The clinical scenarios in paediatric training selection look like adult scenarios with smaller patients, and the panels score the difference. Weight based doses, fluid calculations, the particular risks of treating children, and the escalation and retrieval pathways for children are the specifics that show a candidate has worked in paediatrics rather than read about it. This guide covers the scenarios that recur and the specifics each needs.
The structure
Assess systematically using the paediatric approach, treat what can be treated with the right doses, escalate to the consultant and the retrieval service early, talk to the parents, and say what you would do if the first step did not work. The paediatric specifics belong in the treatment step, and the panel is listening for them.
The febrile infant
A six week old with a fever of 38.5 and poor feeding, who becomes mottled and lethargic. Under three months, a fever is sepsis until proven otherwise. The full septic screen including lumbar puncture, intravenous antibiotics without delay at the weight based dose, fluids by weight, and the consultant called. When the infant becomes mottled and lethargic, a fluid bolus, reassessment, and the retrieval service if you are not in a tertiary centre. Say that you would not wait for results to start antibiotics.
The child with a non blanching rash
The four year old with a fever, a non blanching rash and a capillary refill of four seconds is meningococcal sepsis until proven otherwise. Antibiotics immediately, fluid boluses by weight with reassessment after each, the consultant and the retrieval service, and the public health notification afterwards. Say the dose per kilogram and the volume per kilogram.
The fitting child
The two year old who has been fitting for ten minutes. ABCDE, oxygen, check the glucose, then the status epilepticus pathway: a benzodiazepine, repeated once if needed, then the second line agent, with the consultant called and anaesthetics or retrieval involved if the seizure continues. Know your hospital's pathway and the doses by weight. Say what you would tell the parents.
Diabetic ketoacidosis
The twelve year old with vomiting and a glucose of 30. The paediatric specifics are the ones the panel wants: cautious fluid resuscitation, insulin started after fluids rather than with them, slow correction, potassium replacement, and the risk of cerebral oedema with its warning signs and its treatment. Say that you would use the hospital's paediatric DKA guideline and involve the consultant and the paediatric intensive care service early.
Bronchiolitis
The eight month old who is wheezy, feeding poorly, with a respiratory rate of 70. Supportive care: oxygen if hypoxic, feeding support, minimal handling. No antibiotics, no bronchodilators in most cases. The specifics are knowing when to escalate: apnoeas, rising work of breathing, falling saturations, poor feeding, and the role of high flow and the paediatric intensive care service. Then the conversation with the parents about why antibiotics will not help.
Neonatal jaundice
The three day old who is jaundiced and sleepy. The bilirubin level against the gestational age and hour specific chart, the risk factors, the possibility of sepsis or haemolysis, the feeding assessment, phototherapy or exchange transfusion by the threshold, and the consultant. Sleepy is a warning sign.
The limping child
The five year old with a limp and a low grade fever. Septic arthritis until proven otherwise; the criteria, the bloods, the imaging, the urgent orthopaedic involvement, and the differential including transient synovitis and the serious diagnoses that must not be missed.
Anaphylaxis
Intramuscular adrenaline at the weight based dose immediately, repeated if needed, then the rest. Say the dose. The panel listens for adrenaline first.
The newborn not breathing
The neonatal resuscitation algorithm: warm, dry, stimulate, assess, airway, inflation breaths, ventilation, compressions if needed, and the call for help from the first moment. Know your hospital's pathway.
The remote child
Severe dehydration in a remote community: rehydration by the appropriate route with the volumes by weight, the retrieval service called early, telehealth with the paediatrician, and the Aboriginal health worker and family involved.
What the panels score
The specifics, the escalation, the parents, and the plan for when the first step fails. The common failure is adult management with the numbers scaled down.
Preparing
Learn your hospital's paediatric guidelines for each scenario and the doses by weight until they are automatic. Talk each scenario through aloud in six minutes with the parent conversation at the end and the worsening half way through. The specifics are what the panel is waiting to hear.