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  <head>
    <title>070-01 Mechanistic foundations, classification, normal variation, and clinical presentation</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Paediatric foundations and presentation">
      <outline text="Development-based paediatrics">
        <outline text="Organs mature at different rates"/>
        <outline text="Body composition changes"/>
        <outline text="Disease threatens future growth"/>
        <outline text="Trajectory, proportion, skills inform"/>
      </outline>
      <outline text="Growth">
        <outline text="Genetics, placenta, nutrition, hormones, environment"/>
        <outline text="Velocity beats a single centile">
          <outline text="Accurate, serial, plotted measurements"/>
        </outline>
        <outline text="Centile crossing">
          <outline text="Catch-up or catch-down can be normal"/>
          <outline text="Sustained fall or discordance needs evaluation"/>
        </outline>
        <outline text="Poor intake: weight falls before length"/>
        <outline text="Endocrine: linear growth falls, weight kept"/>
        <outline text="Head size read with parents and neurology"/>
        <outline text="Bone age estimates skeletal maturation">
          <outline text="Delayed maturation vs impaired potential"/>
        </outline>
        <outline text="Mid-parental height is a target, not a guarantee"/>
      </outline>
      <outline text="Puberty">
        <outline text="Reactivated hypothalamic GnRH pulsatility">
          <outline text="Gonadotropins, then gonadal steroids"/>
        </outline>
        <outline text="Adrenarche partly independent">
          <outline text="Pubic or axillary hair, body odour"/>
        </outline>
        <outline text="Staged by physical development, not age"/>
        <outline text="Timing varies with genetics, nutrition, illness"/>
      </outline>
      <outline text="Developmental domains">
        <outline text="Motor, language, cognitive, social, adaptive, executive"/>
        <outline text="Milestones are distributions, not deadlines">
          <outline text="Sequence, quality, practice, regression matter"/>
        </outline>
        <outline text="Primitive reflexes inhibited by cortical control">
          <outline text="Asymmetry, abnormal tone, early handedness"/>
        </outline>
        <outline text="Language needs hearing and interaction">
          <outline text="Bilingual children not inherently delayed"/>
          <outline text="Assess hearing in every speech delay"/>
        </outline>
        <outline text="Attachment from responsive caregiving">
          <outline text="No single behaviour proves family circumstance"/>
        </outline>
        <outline text="Executive function matures into adolescence">
          <outline text="Reward sensitivity precedes regulatory control"/>
          <outline text="Not a reason to exclude from decisions"/>
        </outline>
      </outline>
      <outline text="Delay, regression, neurodevelopment">
        <outline text="Delay vs intellectual disability vs specific disorder"/>
        <outline text="Regression is always important">
          <outline text="Epileptic, degenerative, metabolic, inflammatory"/>
          <outline text="Apparent loss when demands exceed capacity"/>
          <outline text="Which skill, which settings, sensory change"/>
        </outline>
        <outline text="Autism: social communication, restricted patterns">
          <outline text="Identify strengths and needs"/>
          <outline text="Does not explain every symptom"/>
        </outline>
        <outline text="ADHD: across settings with impairment">
          <outline text="Sleep, anxiety, hearing, absence seizures mimic"/>
        </outline>
      </outline>
      <outline text="Paediatric physiology">
        <outline text="Airway and breathing">
          <outline text="Small radius loss sharply raises resistance"/>
          <outline text="Fatigue after prolonged work of breathing"/>
          <outline text="Bradycardia signals hypoxia, pre-arrest"/>
        </outline>
        <outline text="Fluids">
          <outline text="High body water, immature concentration"/>
          <outline text="Rapid dehydration, hypotonic hyponatraemia"/>
        </outline>
        <outline text="Maturing drug handling prevents linear scaling"/>
        <outline text="Neonatal thermoregulation inefficient">
          <outline text="Brown fat non-shivering thermogenesis"/>
          <outline text="Hypothermia may signal sepsis"/>
        </outline>
        <outline text="Limited glycogen, hypoglycaemia risk"/>
        <outline text="Immature immunity: serious infection, subtle signs"/>
      </outline>
      <outline text="Presentations by mechanism">
        <outline text="Fever">
          <outline text="Height does not separate bacterial from viral"/>
          <outline text="Young infants: invasive infection without fever"/>
        </outline>
        <outline text="Noisy breathing localised by sound and phase">
          <outline text="Stridor: upper-airway narrowing"/>
          <outline text="Wheeze: intrathoracic obstruction"/>
          <outline text="Stertor: nasopharynx"/>
        </outline>
        <outline text="Vomiting">
          <outline text="Bilious: obstruction distal to ampulla"/>
          <outline text="Projectile non-bilious: pyloric stenosis"/>
          <outline text="With lethargy: metabolic decompensation"/>
        </outline>
        <outline text="Rash">
          <outline text="Morphology, distribution, blanching, mucosa"/>
          <outline text="Non-blanching plus illness: invasive infection"/>
          <outline text="Purpura with shock needs urgent assessment"/>
        </outline>
      </outline>
      <outline text="Family, school, longitudinal reasoning">
        <outline text="Function across home, school, play, sleep"/>
        <outline text="Hear the child directly"/>
        <outline text="Poverty, housing, food security shape health"/>
        <outline text="Adolescents need confidential time">
          <outline text="Limits explained, safeguarding may share"/>
        </outline>
        <outline text="Compare with the child&#x27;s own trajectory"/>
        <outline text="Act early when growth and learning are threatened"/>
      </outline>
    </outline>
  </body>
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