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title: "General Paediatrics"

General Paediatrics

Core paediatric assessment, growth and development, and common presentations across systems.

Paediatric Vital Signs

Normal Ranges by Age

Weight Estimation

APLS formula: Weight (kg) = (Age + 4) × 2 for ages 1-10 years

Or: 0-12 months = (0.5 × age in months) + 4

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Growth and Development

Growth Parameters

Weight:

• Birth: ~3.5 kg
• Doubles by 4-5 months
• Triples by 12 months
• Quadruples by 2 years

Length/Height:

• Birth: ~50 cm
• 75 cm by 12 months
• 87 cm by 2 years
• Doubles birth length by 4 years

Head Circumference:

• Birth: ~35 cm
• 47 cm by 12 months
• 90% adult size by 2 years

Developmental Milestones

Red Flags for Development

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Failure to Thrive

Definition

• Weight <3rd percentile
• Weight crossing ≥2 centile lines downward
• Weight-for-length <5th percentile

Causes

Inadequate Intake:

• Feeding difficulties (technique, supply)
• Poverty, neglect
• Restrictive diets
• Oral-motor dysfunction

Inadequate Absorption:

• Coeliac disease
• Cystic fibrosis
• Cow's milk protein allergy
• Inflammatory bowel disease

Increased Requirements:

• Chronic infection
• Congenital heart disease
• Chronic lung disease
• Malignancy

Metabolic:

• Inborn errors of metabolism
• Thyroid dysfunction

Assessment

History:

• Detailed feeding/diet history
• Stool pattern (malabsorption signs)
• Developmental history
• Family/social history

Examination:

• Accurate growth measurements
• Signs of neglect
• Dysmorphic features
• Systemic signs

Investigations (directed by history):

• FBC, iron studies
• Coeliac serology
• Thyroid function
• Urine MC&S

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Childhood Immunisation

Australian Schedule Highlights

Contraindications

True contraindications:

• Anaphylaxis to previous dose or vaccine component
• Immunocompromise (for live vaccines only)

Not contraindications (common misconceptions):

• Mild illness with or without fever
• Family history of adverse events
• Prematurity
• Recent antibiotic use
• Breastfeeding

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Common Infectious Diseases

Viral Exanthems

Scarlet Fever

Cause: Group A Streptococcus (toxin-mediated)

Features:

• Sandpaper rash (fine papular, blanching)
• Strawberry tongue
• Flushed cheeks with perioral pallor
• Pastia's lines (linear petechiae in skin folds)
• Pharyngitis, fever

Treatment: Phenoxymethylpenicillin 10 days

Kawasaki Disease

Diagnostic criteria: Fever ≥5 days PLUS ≥4 of:

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Gastroenteritis and Dehydration

Assessment of Dehydration

Oral Rehydration

ORS composition: Sodium, potassium, glucose, citrate

Volume for rehydration:

• Mild: 50 mL/kg over 4 hours
• Moderate: 100 mL/kg over 4 hours

Maintenance: Continue breastfeeding or formula, avoid sugary drinks

When to Admit

• Severe dehydration
• Unable to tolerate oral fluids (persistent vomiting)
• <6 months old with significant dehydration
• Concern about diagnosis
• Social concerns

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Respiratory Conditions

Otitis Media

Acute Otitis Media:

• Red, bulging tympanic membrane
• Ear pain, fever
• May have effusion

Management:

• Pain relief (paracetamol, ibuprofen)
• Delayed antibiotic prescription (most resolve spontaneously)
• Immediate antibiotics if: <6 months, systemically unwell, bilateral, perforation

Pneumonia

Clinical features:

• Fever, cough
• Tachypnoea (most sensitive sign)
• Respiratory distress
• Crackles, reduced air entry

Age-based aetiology:

Treatment:

• Mild-moderate: Oral amoxicillin
• Severe: IV ampicillin or ceftriaxone
• Mycoplasma suspected: Azithromycin

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Urinary Tract Infections

Importance in Children

• Common cause of fever without focus
• Atypical presentation in young children
• Risk of renal scarring if undertreated
• May indicate structural abnormality

Presentation by Age

Diagnosis

Collection methods:

• Clean catch (preferred)
• Catheter specimen (if unable to clean catch)
• Suprapubic aspirate (gold standard in infants)
• NOT bag specimens (high contamination)

Significant bacteriuria:

• Clean catch: >10^8 CFU/L with pyuria
• Catheter: >10^7 CFU/L

Management

Follow-up Imaging

Who needs imaging:

• <6 months with first UTI
• Recurrent UTIs
• Atypical organisms
• Poor response to treatment
• Abnormal voiding pattern

Options: Renal ultrasound, MCUG (for VUR), DMSA (for scarring)

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Constipation

Functional Constipation

Rome IV Criteria (≥2 criteria for ≥1 month):

• ≤2 defecations per week
• Excessive stool retention
• Painful/hard stools
• Large stools that may obstruct toilet
• Faecal incontinence (after toilet trained)

Red Flags (Organic Causes)

Management

Disimpaction (if faecal loading):

• High-dose macrogol (Movicol) for 2-7 days
• May need suppositories or enemas if severe

Maintenance:

• Macrogol (first-line)
• Lactulose (alternative)
• Continue for at least 3-6 months

Behavioural:

• Toilet sitting routine (after meals)
• Adequate fluid and fibre
• Reward systems

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Child at Risk

Signs of Abuse

Physical abuse:

• Bruises in unusual locations (ears, neck, buttocks)
• Patterned bruises (belt, cord marks)
• Burns with clear demarcation
• Multiple fractures at different stages
• Injuries inconsistent with history or development

Neglect:

• Failure to thrive
• Poor hygiene
• Untreated medical conditions
• Inappropriate clothing
• Developmental delay

Sexual abuse:

• Genital injuries
• STIs
• Inappropriate sexual knowledge
• Behavioural changes

Emotional abuse:

• Behavioural extremes
• Developmental delay
• Low self-esteem

What to Do

1. Document carefully: Exact quotes, detailed description of injuries
2. Don't delay medical treatment
3. Report to child protection services
4. Photography with consent if appropriate
5. Don't investigate - that's for child protection/police

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Common Orthopaedic Presentations

Developmental Dysplasia of Hip (DDH)

Risk factors:

• Female
• Breech presentation
• Family history
• First-born
• Oligohydramnios

Screening: Barlow and Ortolani manoeuvres at birth and 6-week check

Management:

• <6 months: Pavlik harness

• 6 months: May need surgical intervention

Limping Child

By age:

Red flags (septic arthritis):

• Fever
• Unable to weight bear
• Severe pain
• Elevated WCC, CRP

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Sources

• APLS (weight estimation, paediatric norms)
• RCH Clinical Practice Guidelines
• Australian Immunisation Handbook (NIP schedule)