroenteritis: Oral rehydration therapy (ORT), antiemetics (ondansetron) if severe vomiting, zinc supplementation (WHO/UNICEF recommendation).
  • Pyloric Stenosis: Pyloromyotomy (surgical).
  • Intussusception: Air/barium enema (therapeutic). Surgical reduction if enema fails.
• **Neurological:**
  • Febrile Seizures: Reassurance, manage fever, no routine anticonvulsants.
  • Meningitis: Empirical IV antibiotics (e.g., Ceftriaxone) immediately after LP or blood cultures if LP delayed, plus dexamethasone in bacterial meningitis.
• **Renal/Urinary:** UTI: Oral antibiotics (e.g., co-amoxiclav, trimethoprim-sulfamethoxazole) after urine culture.
• **Preventative:** Adherence to national immunization schedules.

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