--- module: 070-03 language: en chapter: 70 title: "Child Growth, Development, Paediatric Assessment, and Longitudinal Care" module_title: "Management, monitoring, prevention, safety, ethics, systems issues, and longitudinal care" source_sha256: 9a995964f2c302add2f4685dc84475eb59478e2bf6fbf4db330d9f585dd8fd72 --- # Paediatric management and longitudinal care ## Aims of paediatric management ### Relieve illness, protect development ### Adapt doses, devices, consent to age ### Prevention shapes decades of outcome ## Safe prescribing ### Dose from accurate current weight #### Check adult maximum, concentration, route ### Per-dose vs per-day confusion causes errors ### Record calculated and administered dose #### Avoid trailing zeros, ambiguous decimals ### Immature infant pharmacokinetics #### Body water, binding, liver enzymes, clearance ### Obesity: actual, ideal, or adjusted weight #### Calculator cannot choose the weight scalar ### Liquids: prescribe mass and volume #### Oral syringe, demonstration, teach-back ### Reconcile over-the-counter and shared drugs ### Pain assessed with developmental tools #### Presence, distraction, topical anaesthesia #### Replace restraint with analgesia, sedation ## Fluids and nutrition ### Oral rehydration: glucose-sodium cotransport #### Small frequent amounts overcome vomiting ### Isotonic intravenous fluid for shock ### Maintenance separate from deficit and losses ### Hypotonic fluid plus non-osmotic ADH #### Hospital-acquired hyponatraemia ### Formula concentration #### Over-dilution: malnutrition, hyponatraemia #### Over-concentration: dehydration, solute load ### Complementary foods: iron, texture, allergens ### Refeeding: phosphate, potassium, thiamine ## Vaccination and stewardship ### Check the actual vaccination record ### Interrupted schedules: catch-up, not restart ### Live vaccines: immunosuppression, pregnancy ### Temporal association is not causation ### No antibiotic benefit in viral illness #### Culture without delaying urgent therapy #### Narrowest effective agent, written stop date #### Repeat courses delay asthma, foreign body ## Anticipatory guidance ### Infancy: safe sleep, smoke avoidance ### Mobility: choking, poisoning, water, falls ### Adolescence: sexual health, substances, mood ### Tie advice to family resources ## Development, disability, school ### Hearing and vision assessment ### Support before final diagnosis #### Early intervention uses neuroplasticity ### Functional, family-centred goals ### Neurodiversity-affirming care #### Behaviour may communicate pain or fear ### School as a health partner #### Consented, limited information sharing #### Accommodations reduce barriers ## Adolescent health ### Private time, confidentiality limits explained ### Decision-specific capacity ### Direct mental health questions #### Safety plan, not a verbal promise ### Eating disorders at any body size #### Unstable despite looking well ### Inclusive sexual and reproductive care #### Consent versus coercion or exploitation ## Child maltreatment ### No single bruise proves abuse ### Sentinel injuries in non-mobile infants ### Stabilise, document exactly, involve specialists ### Avoid repeated leading interviews ### Uncertainty does not justify silence ### Neglect: deprivation is not indifference ## Transitions and complex care ### Shared plan: devices, risks, clinicians ### Technology dependence: power, supply, exhaustion ### Transition is gradual, not a birthday letter #### Self-management, medication responsibility ### Adult services need an accessible summary ### Follow-up across transitions